"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"Quantity"|"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"
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA ACO WILCO [101532]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|512.93||||512.93|256.98|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|512.93||||512.93|180.04|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|512.93||||512.93|220.56|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|512.93||||512.93|218.51|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|512.93||||512.93|256.47|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|512.93||||512.93|333.4|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CORESOURCE [1315]|CORESOURCE [131500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|512.93||||512.93|189.78|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GEHA [1415]|GEHA [141500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHNET [1495]|HEALTHNET [149500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|512.93||||512.93|220.56|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|512.93||||512.93|477.02|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|512.93||||512.93|307.76|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MULTIPLAN [1680]|HMA [168003]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MULTIPLAN [1680]|IHC HS [168011]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|Self-pay|Self-pay|512.93||||512.93|153.88|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|512.93||||512.93|107.72|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRUSTMARK [2030]|STARMARK [203000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|512.93||||512.93|245.95|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR [2035]|UMR OPTIONS [203501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|512.93||||512.93|189.78|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|512.93||||512.93|256.47|477.02|107.72
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|10.92|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MULTIPLAN [1680]|HMA [168003]|90||||90|31.5|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|Self-pay|Self-pay|90||||90|27|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|7.27|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|7.27
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|200 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|7.27
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|AETNA [1015]|AETNA ACO WILCO [101532]|3164.12||||3164.12|0|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3164.12||||3164.12|1241.34|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3164.12||||3164.12|1470|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3164.12||||3164.12|1470|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3164.12||||3164.12|1585.22|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3164.12||||3164.12|1110.61|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3164.12||||3164.12|1360.57|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3164.12||||3164.12|1347.92|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3164.12||||3164.12|1582.06|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3164.12||||3164.12|2056.68|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|CORESOURCE [1315]|CORESOURCE [131500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|CORVEL CORP [2235]|CORVEL CORP [223500]|3164.12||||3164.12|1202.85|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3164.12||||3164.12|1170.72|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|FIRST HEALTH [1375]|QUALCHOICE [137513]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|FMH BENEFIT SERVICES [1390]|FMH [139000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|GEHA [1415]|GEHA [141500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3164.12||||3164.12|1107.44|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HEALTHNET [1495]|HEALTHNET [149500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3164.12||||3164.12|1360.57|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HEALTHSMART [1505]|HEALTHSMART [150501]|3164.12||||3164.12|2942.63|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3164.12||||3164.12|1898.47|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3164.12||||3164.12|1338.7|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3164.12||||3164.12|1774|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3164.12||||3164.12|1421|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3164.12||||3164.12|1642.95|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3164.12||||3164.12|1241.34|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MULTIPLAN [1680]|HMA [168003]|3164.12||||3164.12|1107.44|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MULTIPLAN [1680]|IHC HS [168011]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|PENDING SSI [1616]|PENDING SSI RCA [161601]|3164.12||||3164.12|1527.88|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3164.12||||3164.12|1338.7|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|Self-pay|Self-pay|3164.12||||3164.12|949.24|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3164.12||||3164.12|664.47|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3164.12||||3164.12|1192.66|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3164.12||||3164.12|1288.96|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|TRUSTMARK [2030]|STARMARK [203000]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3164.12||||3164.12|1517.2|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|UMR [2035]|UMR OPTIONS [203501]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3164.12||||3164.12|1353.3|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3164.12||||3164.12|2847.71|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3164.12||||3164.12|0|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3164.12||||3164.12|1170.72|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3164.12||||3164.12|1217|2942.63|664.47
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|200 Units|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3164.12||||3164.12|1582.06|2942.63|664.47
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|AETNA [1015]|AETNA ACO WILCO [101532]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66.83||||66.83|33.48|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.83||||66.83|23.46|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.83||||66.83|28.74|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66.83||||66.83|28.47|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66.83||||66.83|33.42|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.83||||66.83|43.44|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|CORESOURCE [1315]|CORESOURCE [131500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|CORVEL CORP [2235]|CORVEL CORP [223500]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66.83||||66.83|24.73|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|GEHA [1415]|GEHA [141500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HEALTHNET [1495]|HEALTHNET [149500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.83||||66.83|28.74|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HEALTHSMART [1505]|HEALTHSMART [150501]|66.83||||66.83|62.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.83||||66.83|40.1|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MULTIPLAN [1680]|HMA [168003]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MULTIPLAN [1680]|IHC HS [168011]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|Self-pay|Self-pay|66.83||||66.83|20.05|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.83||||66.83|14.03|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|TRUSTMARK [2030]|STARMARK [203000]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.83||||66.83|32.04|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|UMR [2035]|UMR OPTIONS [203501]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.83||||66.83|60.15|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66.83||||66.83|0|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66.83||||66.83|24.73|62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66.83||||66.83||62.15|14.03
100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|100 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66.83||||66.83|33.42|62.15|14.03
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|AETNA [1015]|AETNA ACO WILCO [101532]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57.36||||57.36|28.74|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.36||||57.36|20.13|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.36||||57.36|24.66|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57.36||||57.36|24.44|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57.36||||57.36|28.68|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.36||||57.36|37.28|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|CORESOURCE [1315]|CORESOURCE [131500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|57.36||||57.36|17|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57.36||||57.36|21.22|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|GEHA [1415]|GEHA [141500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HEALTHNET [1495]|HEALTHNET [149500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.36||||57.36|24.66|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|57.36||||57.36|53.34|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.36||||57.36|34.42|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MULTIPLAN [1680]|HMA [168003]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MULTIPLAN [1680]|IHC HS [168011]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|Self-pay|Self-pay|57.36||||57.36|17.21|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.36||||57.36|12.05|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|TRUSTMARK [2030]|STARMARK [203000]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.36||||57.36|27.5|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|UMR [2035]|UMR OPTIONS [203501]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.36||||57.36|51.62|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57.36||||57.36|0|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57.36||||57.36|21.22|53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57.36||||57.36||53.34|12.05
10162|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION|0.25 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57.36||||57.36|28.68|53.34|12.05
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39.72||||39.72|19.9|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.72||||39.72|13.94|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.72||||39.72|17.08|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39.72||||39.72|16.92|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39.72||||39.72|19.86|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.72||||39.72|25.82|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|39.72||||39.72|1.97|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39.72||||39.72|14.7|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.72||||39.72|17.08|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|39.72||||39.72|36.94|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.72||||39.72|23.83|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|39.72||||39.72|13.9|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|Self-pay|Self-pay|39.72||||39.72|11.92|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.72||||39.72|8.34|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.72||||39.72|3.07|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.72||||39.72|19.05|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.72||||39.72|35.75|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39.72||||39.72|0|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39.72||||39.72|14.7|36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39.72||||39.72||36.94|1.97
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39.72||||39.72|19.86|36.94|1.97
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.98|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|1.54|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.98
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.98
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12.78||||12.78|6.4|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.78||||12.78|4.49|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.78||||12.78|5.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12.78||||12.78|5.44|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12.78||||12.78|6.39|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.78||||12.78|8.31|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12.78||||12.78|4.73|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.78||||12.78|5.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|12.78||||12.78|11.89|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.78||||12.78|7.67|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|Self-pay|Self-pay|12.78||||12.78|3.83|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.78||||12.78|2.68|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.78||||12.78|6.13|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.78||||12.78|11.5|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12.78||||12.78|0|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12.78||||12.78|4.73|11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12.78||||12.78||11.89|2.68
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12.78||||12.78|6.39|11.89|2.68
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|AETNA [1015]|AETNA ACO WILCO [101532]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|238.91||||238.91|119.69|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238.91||||238.91|83.86|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238.91||||238.91|102.73|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|238.91||||238.91|101.78|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|238.91||||238.91|119.46|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238.91||||238.91|155.29|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|CORESOURCE [1315]|CORESOURCE [131500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|CORVEL CORP [2235]|CORVEL CORP [223500]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|238.91||||238.91|88.4|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|GEHA [1415]|GEHA [141500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HEALTHNET [1495]|HEALTHNET [149500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238.91||||238.91|102.73|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HEALTHSMART [1505]|HEALTHSMART [150501]|238.91||||238.91|222.19|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238.91||||238.91|143.35|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MULTIPLAN [1680]|HMA [168003]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MULTIPLAN [1680]|IHC HS [168011]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|Self-pay|Self-pay|238.91||||238.91|71.67|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238.91||||238.91|50.17|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|TRUSTMARK [2030]|STARMARK [203000]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238.91||||238.91|114.56|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|UMR [2035]|UMR OPTIONS [203501]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238.91||||238.91|215.02|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|238.91||||238.91|0|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|238.91||||238.91|88.4|222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|238.91||||238.91||222.19|50.17
1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|45 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|238.91||||238.91|119.46|222.19|50.17
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128.28||||128.28|64.27|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.28||||128.28|45.03|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.28||||128.28|55.16|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128.28||||128.28|54.65|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128.28||||128.28|64.14|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.28||||128.28|83.38|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128.28||||128.28|47.46|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|GEHA [1415]|GEHA [141500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.28||||128.28|55.16|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|128.28||||128.28|119.3|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.28||||128.28|76.97|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MULTIPLAN [1680]|HMA [168003]|128.28||||128.28|44.9|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|Self-pay|Self-pay|128.28||||128.28|38.48|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.28||||128.28|26.94|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.28||||128.28|184.44|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.28||||128.28|61.51|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|UMR [2035]|UMR OPTIONS [203501]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.28||||128.28|115.45|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128.28||||128.28|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128.28||||128.28|47.46|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128.28||||128.28||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128.28||||128.28|64.14|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58.46||||58.46|29.29|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.46||||58.46|20.52|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.46||||58.46|25.14|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58.46||||58.46|24.9|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58.46||||58.46|29.23|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.46||||58.46|38|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|58.46||||58.46|52.33|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58.46||||58.46|21.63|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|GEHA [1415]|GEHA [141500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.46||||58.46|25.14|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|58.46||||58.46|54.37|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.46||||58.46|35.08|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MULTIPLAN [1680]|HMA [168003]|58.46||||58.46|20.46|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MULTIPLAN [1680]|IHC HS [168011]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|Self-pay|Self-pay|58.46||||58.46|17.54|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.46||||58.46|12.28|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.46||||58.46|55.33|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|TRUSTMARK [2030]|STARMARK [203000]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.46||||58.46|28.03|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|UMR [2035]|UMR OPTIONS [203501]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.46||||58.46|52.61|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58.46||||58.46|0|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58.46||||58.46|21.63|184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58.46||||58.46||184.44|12.28
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58.46||||58.46|29.23|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128.28||||128.28|64.27|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.28||||128.28|45.03|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.28||||128.28|55.16|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128.28||||128.28|54.65|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128.28||||128.28|64.14|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.28||||128.28|83.38|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128.28||||128.28|47.46|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|GEHA [1415]|GEHA [141500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.28||||128.28|55.16|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|128.28||||128.28|119.3|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.28||||128.28|76.97|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MULTIPLAN [1680]|HMA [168003]|128.28||||128.28|44.9|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MULTIPLAN [1680]|IHC HS [168011]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|Self-pay|Self-pay|128.28||||128.28|38.48|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.28||||128.28|26.94|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.28||||128.28|184.44|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|TRUSTMARK [2030]|STARMARK [203000]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.28||||128.28|61.51|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|UMR [2035]|UMR OPTIONS [203501]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.28||||128.28|115.45|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128.28||||128.28|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128.28||||128.28|47.46|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128.28||||128.28||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128.28||||128.28|64.14|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58.46||||58.46|29.29|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.46||||58.46|20.52|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.46||||58.46|25.14|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58.46||||58.46|24.9|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58.46||||58.46|29.23|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.46||||58.46|38|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|58.46||||58.46|52.33|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58.46||||58.46|21.63|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|GEHA [1415]|GEHA [141500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.46||||58.46|25.14|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|58.46||||58.46|54.37|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.46||||58.46|35.08|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MULTIPLAN [1680]|HMA [168003]|58.46||||58.46|20.46|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MULTIPLAN [1680]|IHC HS [168011]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|Self-pay|Self-pay|58.46||||58.46|17.54|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.46||||58.46|12.28|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.46||||58.46|55.33|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|TRUSTMARK [2030]|STARMARK [203000]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.46||||58.46|28.03|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|UMR [2035]|UMR OPTIONS [203501]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.46||||58.46|52.61|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58.46||||58.46|0|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58.46||||58.46|21.63|184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58.46||||58.46||184.44|12.28
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58.46||||58.46|29.23|184.44|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58.46||||58.46|29.29|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.46||||58.46|20.52|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.46||||58.46|25.14|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58.46||||58.46|24.9|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58.46||||58.46|29.23|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.46||||58.46|38|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|58.46||||58.46|52.33|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58.46||||58.46|21.63|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|GEHA [1415]|GEHA [141500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.46||||58.46|25.14|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|58.46||||58.46|54.37|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.46||||58.46|35.08|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MULTIPLAN [1680]|HMA [168003]|58.46||||58.46|20.46|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MULTIPLAN [1680]|IHC HS [168011]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|Self-pay|Self-pay|58.46||||58.46|17.54|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.46||||58.46|12.28|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.46||||58.46|55.33|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|TRUSTMARK [2030]|STARMARK [203000]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.46||||58.46|28.03|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|UMR [2035]|UMR OPTIONS [203501]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.46||||58.46|52.61|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58.46||||58.46|0|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58.46||||58.46|21.63|55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58.46||||58.46||55.33|12.28
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58.46||||58.46|29.23|55.33|12.28
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|209.58||||209.58|105|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.58||||209.58|73.56|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.58||||209.58|90.12|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|209.58||||209.58|89.28|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|209.58||||209.58|104.79|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.58||||209.58|136.23|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|209.58||||209.58|5.88|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|209.58||||209.58|77.54|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.58||||209.58|90.12|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|209.58||||209.58|194.91|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.58||||209.58|125.75|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.58||||209.58|104.79|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|209.58||||209.58|62.87|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.58||||209.58|44.01|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.58||||209.58|5.3|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.58||||209.58|100.49|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.58||||209.58|188.62|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|209.58||||209.58|0|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|209.58||||209.58|77.54|194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|209.58||||209.58||194.91|5.3
10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|209.58||||209.58|104.79|194.91|5.3
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|343.23||||343.23|171.96|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|343.23||||343.23|120.47|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|343.23||||343.23|147.59|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|343.23||||343.23|146.22|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|343.23||||343.23|171.62|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|343.23||||343.23|223.1|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|343.23||||343.23|11.76|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|343.23||||343.23|127|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|GEHA [1415]|GEHA [141500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|343.23||||343.23|147.59|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|343.23||||343.23|319.2|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|343.23||||343.23|205.94|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|343.23||||343.23|171.62|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|HMA [168003]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|Self-pay|Self-pay|343.23||||343.23|102.97|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|343.23||||343.23|72.08|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|343.23||||343.23|10.6|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|343.23||||343.23|164.58|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|UMR [2035]|UMR OPTIONS [203501]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|343.23||||343.23|308.91|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|343.23||||343.23|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|343.23||||343.23|127|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|343.23||||343.23||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|343.23||||343.23|171.62|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|AETNA [1015]|AETNA ACO WILCO [101532]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|405.35||||405.35|203.08|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|405.35||||405.35|142.28|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|405.35||||405.35|174.3|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|405.35||||405.35|172.68|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|405.35||||405.35|202.68|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|405.35||||405.35|263.48|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|CORESOURCE [1315]|CORESOURCE [131500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|405.35||||405.35|14.7|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|405.35||||405.35|149.98|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|GEHA [1415]|GEHA [141500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HEALTHNET [1495]|HEALTHNET [149500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|405.35||||405.35|174.3|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|405.35||||405.35|376.98|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|405.35||||405.35|243.21|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|405.35||||405.35|202.68|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MULTIPLAN [1680]|HMA [168003]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MULTIPLAN [1680]|IHC HS [168011]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|Self-pay|Self-pay|405.35||||405.35|121.6|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|405.35||||405.35|85.12|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|405.35||||405.35|13.25|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|TRUSTMARK [2030]|STARMARK [203000]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|405.35||||405.35|194.37|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|UMR [2035]|UMR OPTIONS [203501]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|405.35||||405.35|364.82|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|405.35||||405.35|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|405.35||||405.35|149.98|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|405.35||||405.35||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|125 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|405.35||||405.35|202.68|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|AETNA ACO WILCO [101532]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|474.84||||474.84|237.89|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|474.84||||474.84|166.67|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|474.84||||474.84|204.18|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|474.84||||474.84|202.28|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|474.84||||474.84|237.42|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|474.84||||474.84|308.65|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|CORESOURCE [1315]|CORESOURCE [131500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|474.84||||474.84|17.64|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|474.84||||474.84|175.69|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|GEHA [1415]|GEHA [141500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HEALTHNET [1495]|HEALTHNET [149500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|474.84||||474.84|204.18|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|474.84||||474.84|441.6|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|474.84||||474.84|284.9|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|474.84||||474.84|237.42|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MULTIPLAN [1680]|HMA [168003]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MULTIPLAN [1680]|IHC HS [168011]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|Self-pay|Self-pay|474.84||||474.84|142.45|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|474.84||||474.84|99.72|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|474.84||||474.84|15.9|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|TRUSTMARK [2030]|STARMARK [203000]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|474.84||||474.84|227.69|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|UMR [2035]|UMR OPTIONS [203501]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|474.84||||474.84|427.36|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|474.84||||474.84|0|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|474.84||||474.84|175.69|441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|474.84||||474.84||441.6|10.6
10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|150 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|474.84||||474.84|237.42|441.6|10.6
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|AETNA [1015]|AETNA ACO WILCO [101532]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|115.49||||115.49|57.86|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|115.49||||115.49|40.54|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|115.49||||115.49|49.66|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|115.49||||115.49|49.2|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|115.49||||115.49|57.75|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|115.49||||115.49|75.07|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|CORESOURCE [1315]|CORESOURCE [131500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|CORVEL CORP [2235]|CORVEL CORP [223500]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|115.49||||115.49|42.73|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|GEHA [1415]|GEHA [141500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HEALTHNET [1495]|HEALTHNET [149500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|115.49||||115.49|49.66|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HEALTHSMART [1505]|HEALTHSMART [150501]|115.49||||115.49|107.41|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|115.49||||115.49|69.29|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MULTIPLAN [1680]|HMA [168003]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MULTIPLAN [1680]|IHC HS [168011]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|Self-pay|Self-pay|115.49||||115.49|34.65|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|115.49||||115.49|24.25|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|TRUSTMARK [2030]|STARMARK [203000]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|115.49||||115.49|55.38|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|UMR [2035]|UMR OPTIONS [203501]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|115.49||||115.49|103.94|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|115.49||||115.49|0|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|115.49||||115.49|42.73|107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|115.49||||115.49||107.41|24.25
10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|30 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|115.49||||115.49|57.75|107.41|24.25
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349.29||||349.29|174.99|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349.29||||349.29|122.6|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349.29||||349.29|150.19|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349.29||||349.29|148.8|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349.29||||349.29|174.65|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349.29||||349.29|227.04|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|CORESOURCE [1315]|CORESOURCE [131500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349.29||||349.29|129.24|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|GEHA [1415]|GEHA [141500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HEALTHNET [1495]|HEALTHNET [149500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349.29||||349.29|150.19|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|349.29||||349.29|324.84|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349.29||||349.29|209.57|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MULTIPLAN [1680]|HMA [168003]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MULTIPLAN [1680]|IHC HS [168011]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|Self-pay|Self-pay|349.29||||349.29|104.79|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349.29||||349.29|73.35|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|TRUSTMARK [2030]|STARMARK [203000]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349.29||||349.29|167.48|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|UMR [2035]|UMR OPTIONS [203501]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349.29||||349.29|314.36|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349.29||||349.29|0|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349.29||||349.29|129.24|324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349.29||||349.29||324.84|73.35
104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349.29||||349.29|174.65|324.84|73.35
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76.79||||76.79|38.47|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76.79||||76.79|26.95|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76.79||||76.79|33.02|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76.79||||76.79|32.71|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76.79||||76.79|38.4|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76.79||||76.79|49.91|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|CORESOURCE [1315]|CORESOURCE [131500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76.79||||76.79|28.41|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|GEHA [1415]|GEHA [141500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HEALTHNET [1495]|HEALTHNET [149500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76.79||||76.79|33.02|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|76.79||||76.79|71.41|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.79||||76.79|46.07|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MULTIPLAN [1680]|HMA [168003]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MULTIPLAN [1680]|IHC HS [168011]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|Self-pay|Self-pay|76.79||||76.79|23.04|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76.79||||76.79|16.13|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|TRUSTMARK [2030]|STARMARK [203000]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76.79||||76.79|36.82|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|UMR [2035]|UMR OPTIONS [203501]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76.79||||76.79|69.11|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76.79||||76.79|0|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76.79||||76.79|28.41|71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76.79||||76.79||71.41|16.13
104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|0.5 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76.79||||76.79|38.4|71.41|16.13
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.72|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.8|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.72
10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.72
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.93||||13.93|6.98|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.93||||13.93|4.89|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.93||||13.93|5.99|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.93||||13.93|5.93|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.93||||13.93|6.97|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.93||||13.93|9.05|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.93||||13.93|5.15|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.93||||13.93|5.99|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|13.93||||13.93|12.95|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.93||||13.93|8.36|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|Self-pay|Self-pay|13.93||||13.93|4.18|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.93||||13.93|2.93|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.93||||13.93|6.68|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.93||||13.93|12.54|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.93||||13.93|0|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.93||||13.93|5.15|12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.93||||13.93||12.95|2.93
10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.93||||13.93|6.97|12.95|2.93
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|AETNA [1015]|AETNA ACO WILCO [101532]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58.76||||58.76|29.44|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.76||||58.76|20.62|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.76||||58.76|25.27|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58.76||||58.76|25.03|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58.76||||58.76|29.38|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.76||||58.76|38.19|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|CORESOURCE [1315]|CORESOURCE [131500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58.76||||58.76|21.74|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|GEHA [1415]|GEHA [141500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HEALTHNET [1495]|HEALTHNET [149500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.76||||58.76|25.27|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|58.76||||58.76|54.65|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.76||||58.76|35.26|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MULTIPLAN [1680]|HMA [168003]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MULTIPLAN [1680]|IHC HS [168011]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|Self-pay|Self-pay|58.76||||58.76|17.63|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.76||||58.76|12.34|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|TRUSTMARK [2030]|STARMARK [203000]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.76||||58.76|28.18|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|UMR [2035]|UMR OPTIONS [203501]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.76||||58.76|52.88|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58.76||||58.76|0|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58.76||||58.76|21.74|54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58.76||||58.76||54.65|12.34
10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|60 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58.76||||58.76|29.38|54.65|12.34
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
105640|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|AETNA [1015]|AETNA ACO WILCO [101532]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182.52||||182.52|91.44|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.52||||182.52|64.06|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.52||||182.52|78.48|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182.52||||182.52|77.75|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182.52||||182.52|91.26|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.52||||182.52|118.64|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|CORESOURCE [1315]|CORESOURCE [131500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|182.52||||182.52|54.32|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182.52||||182.52|67.53|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|GEHA [1415]|GEHA [141500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HEALTHNET [1495]|HEALTHNET [149500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.52||||182.52|78.48|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|182.52||||182.52|169.74|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.52||||182.52|109.51|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MULTIPLAN [1680]|HMA [168003]|182.52||||182.52|63.88|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MULTIPLAN [1680]|IHC HS [168011]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|Self-pay|Self-pay|182.52||||182.52|54.76|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.52||||182.52|38.33|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.52||||182.52|47.83|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|TRUSTMARK [2030]|STARMARK [203000]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.52||||182.52|87.52|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|UMR [2035]|UMR OPTIONS [203501]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.52||||182.52|164.27|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182.52||||182.52|0|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182.52||||182.52|67.53|169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182.52||||182.52||169.74|38.33
10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|1,000 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182.52||||182.52|91.26|169.74|38.33
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63.64||||63.64|31.88|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.64||||63.64|22.34|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.64||||63.64|27.37|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63.64||||63.64|27.11|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63.64||||63.64|31.82|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.64||||63.64|41.37|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|63.64||||63.64|6.79|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63.64||||63.64|23.55|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|GEHA [1415]|GEHA [141500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.64||||63.64|27.37|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|63.64||||63.64|59.19|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.64||||63.64|38.18|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MULTIPLAN [1680]|HMA [168003]|63.64||||63.64|22.27|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|Self-pay|Self-pay|63.64||||63.64|19.09|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.64||||63.64|13.36|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.64||||63.64|5.98|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.64||||63.64|30.52|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|UMR [2035]|UMR OPTIONS [203501]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.64||||63.64|57.28|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63.64||||63.64|0|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63.64||||63.64|23.55|59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63.64||||63.64||59.19|5.98
10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63.64||||63.64|31.82|59.19|5.98
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12.03||||12.03|6.03|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.03||||12.03|4.22|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.03||||12.03|5.17|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12.03||||12.03|5.12|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12.03||||12.03|6.02|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.03||||12.03|7.82|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12.03||||12.03|4.45|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.03||||12.03|5.17|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|12.03||||12.03|11.19|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.03||||12.03|7.22|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|12.03||||12.03|3.61|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.03||||12.03|2.53|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.03||||12.03|5.77|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.03||||12.03|10.83|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12.03||||12.03|0|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12.03||||12.03|4.45|11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12.03||||12.03||11.19|2.53
10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12.03||||12.03|6.02|11.19|2.53
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.67||||13.67|6.85|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.67||||13.67|4.8|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.67||||13.67|5.88|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.67||||13.67|5.82|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.67||||13.67|6.84|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.67||||13.67|8.89|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.67||||13.67|5.06|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.67||||13.67|5.88|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|13.67||||13.67|12.71|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.67||||13.67|8.2|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|Self-pay|Self-pay|13.67||||13.67|4.1|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.67||||13.67|2.87|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.67||||13.67|6.55|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.67||||13.67|12.3|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.67||||13.67|0|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.67||||13.67|5.06|12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.67||||13.67||12.71|2.87
10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.67||||13.67|6.84|12.71|2.87
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32.62||||32.62|16.34|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.62||||32.62|11.45|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.62||||32.62|14.03|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32.62||||32.62|13.9|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32.62||||32.62|16.31|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.62||||32.62|21.2|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|CORESOURCE [1315]|CORESOURCE [131500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|32.62||||32.62|2.25|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32.62||||32.62|12.07|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|GEHA [1415]|GEHA [141500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HEALTHNET [1495]|HEALTHNET [149500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.62||||32.62|14.03|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|32.62||||32.62|30.34|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.62||||32.62|19.57|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MULTIPLAN [1680]|HMA [168003]|32.62||||32.62|11.42|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MULTIPLAN [1680]|IHC HS [168011]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|Self-pay|Self-pay|32.62||||32.62|9.79|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.62||||32.62|6.85|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.62||||32.62|2.19|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|TRUSTMARK [2030]|STARMARK [203000]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.62||||32.62|15.64|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|UMR [2035]|UMR OPTIONS [203501]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.62||||32.62|29.36|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32.62||||32.62|0|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32.62||||32.62|12.07|30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32.62||||32.62||30.34|2.19
105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|0.3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32.62||||32.62|16.31|30.34|2.19
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|AETNA [1015]|AETNA ACO WILCO [101532]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43.38||||43.38|21.73|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.38||||43.38|15.23|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.38||||43.38|18.65|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43.38||||43.38|18.48|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43.38||||43.38|21.69|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.38||||43.38|28.2|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|CORESOURCE [1315]|CORESOURCE [131500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|43.38||||43.38|3.01|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43.38||||43.38|16.05|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|GEHA [1415]|GEHA [141500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HEALTHNET [1495]|HEALTHNET [149500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.38||||43.38|18.65|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|43.38||||43.38|40.34|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.38||||43.38|26.03|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MULTIPLAN [1680]|HMA [168003]|43.38||||43.38|15.18|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MULTIPLAN [1680]|IHC HS [168011]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|Self-pay|Self-pay|43.38||||43.38|13.01|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.38||||43.38|9.11|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.38||||43.38|2.93|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|TRUSTMARK [2030]|STARMARK [203000]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.38||||43.38|20.8|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|UMR [2035]|UMR OPTIONS [203501]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.38||||43.38|39.04|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43.38||||43.38|0|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43.38||||43.38|16.05|40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43.38||||43.38||40.34|2.93
105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|0.4 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43.38||||43.38|21.69|40.34|2.93
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|AETNA [1015]|AETNA ACO WILCO [101532]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65.17||||65.17|32.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65.17||||65.17|22.87|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65.17||||65.17|28.02|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65.17||||65.17|27.76|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65.17||||65.17|32.59|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65.17||||65.17|42.36|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|CORESOURCE [1315]|CORESOURCE [131500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|65.17||||65.17|4.51|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65.17||||65.17|24.11|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|GEHA [1415]|GEHA [141500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HEALTHNET [1495]|HEALTHNET [149500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65.17||||65.17|28.02|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|65.17||||65.17|60.61|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65.17||||65.17|39.1|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MULTIPLAN [1680]|HMA [168003]|65.17||||65.17|22.81|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MULTIPLAN [1680]|IHC HS [168011]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|Self-pay|Self-pay|65.17||||65.17|19.55|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65.17||||65.17|13.69|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65.17||||65.17|4.39|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|TRUSTMARK [2030]|STARMARK [203000]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65.17||||65.17|31.25|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|UMR [2035]|UMR OPTIONS [203501]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65.17||||65.17|58.65|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65.17||||65.17|0|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65.17||||65.17|24.11|60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65.17||||65.17||60.61|4.39
105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|0.6 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65.17||||65.17|32.59|60.61|4.39
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA [1015]|AETNA ACO WILCO [101532]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65.55||||65.55|32.84|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65.55||||65.55|23.01|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65.55||||65.55|28.19|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65.55||||65.55|27.92|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65.55||||65.55|32.78|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65.55||||65.55|42.61|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CORESOURCE [1315]|CORESOURCE [131500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|65.55||||65.55|6.01|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65.55||||65.55|24.25|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|GEHA [1415]|GEHA [141500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHNET [1495]|HEALTHNET [149500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65.55||||65.55|28.19|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|65.55||||65.55|60.96|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65.55||||65.55|39.33|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MULTIPLAN [1680]|HMA [168003]|65.55||||65.55|22.94|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MULTIPLAN [1680]|IHC HS [168011]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|Self-pay|Self-pay|65.55||||65.55|19.66|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65.55||||65.55|13.77|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65.55||||65.55|5.85|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TRUSTMARK [2030]|STARMARK [203000]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65.55||||65.55|31.43|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UMR [2035]|UMR OPTIONS [203501]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65.55||||65.55|59|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65.55||||65.55|0|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65.55||||65.55|24.25|60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65.55||||65.55||60.96|5.85
105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65.55||||65.55|32.78|60.96|5.85
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82.51||||82.51|41.34|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82.51||||82.51|28.96|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82.51||||82.51|35.48|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82.51||||82.51|35.15|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82.51||||82.51|41.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82.51||||82.51|53.63|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|82.51||||82.51|7.52|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82.51||||82.51|30.53|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|GEHA [1415]|GEHA [141500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82.51||||82.51|35.48|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|82.51||||82.51|76.73|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82.51||||82.51|49.51|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MULTIPLAN [1680]|HMA [168003]|82.51||||82.51|28.88|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MULTIPLAN [1680]|IHC HS [168011]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|Self-pay|Self-pay|82.51||||82.51|24.75|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82.51||||82.51|17.33|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82.51||||82.51|7.31|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TRUSTMARK [2030]|STARMARK [203000]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82.51||||82.51|39.56|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UMR [2035]|UMR OPTIONS [203501]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82.51||||82.51|74.26|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82.51||||82.51|0|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82.51||||82.51|30.53|76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82.51||||82.51||76.73|7.31
105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82.51||||82.51|41.26|76.73|7.31
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA [1015]|AETNA ACO WILCO [101532]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|98.98||||98.98|49.59|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98.98||||98.98|34.74|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98.98||||98.98|42.56|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|98.98||||98.98|42.17|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|98.98||||98.98|49.49|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98.98||||98.98|64.34|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CORESOURCE [1315]|CORESOURCE [131500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|98.98||||98.98|9.02|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|98.98||||98.98|36.62|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|GEHA [1415]|GEHA [141500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHNET [1495]|HEALTHNET [149500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98.98||||98.98|42.56|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|98.98||||98.98|92.05|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98.98||||98.98|59.39|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MULTIPLAN [1680]|HMA [168003]|98.98||||98.98|34.64|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MULTIPLAN [1680]|IHC HS [168011]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|Self-pay|Self-pay|98.98||||98.98|29.69|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98.98||||98.98|20.79|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98.98||||98.98|8.78|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|TRUSTMARK [2030]|STARMARK [203000]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98.98||||98.98|47.46|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UMR [2035]|UMR OPTIONS [203501]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98.98||||98.98|89.08|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|98.98||||98.98|0|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|98.98||||98.98|36.62|92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|98.98||||98.98||92.05|8.78
105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|0.8 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|98.98||||98.98|49.49|92.05|8.78
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|AETNA [1015]|AETNA ACO WILCO [101532]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.15||||60.15|30.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.15||||60.15|21.11|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.15||||60.15|25.86|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.15||||60.15|25.62|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.15||||60.15|30.08|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.15||||60.15|39.1|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|CORESOURCE [1315]|CORESOURCE [131500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.15||||60.15|22.26|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|GEHA [1415]|GEHA [141500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HEALTHNET [1495]|HEALTHNET [149500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.15||||60.15|25.86|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|60.15||||60.15|55.94|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.15||||60.15|36.09|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MULTIPLAN [1680]|HMA [168003]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MULTIPLAN [1680]|IHC HS [168011]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|Self-pay|Self-pay|60.15||||60.15|18.04|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.15||||60.15|12.63|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|TRUSTMARK [2030]|STARMARK [203000]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.15||||60.15|28.84|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|UMR [2035]|UMR OPTIONS [203501]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.15||||60.15|54.14|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.15||||60.15|0|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.15||||60.15|22.26|55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.15||||60.15||55.94|12.63
106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|3.5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.15||||60.15|30.08|55.94|12.63
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|114.31||||114.31|57.27|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114.31||||114.31|40.12|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114.31||||114.31|49.15|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|114.31||||114.31|48.7|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|114.31||||114.31|57.16|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114.31||||114.31|74.3|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|114.31||||114.31|13.48|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|114.31||||114.31|42.29|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|GEHA [1415]|GEHA [141500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114.31||||114.31|49.15|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|114.31||||114.31|106.31|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114.31||||114.31|68.59|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MULTIPLAN [1680]|HMA [168003]|114.31||||114.31|40.01|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MULTIPLAN [1680]|IHC HS [168011]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|Self-pay|Self-pay|114.31||||114.31|34.29|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114.31||||114.31|24.01|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114.31||||114.31|12.83|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|TRUSTMARK [2030]|STARMARK [203000]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114.31||||114.31|54.81|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|UMR [2035]|UMR OPTIONS [203501]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114.31||||114.31|102.88|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|114.31||||114.31|0|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|114.31||||114.31|42.29|106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|114.31||||114.31||106.31|12.83
106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|114.31||||114.31|57.16|106.31|12.83
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10628|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MISOPROSTOL 100 MCG TABLET|0.25 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.67|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.38|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.38
106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.38
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|AETNA [1015]|AETNA ACO WILCO [101532]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39.52||||39.52|19.8|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.52||||39.52|13.87|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.52||||39.52|16.99|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39.52||||39.52|16.84|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39.52||||39.52|19.76|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.52||||39.52|25.69|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|CORESOURCE [1315]|CORESOURCE [131500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|CORVEL CORP [2235]|CORVEL CORP [223500]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39.52||||39.52|14.62|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|GEHA [1415]|GEHA [141500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HEALTHNET [1495]|HEALTHNET [149500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.52||||39.52|16.99|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HEALTHSMART [1505]|HEALTHSMART [150501]|39.52||||39.52|36.75|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.52||||39.52|23.71|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MULTIPLAN [1680]|HMA [168003]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MULTIPLAN [1680]|IHC HS [168011]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|Self-pay|Self-pay|39.52||||39.52|11.86|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.52||||39.52|8.3|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|TRUSTMARK [2030]|STARMARK [203000]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.52||||39.52|18.95|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|UMR [2035]|UMR OPTIONS [203501]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.52||||39.52|35.57|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39.52||||39.52|0|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39.52||||39.52|14.62|36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39.52||||39.52||36.75|8.3
10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|22 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39.52||||39.52|19.76|36.75|8.3
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.15||||60.15|30.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.15||||60.15|21.11|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.15||||60.15|25.86|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.15||||60.15|25.62|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.15||||60.15|30.08|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.15||||60.15|39.1|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.15||||60.15|22.26|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.15||||60.15|25.86|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|60.15||||60.15|55.94|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.15||||60.15|36.09|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|Self-pay|Self-pay|60.15||||60.15|18.04|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.15||||60.15|12.63|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.15||||60.15|28.84|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.15||||60.15|54.14|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.15||||60.15|0|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.15||||60.15|22.26|55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.15||||60.15||55.94|12.63
10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.15||||60.15|30.08|55.94|12.63
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149.97||||149.97|75.13|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.97||||149.97|52.64|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.97||||149.97|64.49|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149.97||||149.97|63.89|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149.97||||149.97|74.99|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.97||||149.97|97.48|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149.97||||149.97|55.49|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.97||||149.97|64.49|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|149.97||||149.97|139.47|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.97||||149.97|89.98|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|Self-pay|Self-pay|149.97||||149.97|44.99|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.97||||149.97|31.49|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.97||||149.97|71.91|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.97||||149.97|134.97|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149.97||||149.97|0|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149.97||||149.97|55.49|139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149.97||||149.97||139.47|31.49
107668|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149.97||||149.97|74.99|139.47|31.49
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|AETNA [1015]|AETNA ACO WILCO [101532]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|225.43||||225.43|112.94|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.43||||225.43|79.13|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.43||||225.43|96.93|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|225.43||||225.43|96.03|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|225.43||||225.43|112.72|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.43||||225.43|146.53|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|CORESOURCE [1315]|CORESOURCE [131500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|225.43||||225.43|30.36|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|225.43||||225.43|83.41|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|GEHA [1415]|GEHA [141500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HEALTHNET [1495]|HEALTHNET [149500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.43||||225.43|96.93|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|225.43||||225.43|209.65|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.43||||225.43|135.26|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MULTIPLAN [1680]|HMA [168003]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MULTIPLAN [1680]|IHC HS [168011]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|Self-pay|Self-pay|225.43||||225.43|67.63|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.43||||225.43|47.34|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|TRUSTMARK [2030]|STARMARK [203000]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.43||||225.43|108.09|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|UMR [2035]|UMR OPTIONS [203501]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.43||||225.43|202.89|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|225.43||||225.43|0|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|225.43||||225.43|83.41|209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|225.43||||225.43||209.65|30.36
108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|0.6 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|225.43||||225.43|112.72|209.65|30.36
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|AETNA [1015]|AETNA ACO WILCO [101532]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|225.43||||225.43|112.94|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.43||||225.43|79.13|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.43||||225.43|96.93|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|225.43||||225.43|96.03|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|225.43||||225.43|112.72|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.43||||225.43|146.53|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|CORESOURCE [1315]|CORESOURCE [131500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|225.43||||225.43|40.47|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|225.43||||225.43|83.41|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|GEHA [1415]|GEHA [141500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HEALTHNET [1495]|HEALTHNET [149500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.43||||225.43|96.93|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|225.43||||225.43|209.65|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.43||||225.43|135.26|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MULTIPLAN [1680]|HMA [168003]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MULTIPLAN [1680]|IHC HS [168011]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|Self-pay|Self-pay|225.43||||225.43|67.63|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.43||||225.43|47.34|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|TRUSTMARK [2030]|STARMARK [203000]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.43||||225.43|108.09|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|UMR [2035]|UMR OPTIONS [203501]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.43||||225.43|202.89|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|225.43||||225.43|0|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|225.43||||225.43|83.41|209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|225.43||||225.43||209.65|40.47
108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|0.8 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|225.43||||225.43|112.72|209.65|40.47
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|493.93||||493.93|0|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|493.93||||493.93|124.08|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|493.93||||493.93|124.08|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|493.93||||493.93|247.46|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|493.93||||493.93|173.37|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|493.93||||493.93|212.39|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|493.93||||493.93|210.41|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|493.93||||493.93|246.97|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|493.93||||493.93|321.05|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|493.93||||493.93|162.91|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|493.93||||493.93|182.75|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|GEHA [1415]|GEHA [141500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|493.93||||493.93|212.39|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|493.93||||493.93|459.35|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|493.93||||493.93|296.36|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|493.93||||493.93|241.32|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|493.93||||493.93|119.84|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MULTIPLAN [1680]|HMA [168003]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MULTIPLAN [1680]|IHC HS [168011]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|493.93||||493.93|128.97|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|Self-pay|Self-pay|493.93||||493.93|148.18|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|493.93||||493.93|103.73|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|TRUSTMARK [2030]|STARMARK [203000]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|493.93||||493.93|236.84|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|UMR [2035]|UMR OPTIONS [203501]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|493.93||||493.93|114.13|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|493.93||||493.93|444.54|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|493.93||||493.93|0|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|493.93||||493.93|182.75|459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|493.93||||493.93||459.35|103.73
108049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|493.93||||493.93|246.97|459.35|103.73
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128.24||||128.24|64.25|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.24||||128.24|45.01|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.24||||128.24|55.14|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128.24||||128.24|54.63|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128.24||||128.24|64.12|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.24||||128.24|83.36|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|128.24||||128.24|2.89|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128.24||||128.24|47.45|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|GEHA [1415]|GEHA [141500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.24||||128.24|55.14|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|128.24||||128.24|119.26|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.24||||128.24|76.94|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|128.24||||128.24|44.88|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|128.24||||128.24|38.47|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.24||||128.24|26.93|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.24||||128.24|0.85|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.24||||128.24|61.49|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.24||||128.24|115.42|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128.24||||128.24|0|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128.24||||128.24|47.45|119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128.24||||128.24||119.26|0.85
108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128.24||||128.24|64.12|119.26|0.85
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|4.33|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MULTIPLAN [1680]|HMA [168003]|90||||90|31.5|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|Self-pay|Self-pay|90||||90|27|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|1.27|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|1.27
108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|150 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|1.27
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25.91||||25.91|12.98|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.91||||25.91|9.09|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.91||||25.91|11.14|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25.91||||25.91|11.04|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25.91||||25.91|12.96|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.91||||25.91|16.84|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25.91||||25.91|9.59|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.91||||25.91|11.14|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|25.91||||25.91|24.1|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.91||||25.91|15.55|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|Self-pay|Self-pay|25.91||||25.91|7.77|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.91||||25.91|5.44|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.91||||25.91|12.42|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.91||||25.91|23.32|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25.91||||25.91|0|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25.91||||25.91|9.59|24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25.91||||25.91||24.1|5.44
10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25.91||||25.91|12.96|24.1|5.44
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|2.85|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MULTIPLAN [1680]|HMA [168003]|90||||90|31.5|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|Self-pay|Self-pay|90||||90|27|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.12|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|2.12
108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|200 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|2.12
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|177||||177|88.68|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177||||177|62.13|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177||||177|76.11|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|177||||177|75.4|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|177||||177|88.5|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177||||177|115.05|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|177||||177|65.49|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|GEHA [1415]|GEHA [141500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177||||177|76.11|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|177||||177|164.61|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177||||177|106.2|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177||||177|88.5|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MULTIPLAN [1680]|HMA [168003]|177||||177|61.95|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MULTIPLAN [1680]|IHC HS [168011]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|Self-pay|Self-pay|177||||177|53.1|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177||||177|37.17|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|TRUSTMARK [2030]|STARMARK [203000]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177||||177|84.87|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|UMR [2035]|UMR OPTIONS [203501]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177||||177|159.3|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|177||||177|0|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|177||||177|65.49|164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|177||||177||164.61|37.17
109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|25 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|177||||177|88.5|164.61|37.17
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|AETNA [1015]|AETNA ACO WILCO [101532]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|AETNA [1015]|COVENTRY HEALTHCARE [101502]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|585.28||||585.28|293.23|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|585.28||||585.28|205.43|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|585.28||||585.28|251.67|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|585.28||||585.28|249.33|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|585.28||||585.28|292.64|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|585.28||||585.28|380.43|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|CORESOURCE [1315]|CORESOURCE [131500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|CORVEL CORP [2235]|CORVEL CORP [223500]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|585.28||||585.28|216.55|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|FIRST HEALTH [1375]|QUALCHOICE [137513]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|FMH BENEFIT SERVICES [1390]|FMH [139000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|GEHA [1415]|GEHA [141500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HEALTHNET [1495]|HEALTHNET [149500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|585.28||||585.28|251.67|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HEALTHSMART [1505]|HEALTHSMART [150501]|585.28||||585.28|544.31|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|585.28||||585.28|351.17|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MULTIPLAN [1680]|HMA [168003]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MULTIPLAN [1680]|IHC HS [168011]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|PENDING SSI [1616]|PENDING SSI RCA [161601]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|Self-pay|Self-pay|585.28||||585.28|175.58|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|585.28||||585.28|122.91|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|TRIWEST [3750]|TRIWEST TWVACCN [375000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|TRUSTMARK [2030]|STARMARK [203000]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|585.28||||585.28|280.64|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|UMR [2035]|UMR OPTIONS [203501]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|585.28||||585.28|526.75|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|585.28||||585.28|0|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|585.28||||585.28|216.55|544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|585.28||||585.28||544.31|122.91
109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|60 kit|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|585.28||||585.28|292.64|544.31|122.91
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52.97||||52.97|26.54|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.97||||52.97|18.59|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.97||||52.97|22.78|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52.97||||52.97|22.57|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52.97||||52.97|26.49|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.97||||52.97|34.43|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|CORESOURCE [1315]|CORESOURCE [131500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|52.97||||52.97|8.29|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52.97||||52.97|19.6|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|GEHA [1415]|GEHA [141500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHNET [1495]|HEALTHNET [149500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.97||||52.97|22.78|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|52.97||||52.97|49.26|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.97||||52.97|31.78|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MULTIPLAN [1680]|HMA [168003]|52.97||||52.97|18.54|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MULTIPLAN [1680]|IHC HS [168011]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|Self-pay|Self-pay|52.97||||52.97|15.89|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.97||||52.97|11.12|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.97||||52.97|8.08|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|TRUSTMARK [2030]|STARMARK [203000]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.97||||52.97|25.4|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|UMR [2035]|UMR OPTIONS [203501]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.97||||52.97|47.67|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52.97||||52.97|0|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52.97||||52.97|19.6|49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52.97||||52.97||49.26|8.08
11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|0.2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52.97||||52.97|26.49|49.26|8.08
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|AETNA [1015]|AETNA ACO WILCO [101532]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.86||||54.86|27.48|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.86||||54.86|19.26|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.86||||54.86|23.59|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.86||||54.86|23.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.86||||54.86|27.43|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.86||||54.86|35.66|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|CORESOURCE [1315]|CORESOURCE [131500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.86||||54.86|20.3|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|GEHA [1415]|GEHA [141500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HEALTHNET [1495]|HEALTHNET [149500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.86||||54.86|23.59|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|54.86||||54.86|51.02|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.86||||54.86|32.92|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MULTIPLAN [1680]|HMA [168003]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MULTIPLAN [1680]|IHC HS [168011]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|Self-pay|Self-pay|54.86||||54.86|16.46|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.86||||54.86|11.52|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|TRUSTMARK [2030]|STARMARK [203000]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.86||||54.86|26.31|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|UMR [2035]|UMR OPTIONS [203501]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.86||||54.86|49.37|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.86||||54.86|0|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.86||||54.86|20.3|51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.86||||54.86||51.02|11.52
110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|10 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.86||||54.86|27.43|51.02|11.52
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30.23||||30.23|15.15|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.23||||30.23|10.61|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.23||||30.23|13|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30.23||||30.23|12.88|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30.23||||30.23|15.12|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.23||||30.23|19.65|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30.23||||30.23|11.19|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.23||||30.23|13|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|30.23||||30.23|28.11|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.23||||30.23|18.14|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|Self-pay|Self-pay|30.23||||30.23|9.07|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.23||||30.23|6.35|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.23||||30.23|14.5|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.23||||30.23|27.21|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30.23||||30.23|0|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30.23||||30.23|11.19|28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30.23||||30.23||28.11|6.35
110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30.23||||30.23|15.12|28.11|6.35
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0.7|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|90||||90|31.5|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|90||||90|27|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|0.8|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|0.7
11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|0.7
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104.92||||104.92|52.56|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.92||||104.92|36.83|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.92||||104.92|45.12|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104.92||||104.92|44.7|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104.92||||104.92|52.46|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.92||||104.92|68.2|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|104.92||||104.92|1.4|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104.92||||104.92|38.82|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|GEHA [1415]|GEHA [141500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.92||||104.92|45.12|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|104.92||||104.92|97.58|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.92||||104.92|62.95|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MULTIPLAN [1680]|HMA [168003]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|Self-pay|Self-pay|104.92||||104.92|31.48|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.92||||104.92|22.03|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.92||||104.92|1.59|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.92||||104.92|50.31|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.92||||104.92|94.43|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104.92||||104.92|0|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104.92||||104.92|38.82|97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104.92||||104.92||97.58|1.4
11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104.92||||104.92|52.46|97.58|1.4
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|AETNA [1015]|AETNA ACO WILCO [101532]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|177.24||||177.24|88.8|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.24||||177.24|62.21|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.24||||177.24|76.21|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|177.24||||177.24|75.5|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|177.24||||177.24|88.62|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.24||||177.24|115.21|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|CORESOURCE [1315]|CORESOURCE [131500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|177.24||||177.24|7.9|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|177.24||||177.24|65.58|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|GEHA [1415]|GEHA [141500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HEALTHNET [1495]|HEALTHNET [149500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.24||||177.24|76.21|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|177.24||||177.24|164.83|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.24||||177.24|106.34|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MULTIPLAN [1680]|HMA [168003]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MULTIPLAN [1680]|IHC HS [168011]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|Self-pay|Self-pay|177.24||||177.24|53.17|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.24||||177.24|37.22|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|TRUSTMARK [2030]|STARMARK [203000]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.24||||177.24|84.99|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|UMR [2035]|UMR OPTIONS [203501]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.24||||177.24|159.52|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|177.24||||177.24|0|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|177.24||||177.24|65.58|164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|177.24||||177.24||164.83|7.9
11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|240 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|177.24||||177.24|88.62|164.83|7.9
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|AETNA ACO WILCO [101532]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42.81||||42.81|21.45|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.81||||42.81|15.03|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.81||||42.81|18.41|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42.81||||42.81|18.24|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42.81||||42.81|21.41|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.81||||42.81|27.83|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|CORESOURCE [1315]|CORESOURCE [131500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|CORVEL CORP [2235]|CORVEL CORP [223500]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42.81||||42.81|15.84|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|GEHA [1415]|GEHA [141500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HEALTHNET [1495]|HEALTHNET [149500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.81||||42.81|18.41|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSMART [1505]|HEALTHSMART [150501]|42.81||||42.81|39.81|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.81||||42.81|25.69|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MULTIPLAN [1680]|HMA [168003]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MULTIPLAN [1680]|IHC HS [168011]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|PENDING SSI [1616]|PENDING SSI RCA [161601]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|Self-pay|Self-pay|42.81||||42.81|12.84|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.81||||42.81|8.99|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|TRUSTMARK [2030]|STARMARK [203000]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.81||||42.81|20.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|UMR [2035]|UMR OPTIONS [203501]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.81||||42.81|38.53|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42.81||||42.81|0|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42.81||||42.81|15.84|39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42.81||||42.81||39.81|8.99
11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|1 suppository|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42.81||||42.81|21.41|39.81|8.99
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11146|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPAFENONE 150 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|80.61||||80.61|40.39|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80.61||||80.61|28.29|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80.61||||80.61|34.66|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|80.61||||80.61|34.34|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|80.61||||80.61|40.31|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80.61||||80.61|52.4|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|80.61||||80.61|29.83|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80.61||||80.61|34.66|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|80.61||||80.61|74.97|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80.61||||80.61|48.37|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|Self-pay|Self-pay|80.61||||80.61|24.18|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80.61||||80.61|16.93|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80.61||||80.61|38.65|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80.61||||80.61|72.55|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|80.61||||80.61|0|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|80.61||||80.61|29.83|74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|80.61||||80.61||74.97|16.93
112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|80.61||||80.61|40.31|74.97|16.93
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.86||||54.86|27.48|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.86||||54.86|19.26|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.86||||54.86|23.59|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.86||||54.86|23.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.86||||54.86|27.43|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.86||||54.86|35.66|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.86||||54.86|20.3|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.86||||54.86|23.59|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|54.86||||54.86|51.02|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.86||||54.86|32.92|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|Self-pay|Self-pay|54.86||||54.86|16.46|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.86||||54.86|11.52|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.86||||54.86|26.31|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.86||||54.86|49.37|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.86||||54.86|0|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.86||||54.86|20.3|51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.86||||54.86||51.02|11.52
112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.86||||54.86|27.43|51.02|11.52
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|0.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2091||||2091|1047.59|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2091||||2091|733.94|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2091||||2091|899.13|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2091||||2091|890.77|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2091||||2091|1045.5|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2091||||2091|1359.15|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2091||||2091|773.67|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|GEHA [1415]|GEHA [141500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2091||||2091|899.13|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|2091||||2091|1944.63|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2091||||2091|1254.6|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2091||||2091|1045.5|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MULTIPLAN [1680]|HMA [168003]|2091||||2091|731.85|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MULTIPLAN [1680]|IHC HS [168011]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|Self-pay|Self-pay|2091||||2091|627.3|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2091||||2091|439.11|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|TRUSTMARK [2030]|STARMARK [203000]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2091||||2091|1002.63|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|UMR [2035]|UMR OPTIONS [203501]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2091||||2091|1881.9|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2091||||2091|0|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2091||||2091|773.67|1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2091||||2091||1944.63|439.11
113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 PENTETATE (DTPA) PER 0.5MCI|0.5 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2091||||2091|1045.5|1944.63|439.11
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SELEGILINE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149.97||||149.97|75.13|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.97||||149.97|52.64|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.97||||149.97|64.49|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149.97||||149.97|63.89|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149.97||||149.97|74.99|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.97||||149.97|97.48|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149.97||||149.97|55.49|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.97||||149.97|64.49|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|149.97||||149.97|139.47|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.97||||149.97|89.98|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|Self-pay|Self-pay|149.97||||149.97|44.99|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.97||||149.97|31.49|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.97||||149.97|71.91|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.97||||149.97|134.97|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149.97||||149.97|0|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149.97||||149.97|55.49|139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149.97||||149.97||139.47|31.49
113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149.97||||149.97|74.99|139.47|31.49
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|Self-pay|Self-pay|10||||10|3|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|AETNA [1015]|AETNA ACO WILCO [101532]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|292.78||||292.78|146.68|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|292.78||||292.78|102.77|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|292.78||||292.78|125.9|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|292.78||||292.78|124.72|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|292.78||||292.78|146.39|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|292.78||||292.78|190.31|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|CORESOURCE [1315]|CORESOURCE [131500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|CORVEL CORP [2235]|CORVEL CORP [223500]|292.78||||292.78|102.87|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|292.78||||292.78|108.33|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|FIRST HEALTH [1375]|QUALCHOICE [137513]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|FMH BENEFIT SERVICES [1390]|FMH [139000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|GEHA [1415]|GEHA [141500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HEALTHNET [1495]|HEALTHNET [149500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|292.78||||292.78|125.9|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HEALTHSMART [1505]|HEALTHSMART [150501]|292.78||||292.78|272.29|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|292.78||||292.78|175.67|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MULTIPLAN [1680]|HMA [168003]|292.78||||292.78|102.47|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MULTIPLAN [1680]|IHC HS [168011]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|PENDING SSI [1616]|PENDING SSI RCA [161601]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|Self-pay|Self-pay|292.78||||292.78|87.83|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|292.78||||292.78|61.48|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|292.78||||292.78|122.61|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|TRUSTMARK [2030]|STARMARK [203000]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|292.78||||292.78|140.39|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|UMR [2035]|UMR OPTIONS [203501]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|292.78||||292.78|263.5|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|292.78||||292.78|0|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|292.78||||292.78|108.33|272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|292.78||||292.78||272.29|61.48
11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|5 mcg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|292.78||||292.78|146.39|272.29|61.48
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|148.86||||148.86|74.58|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|148.86||||148.86|52.25|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|148.86||||148.86|64.01|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|148.86||||148.86|63.41|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|148.86||||148.86|74.43|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|148.86||||148.86|96.76|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|148.86||||148.86|3.24|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|148.86||||148.86|55.08|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|GEHA [1415]|GEHA [141500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|148.86||||148.86|64.01|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|148.86||||148.86|138.44|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148.86||||148.86|89.32|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MULTIPLAN [1680]|HMA [168003]|148.86||||148.86|52.1|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MULTIPLAN [1680]|IHC HS [168011]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|Self-pay|Self-pay|148.86||||148.86|44.66|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|148.86||||148.86|31.26|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|148.86||||148.86|4.11|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|TRUSTMARK [2030]|STARMARK [203000]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148.86||||148.86|71.38|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|UMR [2035]|UMR OPTIONS [203501]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|148.86||||148.86|133.97|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|148.86||||148.86|0|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|148.86||||148.86|55.08|138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|148.86||||148.86||138.44|3.24
113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|148.86||||148.86|74.43|138.44|3.24
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|Self-pay|Self-pay|10||||10|3|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|1 enema|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25||||25|12.53|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25||||25|8.78|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25||||25|10.75|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25||||25|10.65|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25||||25|12.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25||||25|16.25|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25||||25|9.25|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25||||25|10.75|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|25||||25|23.25|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25||||25|15|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|Self-pay|Self-pay|25||||25|7.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25||||25|5.25|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25||||25|11.99|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25||||25|22.5|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25||||25|0|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25||||25|9.25|23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25||||25||23.25|5.25
11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25||||25|12.5|23.25|5.25
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15.39||||15.39|7.71|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.39||||15.39|5.4|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.39||||15.39|6.62|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15.39||||15.39|6.56|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15.39||||15.39|7.7|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.39||||15.39|10|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15.39||||15.39|5.69|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.39||||15.39|6.62|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|15.39||||15.39|14.31|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.39||||15.39|9.23|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|Self-pay|Self-pay|15.39||||15.39|4.62|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.39||||15.39|3.23|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.39||||15.39|7.38|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.39||||15.39|13.85|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15.39||||15.39|0|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15.39||||15.39|5.69|14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15.39||||15.39||14.31|3.23
11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15.39||||15.39|7.7|14.31|3.23
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51.83||||51.83|25.97|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51.83||||51.83|18.19|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51.83||||51.83|22.29|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51.83||||51.83|22.08|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51.83||||51.83|25.92|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51.83||||51.83|33.69|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51.83||||51.83|19.18|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|GEHA [1415]|GEHA [141500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51.83||||51.83|22.29|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|51.83||||51.83|48.2|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51.83||||51.83|31.1|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MULTIPLAN [1680]|HMA [168003]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MULTIPLAN [1680]|IHC HS [168011]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|Self-pay|Self-pay|51.83||||51.83|15.55|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51.83||||51.83|10.88|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|TRUSTMARK [2030]|STARMARK [203000]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51.83||||51.83|24.85|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|UMR [2035]|UMR OPTIONS [203501]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51.83||||51.83|46.65|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51.83||||51.83|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51.83||||51.83|19.18|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51.83||||51.83||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51.83||||51.83|25.92|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22.71||||22.71|11.38|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.71||||22.71|7.97|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.71||||22.71|9.77|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22.71||||22.71|9.67|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22.71||||22.71|11.36|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.71||||22.71|14.76|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22.71||||22.71|8.4|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.71||||22.71|9.77|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|22.71||||22.71|21.12|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.71||||22.71|13.63|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|Self-pay|Self-pay|22.71||||22.71|6.81|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.71||||22.71|4.77|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.71||||22.71|10.89|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.71||||22.71|20.44|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22.71||||22.71|0|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22.71||||22.71|8.4|48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22.71||||22.71||48.2|4.77
11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22.71||||22.71|11.36|48.2|4.77
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.59||||54.59|27.35|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.59||||54.59|19.16|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.59||||54.59|23.47|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.59||||54.59|23.26|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.59||||54.59|27.3|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.59||||54.59|35.48|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.59||||54.59|20.2|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|GEHA [1415]|GEHA [141500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.59||||54.59|23.47|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|54.59||||54.59|50.77|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.59||||54.59|32.75|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MULTIPLAN [1680]|HMA [168003]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MULTIPLAN [1680]|IHC HS [168011]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|Self-pay|Self-pay|54.59||||54.59|16.38|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.59||||54.59|11.46|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|TRUSTMARK [2030]|STARMARK [203000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.59||||54.59|26.18|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|UMR [2035]|UMR OPTIONS [203501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.59||||54.59|20.2|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.59||||54.59|27.3|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.59||||54.59|27.35|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.59||||54.59|19.16|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.59||||54.59|23.47|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.59||||54.59|23.26|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.59||||54.59|27.3|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.59||||54.59|35.48|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.59||||54.59|20.2|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.59||||54.59|23.47|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|54.59||||54.59|50.77|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.59||||54.59|32.75|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|Self-pay|Self-pay|54.59||||54.59|16.38|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.59||||54.59|11.46|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.59||||54.59|26.18|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.59||||54.59|49.13|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.59||||54.59|0|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.59||||54.59|20.2|50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.59||||54.59||50.77|11.46
11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.59||||54.59|27.3|50.77|11.46
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26.15||||26.15|13.1|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.15||||26.15|9.18|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.15||||26.15|11.24|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26.15||||26.15|11.14|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26.15||||26.15|13.08|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.15||||26.15|17|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26.15||||26.15|9.68|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.15||||26.15|11.24|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|26.15||||26.15|24.32|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.15||||26.15|15.69|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|Self-pay|Self-pay|26.15||||26.15|7.84|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.15||||26.15|5.49|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.15||||26.15|12.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.15||||26.15|23.54|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26.15||||26.15|0|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26.15||||26.15|9.68|24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26.15||||26.15||24.32|5.49
11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26.15||||26.15|13.08|24.32|5.49
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|AETNA [1015]|AETNA ACO WILCO [101532]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|613.97||||613.97|307.6|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|613.97||||613.97|215.5|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|613.97||||613.97|264.01|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|613.97||||613.97|261.55|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|613.97||||613.97|306.99|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|613.97||||613.97|399.08|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|CORESOURCE [1315]|CORESOURCE [131500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|CORVEL CORP [2235]|CORVEL CORP [223500]|613.97||||613.97|83.01|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|613.97||||613.97|227.17|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|GEHA [1415]|GEHA [141500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HEALTHNET [1495]|HEALTHNET [149500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|613.97||||613.97|264.01|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HEALTHSMART [1505]|HEALTHSMART [150501]|613.97||||613.97|570.99|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|613.97||||613.97|368.38|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MULTIPLAN [1680]|HMA [168003]|613.97||||613.97|214.89|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MULTIPLAN [1680]|IHC HS [168011]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|Self-pay|Self-pay|613.97||||613.97|184.19|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|613.97||||613.97|128.93|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|613.97||||613.97|58.72|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|TRUSTMARK [2030]|STARMARK [203000]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|613.97||||613.97|294.4|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|UMR [2035]|UMR OPTIONS [203501]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|613.97||||613.97|552.57|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|613.97||||613.97|0|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|613.97||||613.97|227.17|570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|613.97||||613.97||570.99|58.72
11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|10 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|613.97||||613.97|306.99|570.99|58.72
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34.2||||34.2|17.13|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.2||||34.2|12|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.2||||34.2|14.71|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34.2||||34.2|14.57|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34.2||||34.2|17.1|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.2||||34.2|22.23|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|34.2||||34.2|1.06|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34.2||||34.2|12.65|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.2||||34.2|14.71|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|34.2||||34.2|31.81|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.2||||34.2|20.52|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|34.2||||34.2|11.97|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|34.2||||34.2|10.26|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.2||||34.2|7.18|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.2||||34.2|1.38|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.2||||34.2|16.4|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.2||||34.2|30.78|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34.2||||34.2|0|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34.2||||34.2|12.65|31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34.2||||34.2||31.81|1.06
116345|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34.2||||34.2|17.1|31.81|1.06
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|3 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|20 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|AETNA [1015]|AETNA ACO WILCO [101532]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1020.97||||1020.97|511.51|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1020.97||||1020.97|358.36|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1020.97||||1020.97|439.02|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1020.97||||1020.97|434.93|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1020.97||||1020.97|510.49|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1020.97||||1020.97|663.63|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|CORESOURCE [1315]|CORESOURCE [131500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|CORVEL CORP [2235]|CORVEL CORP [223500]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1020.97||||1020.97|377.76|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|GEHA [1415]|GEHA [141500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HEALTHNET [1495]|HEALTHNET [149500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1020.97||||1020.97|439.02|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HEALTHSMART [1505]|HEALTHSMART [150501]|1020.97||||1020.97|949.5|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1020.97||||1020.97|612.58|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MULTIPLAN [1680]|HMA [168003]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MULTIPLAN [1680]|IHC HS [168011]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|Self-pay|Self-pay|1020.97||||1020.97|306.29|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1020.97||||1020.97|214.4|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|TRUSTMARK [2030]|STARMARK [203000]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1020.97||||1020.97|489.56|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|UMR [2035]|UMR OPTIONS [203501]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1020.97||||1020.97|918.87|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1020.97||||1020.97|0|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1020.97||||1020.97|377.76|949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1020.97||||1020.97||949.5|214.4
116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|4 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1020.97||||1020.97|510.49|949.5|214.4
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|AETNA [1015]|AETNA ACO WILCO [101532]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|CORESOURCE [1315]|CORESOURCE [131500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|GEHA [1415]|GEHA [141500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HEALTHNET [1495]|HEALTHNET [149500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MULTIPLAN [1680]|HMA [168003]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MULTIPLAN [1680]|IHC HS [168011]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|Self-pay|Self-pay|4001||||4001|1200.3|1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|TRUSTMARK [2030]|STARMARK [203000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|UMR [2035]|UMR OPTIONS [203501]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4001||||4001||1200.3|1200.3
11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4001||||4001||1200.3|1200.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|AETNA [1015]|AETNA ACO WILCO [101532]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|CORESOURCE [1315]|CORESOURCE [131500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|GEHA [1415]|GEHA [141500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HEALTHNET [1495]|HEALTHNET [149500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MULTIPLAN [1680]|HMA [168003]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MULTIPLAN [1680]|IHC HS [168011]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|Self-pay|Self-pay|4401||||4401|1320.3|1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|TRUSTMARK [2030]|STARMARK [203000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|UMR [2035]|UMR OPTIONS [203501]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4401||||4401||1320.3|1320.3
11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4401||||4401||1320.3|1320.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|AETNA [1015]|AETNA ACO WILCO [101532]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|CORESOURCE [1315]|CORESOURCE [131500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|GEHA [1415]|GEHA [141500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HEALTHNET [1495]|HEALTHNET [149500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MULTIPLAN [1680]|HMA [168003]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MULTIPLAN [1680]|IHC HS [168011]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|Self-pay|Self-pay|4841||||4841|1452.3|1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|TRUSTMARK [2030]|STARMARK [203000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|UMR [2035]|UMR OPTIONS [203501]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4841||||4841||1452.3|1452.3
11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4841||||4841||1452.3|1452.3
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36.54||||36.54|18.31|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.54||||36.54|12.83|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.54||||36.54|15.71|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36.54||||36.54|15.57|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36.54||||36.54|18.27|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.54||||36.54|23.75|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36.54||||36.54|13.52|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.54||||36.54|15.71|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|36.54||||36.54|33.98|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.54||||36.54|21.92|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|36.54||||36.54|10.96|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.54||||36.54|7.67|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.54||||36.54|17.52|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.54||||36.54|32.89|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36.54||||36.54|0|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36.54||||36.54|13.52|33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36.54||||36.54||33.98|7.67
119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36.54||||36.54|18.27|33.98|7.67
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71.02||||71.02|35.58|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71.02||||71.02|24.93|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71.02||||71.02|30.54|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71.02||||71.02|30.25|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71.02||||71.02|35.51|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71.02||||71.02|46.16|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71.02||||71.02|26.28|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71.02||||71.02|30.54|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|71.02||||71.02|66.05|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71.02||||71.02|42.61|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|71.02||||71.02|21.31|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71.02||||71.02|14.91|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71.02||||71.02|34.05|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71.02||||71.02|63.92|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71.02||||71.02|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71.02||||71.02|26.28|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71.02||||71.02||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71.02||||71.02|35.51|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182.6||||182.6|91.48|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.6||||182.6|64.09|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.6||||182.6|78.52|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182.6||||182.6|77.79|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182.6||||182.6|91.3|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.6||||182.6|118.69|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182.6||||182.6|67.56|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.6||||182.6|78.52|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|182.6||||182.6|169.82|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.6||||182.6|109.56|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|Self-pay|Self-pay|182.6||||182.6|54.78|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.6||||182.6|38.35|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.6||||182.6|87.56|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.6||||182.6|164.34|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182.6||||182.6|0|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182.6||||182.6|67.56|169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182.6||||182.6||169.82|14.91
119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182.6||||182.6|91.3|169.82|14.91
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.21||||20.21|10.13|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.21||||20.21|7.09|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.21||||20.21|8.69|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.21||||20.21|8.61|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.21||||20.21|10.11|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.21||||20.21|13.14|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.21||||20.21|7.48|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.21||||20.21|8.69|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|20.21||||20.21|18.8|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.21||||20.21|12.13|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|20.21||||20.21|6.06|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.21||||20.21|4.24|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.21||||20.21|9.69|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.21||||20.21|18.19|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.21||||20.21|0|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.21||||20.21|7.48|18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.21||||20.21||18.8|4.24
119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.21||||20.21|10.11|18.8|4.24
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36.54||||36.54|18.31|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.54||||36.54|12.83|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.54||||36.54|15.71|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36.54||||36.54|15.57|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36.54||||36.54|18.27|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.54||||36.54|23.75|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36.54||||36.54|13.52|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.54||||36.54|15.71|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|36.54||||36.54|33.98|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.54||||36.54|21.92|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|Self-pay|Self-pay|36.54||||36.54|10.96|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.54||||36.54|7.67|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.54||||36.54|17.52|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.54||||36.54|32.89|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36.54||||36.54|0|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36.54||||36.54|13.52|33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36.54||||36.54||33.98|7.67
119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36.54||||36.54|18.27|33.98|7.67
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.36||||192.36|96.37|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.36||||192.36|67.52|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.36||||192.36|82.71|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.36||||192.36|81.95|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.36||||192.36|96.18|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.36||||192.36|125.03|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|192.36||||192.36|5.88|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.36||||192.36|71.17|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.36||||192.36|82.71|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|192.36||||192.36|178.89|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.36||||192.36|115.42|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.36||||192.36|96.18|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|192.36||||192.36|57.71|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.36||||192.36|40.4|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.36||||192.36|5.3|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.36||||192.36|92.24|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.36||||192.36|173.12|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192.36||||192.36|0|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.36||||192.36|71.17|178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.36||||192.36||178.89|5.3
119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.36||||192.36|96.18|178.89|5.3
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|162.68||||162.68|81.5|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162.68||||162.68|57.1|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162.68||||162.68|69.95|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|162.68||||162.68|69.3|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|162.68||||162.68|81.34|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162.68||||162.68|105.74|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|162.68||||162.68|16.12|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|162.68||||162.68|60.19|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162.68||||162.68|69.95|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|162.68||||162.68|151.29|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162.68||||162.68|97.61|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162.68||||162.68|81.34|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|162.68||||162.68|48.8|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162.68||||162.68|34.16|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162.68||||162.68|18.02|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162.68||||162.68|78.01|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162.68||||162.68|146.41|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|162.68||||162.68|0|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|162.68||||162.68|60.19|151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|162.68||||162.68||151.29|16.12
119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|162.68||||162.68|81.34|151.29|16.12
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|0.5 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62.88||||62.88|31.5|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.88||||62.88|22.07|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.88||||62.88|27.04|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62.88||||62.88|26.79|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62.88||||62.88|31.44|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.88||||62.88|40.87|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|62.88||||62.88|3.13|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62.88||||62.88|23.27|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.88||||62.88|27.04|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|62.88||||62.88|58.48|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.88||||62.88|37.73|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|Self-pay|Self-pay|62.88||||62.88|18.86|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.88||||62.88|13.2|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.88||||62.88|30.15|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.88||||62.88|56.59|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62.88||||62.88|0|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62.88||||62.88|23.27|58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62.88||||62.88||58.48|3.13
121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62.88||||62.88|31.44|58.48|3.13
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|405.84||||405.84|203.33|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|405.84||||405.84|142.45|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|405.84||||405.84|174.51|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|405.84||||405.84|172.89|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|405.84||||405.84|202.92|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|405.84||||405.84|263.8|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CORESOURCE [1315]|CORESOURCE [131500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|405.84||||405.84|150.16|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|GEHA [1415]|GEHA [141500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHNET [1495]|HEALTHNET [149500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|405.84||||405.84|174.51|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|405.84||||405.84|377.43|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|405.84||||405.84|243.5|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MULTIPLAN [1680]|HMA [168003]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MULTIPLAN [1680]|IHC HS [168011]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|Self-pay|Self-pay|405.84||||405.84|121.75|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|405.84||||405.84|85.23|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TRUSTMARK [2030]|STARMARK [203000]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|405.84||||405.84|194.6|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UMR [2035]|UMR OPTIONS [203501]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|405.84||||405.84|365.26|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|405.84||||405.84|0|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|405.84||||405.84|150.16|377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|405.84||||405.84||377.43|85.23
122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|405.84||||405.84|202.92|377.43|85.23
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|AETNA ACO WILCO [101532]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73.56||||73.56|36.85|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73.56||||73.56|25.82|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73.56||||73.56|31.63|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73.56||||73.56|31.34|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73.56||||73.56|36.78|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73.56||||73.56|47.81|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|CORESOURCE [1315]|CORESOURCE [131500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|CORVEL CORP [2235]|CORVEL CORP [223500]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73.56||||73.56|27.22|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|FIRST HEALTH [1375]|QUALCHOICE [137513]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|FMH BENEFIT SERVICES [1390]|FMH [139000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|GEHA [1415]|GEHA [141500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HEALTHNET [1495]|HEALTHNET [149500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73.56||||73.56|31.63|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSMART [1505]|HEALTHSMART [150501]|73.56||||73.56|68.41|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73.56||||73.56|44.14|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MULTIPLAN [1680]|HMA [168003]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MULTIPLAN [1680]|IHC HS [168011]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|PENDING SSI [1616]|PENDING SSI RCA [161601]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|Self-pay|Self-pay|73.56||||73.56|22.07|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73.56||||73.56|15.45|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|TRUSTMARK [2030]|STARMARK [203000]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73.56||||73.56|35.27|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|UMR [2035]|UMR OPTIONS [203501]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73.56||||73.56|66.2|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73.56||||73.56|0|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73.56||||73.56|27.22|68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73.56||||73.56||68.41|15.45
122026|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BELLADONNA ALKALOIDS-OPIUM 16.2 MG-30 MG RECTAL SUPPOSITORY|1 suppository|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73.56||||73.56|36.78|68.41|15.45
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|AETNA [1015]|AETNA ACO WILCO [101532]|777||||777|0|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|777||||777|148.57|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|777||||777|159.17|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|777||||777|159.17|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|777||||777|389.28|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|777||||777|272.73|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|777||||777|334.11|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|777||||777|331|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|777||||777|388.5|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|777||||777|505.05|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|CORESOURCE [1315]|CORESOURCE [131500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|CORVEL CORP [2235]|CORVEL CORP [223500]|777||||777|0|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|777||||777|287.49|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|GEHA [1415]|GEHA [141500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|777||||777|327.72|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HEALTHNET [1495]|HEALTHNET [149500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|777||||777|334.11|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HEALTHSMART [1505]|HEALTHSMART [150501]|777||||777|722.61|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|777||||777|466.2|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|777||||777|160.22|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|777||||777|388.5|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|777||||777|153.73|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|777||||777|196.63|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|777||||777|148.57|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MULTIPLAN [1680]|HMA [168003]|777||||777|271.95|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MULTIPLAN [1680]|IHC HS [168011]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|777||||777|165.44|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|777||||777|160.22|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|Self-pay|Self-pay|777||||777|233.1|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|777||||777|163.17|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|777||||777|142.74|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|777||||777|212.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|TRUSTMARK [2030]|STARMARK [203000]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|777||||777|372.57|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|UMR [2035]|UMR OPTIONS [203501]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|777||||777|146.41|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|777||||777|699.3|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|777||||777|0|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|777||||777|287.49|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|777||||777|145.65|722.61|142.74
122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223  RADIUM DICHLORIDE (XOFIGO) PER UCI|1 microcurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|777||||777|388.5|722.61|142.74
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48.31||||48.31|24.2|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.31||||48.31|16.96|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.31||||48.31|20.77|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48.31||||48.31|20.58|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48.31||||48.31|24.16|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.31||||48.31|31.4|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48.31||||48.31|17.87|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|GEHA [1415]|GEHA [141500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.31||||48.31|20.77|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|48.31||||48.31|44.93|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.31||||48.31|28.99|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MULTIPLAN [1680]|HMA [168003]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|Self-pay|Self-pay|48.31||||48.31|14.49|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.31||||48.31|10.15|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.31||||48.31|23.16|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|UMR [2035]|UMR OPTIONS [203501]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.31||||48.31|43.48|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48.31||||48.31|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48.31||||48.31|17.87|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48.31||||48.31||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48.31||||48.31|24.16|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|Self-pay|Self-pay|10||||10|3|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||44.93|2.1
122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|44.93|2.1
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
1222|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29.64||||29.64|14.85|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.64||||29.64|10.4|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.64||||29.64|12.75|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29.64||||29.64|12.63|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29.64||||29.64|14.82|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.64||||29.64|19.27|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|CORESOURCE [1315]|CORESOURCE [131500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|29.64||||29.64|4.1|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29.64||||29.64|10.97|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|GEHA [1415]|GEHA [141500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HEALTHNET [1495]|HEALTHNET [149500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.64||||29.64|12.75|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|29.64||||29.64|27.57|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.64||||29.64|17.78|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MULTIPLAN [1680]|HMA [168003]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MULTIPLAN [1680]|IHC HS [168011]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|Self-pay|Self-pay|29.64||||29.64|8.89|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.64||||29.64|6.22|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|TRUSTMARK [2030]|STARMARK [203000]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.64||||29.64|14.21|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|UMR [2035]|UMR OPTIONS [203501]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.64||||29.64|26.68|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29.64||||29.64|0|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29.64||||29.64|10.97|27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29.64||||29.64||27.57|4.1
122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29.64||||29.64|14.82|27.57|4.1
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.01||||20.01|10.03|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.01||||20.01|7.02|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.01||||20.01|8.6|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.01||||20.01|8.52|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.01||||20.01|10.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.01||||20.01|13.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.01||||20.01|7.4|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|GEHA [1415]|GEHA [141500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.01||||20.01|8.6|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|20.01||||20.01|18.61|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.01||||20.01|12.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|Self-pay|Self-pay|20.01||||20.01|6|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.01||||20.01|4.2|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.01||||20.01|9.59|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.01||||20.01|18.01|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.01||||20.01|0|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.01||||20.01|7.4|18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.01||||20.01||18.61|4.2
122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.01||||20.01|10.01|18.61|4.2
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37.28||||37.28|18.68|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.28||||37.28|13.09|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.28||||37.28|16.03|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37.28||||37.28|15.88|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37.28||||37.28|18.64|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.28||||37.28|24.23|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37.28||||37.28|13.79|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|GEHA [1415]|GEHA [141500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.28||||37.28|16.03|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|37.28||||37.28|34.67|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.28||||37.28|22.37|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|Self-pay|Self-pay|37.28||||37.28|11.18|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.28||||37.28|7.83|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.28||||37.28|17.88|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.28||||37.28|33.55|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37.28||||37.28|0|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37.28||||37.28|13.79|34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37.28||||37.28||34.67|7.83
122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37.28||||37.28|18.64|34.67|7.83
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|AETNA [1015]|AETNA ACO WILCO [101532]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149.13||||149.13|74.71|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.13||||149.13|52.34|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.13||||149.13|64.13|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149.13||||149.13|63.53|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149.13||||149.13|74.57|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.13||||149.13|96.93|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|CORESOURCE [1315]|CORESOURCE [131500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149.13||||149.13|55.18|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|GEHA [1415]|GEHA [141500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HEALTHNET [1495]|HEALTHNET [149500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.13||||149.13|64.13|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|149.13||||149.13|138.69|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.13||||149.13|89.48|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MULTIPLAN [1680]|HMA [168003]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MULTIPLAN [1680]|IHC HS [168011]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|Self-pay|Self-pay|149.13||||149.13|44.74|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.13||||149.13|31.32|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|TRUSTMARK [2030]|STARMARK [203000]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.13||||149.13|71.51|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|UMR [2035]|UMR OPTIONS [203501]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.13||||149.13|134.22|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149.13||||149.13|0|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149.13||||149.13|55.18|138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149.13||||149.13||138.69|31.32
123|ERX|0250 - PHARMACY-GENERAL|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|4 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149.13||||149.13|74.57|138.69|31.32
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.72|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.11|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|8.62|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.53|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.11
123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.11
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|1309.82||||1309.82|0|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1309.82||||1309.82|183.37|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1309.82||||1309.82|267.2|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1309.82||||1309.82|267.2|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1309.82||||1309.82|656.22|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1309.82||||1309.82|459.75|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1309.82||||1309.82|563.22|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1309.82||||1309.82|557.98|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1309.82||||1309.82|654.91|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1309.82||||1309.82|851.38|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|1309.82||||1309.82|186.01|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1309.82||||1309.82|484.63|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|GEHA [1415]|GEHA [141500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1309.82||||1309.82|404.5|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1309.82||||1309.82|563.22|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|1309.82||||1309.82|1218.13|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1309.82||||1309.82|785.89|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1309.82||||1309.82|197.75|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1309.82||||1309.82|262.72|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1309.82||||1309.82|258.09|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1309.82||||1309.82|242.7|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1309.82||||1309.82|183.37|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MULTIPLAN [1680]|HMA [168003]|1309.82||||1309.82|458.44|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MULTIPLAN [1680]|IHC HS [168011]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|1309.82||||1309.82|277.72|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1309.82||||1309.82|197.75|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|Self-pay|Self-pay|1309.82||||1309.82|392.95|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1309.82||||1309.82|275.06|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1309.82||||1309.82|176.18|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1309.82||||1309.82|173.33|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|TRUSTMARK [2030]|STARMARK [203000]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1309.82||||1309.82|628.06|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|UMR [2035]|UMR OPTIONS [203501]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1309.82||||1309.82|245.8|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1309.82||||1309.82|1178.84|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1309.82||||1309.82|0|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1309.82||||1309.82|484.63|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1309.82||||1309.82|179.78|1218.13|173.33
124667|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1309.82||||1309.82|654.91|1218.13|173.33
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|AETNA [1015]|AETNA ACO WILCO [101532]|3483.63||||3483.63|0|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3483.63||||3483.63|550.11|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3483.63||||3483.63|801.6|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3483.63||||3483.63|801.6|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3483.63||||3483.63|1745.3|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3483.63||||3483.63|1222.75|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3483.63||||3483.63|1497.96|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3483.63||||3483.63|1484.03|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3483.63||||3483.63|1741.82|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3483.63||||3483.63|2264.36|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|CORESOURCE [1315]|CORESOURCE [131500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|3483.63||||3483.63|558.04|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3483.63||||3483.63|1288.94|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|GEHA [1415]|GEHA [141500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3483.63||||3483.63|1219.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HEALTHNET [1495]|HEALTHNET [149500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3483.63||||3483.63|1497.96|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|3483.63||||3483.63|3239.78|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3483.63||||3483.63|2090.18|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3483.63||||3483.63|593.26|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3483.63||||3483.63|788.16|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3483.63||||3483.63|774.28|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3483.63||||3483.63|728.09|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3483.63||||3483.63|550.11|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MULTIPLAN [1680]|HMA [168003]|3483.63||||3483.63|1219.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MULTIPLAN [1680]|IHC HS [168011]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|3483.63||||3483.63|833.16|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3483.63||||3483.63|593.26|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|Self-pay|Self-pay|3483.63||||3483.63|1045.09|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3483.63||||3483.63|731.56|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3483.63||||3483.63|528.54|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3483.63||||3483.63|519.99|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|TRUSTMARK [2030]|STARMARK [203000]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3483.63||||3483.63|1670.4|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|UMR [2035]|UMR OPTIONS [203501]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3483.63||||3483.63|737.39|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3483.63||||3483.63|3135.27|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3483.63||||3483.63|0|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3483.63||||3483.63|1288.94|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3483.63||||3483.63|539.33|3239.78|519.99
124668|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYLAN G-F 20  48 MG/6 ML INTRA-ARTICULAR SYRINGE|6 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3483.63||||3483.63|1741.82|3239.78|519.99
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|0.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|AETNA [1015]|AETNA ACO WILCO [101532]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19.23||||19.23|9.63|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.23||||19.23|6.75|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.23||||19.23|8.27|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19.23||||19.23|8.19|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19.23||||19.23|9.62|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.23||||19.23|12.5|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|CORESOURCE [1315]|CORESOURCE [131500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19.23||||19.23|7.12|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|GEHA [1415]|GEHA [141500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HEALTHNET [1495]|HEALTHNET [149500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.23||||19.23|8.27|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|19.23||||19.23|17.88|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.23||||19.23|11.54|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MULTIPLAN [1680]|HMA [168003]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MULTIPLAN [1680]|IHC HS [168011]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|Self-pay|Self-pay|19.23||||19.23|5.77|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.23||||19.23|4.04|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|TRUSTMARK [2030]|STARMARK [203000]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.23||||19.23|9.22|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|UMR [2035]|UMR OPTIONS [203501]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.23||||19.23|17.31|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19.23||||19.23|0|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19.23||||19.23|7.12|17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19.23||||19.23||17.88|4.04
124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|22 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19.23||||19.23|9.62|17.88|4.04
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|AETNA [1015]|AETNA ACO WILCO [101532]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.77||||10.77|5.4|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.77||||10.77|3.78|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.77||||10.77|4.63|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.77||||10.77|4.59|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.77||||10.77|5.39|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.77||||10.77|7|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|CORESOURCE [1315]|CORESOURCE [131500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|CORVEL CORP [2235]|CORVEL CORP [223500]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.77||||10.77|3.98|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|GEHA [1415]|GEHA [141500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HEALTHNET [1495]|HEALTHNET [149500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.77||||10.77|4.63|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HEALTHSMART [1505]|HEALTHSMART [150501]|10.77||||10.77|10.02|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.77||||10.77|6.46|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MULTIPLAN [1680]|HMA [168003]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MULTIPLAN [1680]|IHC HS [168011]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|Self-pay|Self-pay|10.77||||10.77|3.23|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.77||||10.77|2.26|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|TRUSTMARK [2030]|STARMARK [203000]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.77||||10.77|5.16|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|UMR [2035]|UMR OPTIONS [203501]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.77||||10.77|9.69|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.77||||10.77|0|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.77||||10.77|3.98|10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.77||||10.77||10.02|2.26
124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|57 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.77||||10.77|5.39|10.02|2.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|AETNA [1015]|AETNA ACO WILCO [101532]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.21||||20.21|10.13|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.21||||20.21|7.09|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.21||||20.21|8.69|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.21||||20.21|8.61|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.21||||20.21|10.11|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.21||||20.21|13.14|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|CORESOURCE [1315]|CORESOURCE [131500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|20.21||||20.21|1.54|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.21||||20.21|7.48|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|GEHA [1415]|GEHA [141500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HEALTHNET [1495]|HEALTHNET [149500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.21||||20.21|8.69|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|20.21||||20.21|18.8|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.21||||20.21|12.13|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.21||||20.21|10.11|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MULTIPLAN [1680]|HMA [168003]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MULTIPLAN [1680]|IHC HS [168011]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|Self-pay|Self-pay|20.21||||20.21|6.06|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.21||||20.21|4.24|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|TRUSTMARK [2030]|STARMARK [203000]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.21||||20.21|9.69|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|UMR [2035]|UMR OPTIONS [203501]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.21||||20.21|18.19|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.21||||20.21|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.21||||20.21|7.48|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.21||||20.21||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|118 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.21||||20.21|10.11|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|AETNA [1015]|AETNA ACO WILCO [101532]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49.86||||49.86|24.98|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.86||||49.86|17.5|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.86||||49.86|21.44|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49.86||||49.86|21.24|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49.86||||49.86|24.93|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.86||||49.86|32.41|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|CORESOURCE [1315]|CORESOURCE [131500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|49.86||||49.86|6.16|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49.86||||49.86|18.45|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|GEHA [1415]|GEHA [141500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HEALTHNET [1495]|HEALTHNET [149500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.86||||49.86|21.44|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|49.86||||49.86|46.37|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.86||||49.86|29.92|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.86||||49.86|24.93|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MULTIPLAN [1680]|HMA [168003]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MULTIPLAN [1680]|IHC HS [168011]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|Self-pay|Self-pay|49.86||||49.86|14.96|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.86||||49.86|10.47|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|TRUSTMARK [2030]|STARMARK [203000]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.86||||49.86|23.91|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|UMR [2035]|UMR OPTIONS [203501]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.86||||49.86|44.87|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49.86||||49.86|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49.86||||49.86|18.45|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49.86||||49.86||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|473 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49.86||||49.86|24.93|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.26|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|5|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|Self-pay|Self-pay|10||||10|3|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||46.37|0.26
12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|46.37|0.26
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|AETNA [1015]|AETNA ACO WILCO [101532]|3815.25||||3815.25|0|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3815.25||||3815.25|778.05|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3815.25||||3815.25|1291.57|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3815.25||||3815.25|1291.57|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3815.25||||3815.25|1911.44|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3815.25||||3815.25|1339.15|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3815.25||||3815.25|1640.56|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3815.25||||3815.25|1625.3|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3815.25||||3815.25|1907.63|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3815.25||||3815.25|2479.91|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|CORESOURCE [1315]|CORESOURCE [131500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|3815.25||||3815.25|775.42|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3815.25||||3815.25|1411.64|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|GEHA [1415]|GEHA [141500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3815.25||||3815.25|1335.34|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HEALTHNET [1495]|HEALTHNET [149500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3815.25||||3815.25|1640.56|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|3815.25||||3815.25|3548.18|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3815.25||||3815.25|2289.15|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3815.25||||3815.25|839.08|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3815.25||||3815.25|2191.16|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3815.25||||3815.25|1247.45|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3815.25||||3815.25|1029.78|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3815.25||||3815.25|778.05|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MULTIPLAN [1680]|HMA [168003]|3815.25||||3815.25|1335.34|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MULTIPLAN [1680]|IHC HS [168011]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|3815.25||||3815.25|1342.43|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3815.25||||3815.25|839.08|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|Self-pay|Self-pay|3815.25||||3815.25|1144.57|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3815.25||||3815.25|801.2|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3815.25||||3815.25|747.54|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3815.25||||3815.25|736.25|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|TRUSTMARK [2030]|STARMARK [203000]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3815.25||||3815.25|1829.41|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|UMR [2035]|UMR OPTIONS [203501]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3815.25||||3815.25|1188.01|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3815.25||||3815.25|3433.73|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3815.25||||3815.25|0|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3815.25||||3815.25|1411.64|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3815.25||||3815.25|762.8|3548.18|736.25
125669|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, STABILIZED 88 MG/4 ML INTRA-ARTICULAR SYRINGE|4 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3815.25||||3815.25|1907.63|3548.18|736.25
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0.62|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MULTIPLAN [1680]|HMA [168003]|90||||90|31.5|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|Self-pay|Self-pay|90||||90|27|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|0.67|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|0.62
125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|0.62
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|2.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|AETNA [1015]|AETNA ACO WILCO [101532]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19.28||||19.28|9.66|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.28||||19.28|6.77|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.28||||19.28|8.29|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19.28||||19.28|8.21|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19.28||||19.28|9.64|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.28||||19.28|12.53|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|CORESOURCE [1315]|CORESOURCE [131500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|CORVEL CORP [2235]|CORVEL CORP [223500]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19.28||||19.28|7.13|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|GEHA [1415]|GEHA [141500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HEALTHNET [1495]|HEALTHNET [149500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.28||||19.28|8.29|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HEALTHSMART [1505]|HEALTHSMART [150501]|19.28||||19.28|17.93|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.28||||19.28|11.57|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MULTIPLAN [1680]|HMA [168003]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MULTIPLAN [1680]|IHC HS [168011]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|Self-pay|Self-pay|19.28||||19.28|5.78|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.28||||19.28|4.05|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|TRUSTMARK [2030]|STARMARK [203000]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.28||||19.28|9.24|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|UMR [2035]|UMR OPTIONS [203501]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.28||||19.28|17.35|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19.28||||19.28|0|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19.28||||19.28|7.13|17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19.28||||19.28||17.93|4.05
125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|36 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19.28||||19.28|9.64|17.93|4.05
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|2925.03||||2925.03|0|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2925.03||||2925.03|740.67|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2925.03||||2925.03|740.67|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2925.03||||2925.03|1465.44|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2925.03||||2925.03|1026.69|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2925.03||||2925.03|1257.76|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2925.03||||2925.03|1246.06|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2925.03||||2925.03|1462.52|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2925.03||||2925.03|1901.27|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|2925.03||||2925.03|0|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2925.03||||2925.03|1082.26|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|GEHA [1415]|GEHA [141500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2925.03||||2925.03|1257.76|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|2925.03||||2925.03|2720.28|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2925.03||||2925.03|1755.02|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2925.03||||2925.03|1533.93|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2925.03||||2925.03|715.37|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MULTIPLAN [1680]|HMA [168003]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MULTIPLAN [1680]|IHC HS [168011]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|2925.03||||2925.03|769.83|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|Self-pay|Self-pay|2925.03||||2925.03|877.51|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2925.03||||2925.03|614.26|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|TRUSTMARK [2030]|STARMARK [203000]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2925.03||||2925.03|1402.55|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|UMR [2035]|UMR OPTIONS [203501]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2925.03||||2925.03|681.29|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2925.03||||2925.03|2632.53|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2925.03||||2925.03|0|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2925.03||||2925.03|1082.26|2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2925.03||||2925.03||2720.28|614.26
126195|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2925.03||||2925.03|1462.52|2720.28|614.26
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.32|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.32
126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|0.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.32
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87.15||||87.15|43.66|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87.15||||87.15|30.59|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87.15||||87.15|37.47|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87.15||||87.15|37.13|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87.15||||87.15|43.58|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87.15||||87.15|56.65|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|87.15||||87.15|5.29|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87.15||||87.15|32.25|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|GEHA [1415]|GEHA [141500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87.15||||87.15|37.47|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|87.15||||87.15|81.05|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87.15||||87.15|52.29|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MULTIPLAN [1680]|HMA [168003]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MULTIPLAN [1680]|IHC HS [168011]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|Self-pay|Self-pay|87.15||||87.15|26.14|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87.15||||87.15|18.3|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|TRUSTMARK [2030]|STARMARK [203000]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87.15||||87.15|41.79|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|UMR [2035]|UMR OPTIONS [203501]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87.15||||87.15|78.44|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87.15||||87.15|0|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87.15||||87.15|32.25|81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87.15||||87.15||81.05|5.29
126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87.15||||87.15|43.58|81.05|5.29
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.09||||60.09|30.11|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.09||||60.09|21.09|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.09||||60.09|25.84|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.09||||60.09|25.6|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.09||||60.09|30.05|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.09||||60.09|39.06|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|60.09||||60.09|7.24|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.09||||60.09|22.23|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.09||||60.09|25.84|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|60.09||||60.09|55.88|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.09||||60.09|36.05|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|60.09||||60.09|21.03|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|Self-pay|Self-pay|60.09||||60.09|18.03|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.09||||60.09|12.62|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.09||||60.09|9.33|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.09||||60.09|28.81|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.09||||60.09|54.08|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.09||||60.09|0|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.09||||60.09|22.23|55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.09||||60.09||55.88|7.24
126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.09||||60.09|30.05|55.88|7.24
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|66 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242.9||||242.9|121.69|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.9||||242.9|85.26|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.9||||242.9|104.45|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242.9||||242.9|103.48|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242.9||||242.9|121.45|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.9||||242.9|157.89|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CORESOURCE [1315]|CORESOURCE [131500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242.9||||242.9|89.87|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|GEHA [1415]|GEHA [141500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHNET [1495]|HEALTHNET [149500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.9||||242.9|104.45|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|242.9||||242.9|225.9|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.9||||242.9|145.74|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MULTIPLAN [1680]|HMA [168003]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MULTIPLAN [1680]|IHC HS [168011]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|Self-pay|Self-pay|242.9||||242.9|72.87|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.9||||242.9|51.01|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TRUSTMARK [2030]|STARMARK [203000]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.9||||242.9|116.47|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UMR [2035]|UMR OPTIONS [203501]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.9||||242.9|218.61|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242.9||||242.9|0|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242.9||||242.9|89.87|225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242.9||||242.9||225.9|51.01
127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242.9||||242.9|121.45|225.9|51.01
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|325.22||||325.22|162.94|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|325.22||||325.22|114.15|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|325.22||||325.22|139.84|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|325.22||||325.22|138.54|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|325.22||||325.22|162.61|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|325.22||||325.22|211.39|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CORESOURCE [1315]|CORESOURCE [131500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|325.22||||325.22|120.33|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|GEHA [1415]|GEHA [141500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHNET [1495]|HEALTHNET [149500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|325.22||||325.22|139.84|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|325.22||||325.22|302.45|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|325.22||||325.22|195.13|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MULTIPLAN [1680]|HMA [168003]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MULTIPLAN [1680]|IHC HS [168011]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|Self-pay|Self-pay|325.22||||325.22|97.57|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|325.22||||325.22|68.3|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|TRUSTMARK [2030]|STARMARK [203000]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|325.22||||325.22|155.94|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UMR [2035]|UMR OPTIONS [203501]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|325.22||||325.22|292.7|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|325.22||||325.22|0|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|325.22||||325.22|120.33|302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|325.22||||325.22||302.45|68.3
127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|325.22||||325.22|162.61|302.45|68.3
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29.87||||29.87|14.96|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.87||||29.87|10.48|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.87||||29.87|12.84|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29.87||||29.87|12.72|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29.87||||29.87|14.94|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.87||||29.87|19.42|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29.87||||29.87|11.05|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.87||||29.87|12.84|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|29.87||||29.87|27.78|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.87||||29.87|17.92|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|Self-pay|Self-pay|29.87||||29.87|8.96|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.87||||29.87|6.27|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.87||||29.87|14.32|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.87||||29.87|26.88|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29.87||||29.87|0|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29.87||||29.87|11.05|27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29.87||||29.87||27.78|6.27
127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29.87||||29.87|14.94|27.78|6.27
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|AETNA [1015]|AETNA ACO WILCO [101532]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|CORESOURCE [1315]|CORESOURCE [131500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|GEHA [1415]|GEHA [141500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HEALTHNET [1495]|HEALTHNET [149500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MULTIPLAN [1680]|HMA [168003]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MULTIPLAN [1680]|IHC HS [168011]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|Self-pay|Self-pay|3594||||3594|1078.2|1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|TRUSTMARK [2030]|STARMARK [203000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|UMR [2035]|UMR OPTIONS [203501]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3594||||3594||1078.2|1078.2
12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3594||||3594||1078.2|1078.2
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|AETNA [1015]|AETNA ACO WILCO [101532]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|CORESOURCE [1315]|CORESOURCE [131500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|GEHA [1415]|GEHA [141500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HEALTHNET [1495]|HEALTHNET [149500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MULTIPLAN [1680]|HMA [168003]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MULTIPLAN [1680]|IHC HS [168011]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|Self-pay|Self-pay|3993||||3993|1197.9|1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|TRUSTMARK [2030]|STARMARK [203000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|UMR [2035]|UMR OPTIONS [203501]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3993||||3993||1197.9|1197.9
12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/ATTENDANT REHAB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3993||||3993||1197.9|1197.9
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|AETNA [1015]|AETNA ACO WILCO [101532]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|CORESOURCE [1315]|CORESOURCE [131500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|GEHA [1415]|GEHA [141500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HEALTHNET [1495]|HEALTHNET [149500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MULTIPLAN [1680]|HMA [168003]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MULTIPLAN [1680]|IHC HS [168011]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|Self-pay|Self-pay|4392||||4392|1317.6|1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|TRUSTMARK [2030]|STARMARK [203000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|UMR [2035]|UMR OPTIONS [203501]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4392||||4392||1317.6|1317.6
12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM  W/SPEC BED REHAB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4392||||4392||1317.6|1317.6
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|AETNA [1015]|AETNA ACO WILCO [101532]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28.11||||28.11|14.08|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.11||||28.11|9.87|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.11||||28.11|12.09|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28.11||||28.11|11.97|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28.11||||28.11|14.06|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.11||||28.11|18.27|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|CORESOURCE [1315]|CORESOURCE [131500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28.11||||28.11|10.4|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|GEHA [1415]|GEHA [141500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HEALTHNET [1495]|HEALTHNET [149500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.11||||28.11|12.09|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|28.11||||28.11|26.14|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.11||||28.11|16.87|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MULTIPLAN [1680]|HMA [168003]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MULTIPLAN [1680]|IHC HS [168011]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|Self-pay|Self-pay|28.11||||28.11|8.43|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.11||||28.11|5.9|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|TRUSTMARK [2030]|STARMARK [203000]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.11||||28.11|13.48|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|UMR [2035]|UMR OPTIONS [203501]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.11||||28.11|25.3|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28.11||||28.11|0|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28.11||||28.11|10.4|26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28.11||||28.11||26.14|5.9
128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|4 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28.11||||28.11|14.06|26.14|5.9
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19.65||||19.65|9.84|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.65||||19.65|6.9|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.65||||19.65|8.45|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19.65||||19.65|8.37|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19.65||||19.65|9.83|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.65||||19.65|12.77|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|CORESOURCE [1315]|CORESOURCE [131500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19.65||||19.65|7.27|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|GEHA [1415]|GEHA [141500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HEALTHNET [1495]|HEALTHNET [149500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.65||||19.65|8.45|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|19.65||||19.65|18.27|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.65||||19.65|11.79|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MULTIPLAN [1680]|HMA [168003]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MULTIPLAN [1680]|IHC HS [168011]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|Self-pay|Self-pay|19.65||||19.65|5.89|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.65||||19.65|4.13|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|TRUSTMARK [2030]|STARMARK [203000]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.65||||19.65|9.42|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|UMR [2035]|UMR OPTIONS [203501]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.65||||19.65|17.69|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19.65||||19.65|0|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19.65||||19.65|7.27|18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19.65||||19.65||18.27|4.13
128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|44.3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19.65||||19.65|9.83|18.27|4.13
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28.15||||28.15|14.1|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.15||||28.15|9.88|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.15||||28.15|12.1|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28.15||||28.15|11.99|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28.15||||28.15|14.08|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.15||||28.15|18.3|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28.15||||28.15|10.42|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|GEHA [1415]|GEHA [141500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.15||||28.15|12.1|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|28.15||||28.15|26.18|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.15||||28.15|16.89|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MULTIPLAN [1680]|HMA [168003]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MULTIPLAN [1680]|IHC HS [168011]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|Self-pay|Self-pay|28.15||||28.15|8.44|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.15||||28.15|5.91|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|TRUSTMARK [2030]|STARMARK [203000]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.15||||28.15|13.5|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|UMR [2035]|UMR OPTIONS [203501]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.15||||28.15|25.34|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28.15||||28.15|0|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28.15||||28.15|10.42|26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28.15||||28.15||26.18|5.91
128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28.15||||28.15|14.08|26.18|5.91
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242.28||||242.28|121.38|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.28||||242.28|85.04|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.28||||242.28|104.18|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242.28||||242.28|103.21|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242.28||||242.28|121.14|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.28||||242.28|157.48|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242.28||||242.28|89.64|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|GEHA [1415]|GEHA [141500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.28||||242.28|104.18|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|242.28||||242.28|225.32|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.28||||242.28|145.37|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MULTIPLAN [1680]|HMA [168003]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|Self-pay|Self-pay|242.28||||242.28|72.68|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.28||||242.28|50.88|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.28||||242.28|116.17|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|UMR [2035]|UMR OPTIONS [203501]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.28||||242.28|218.05|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242.28||||242.28|0|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242.28||||242.28|89.64|225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242.28||||242.28||225.32|50.88
12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242.28||||242.28|121.14|225.32|50.88
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28.94||||28.94|14.5|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.94||||28.94|10.16|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.94||||28.94|12.44|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28.94||||28.94|12.33|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28.94||||28.94|14.47|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.94||||28.94|18.81|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28.94||||28.94|10.71|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.94||||28.94|12.44|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|28.94||||28.94|26.91|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.94||||28.94|17.36|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|Self-pay|Self-pay|28.94||||28.94|8.68|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.94||||28.94|6.08|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.94||||28.94|13.88|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.94||||28.94|26.05|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28.94||||28.94|0|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28.94||||28.94|10.71|26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28.94||||28.94||26.91|6.08
128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28.94||||28.94|14.47|26.91|6.08
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.62|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|Self-pay|Self-pay|29||||29|8.7|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.06|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.62
128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.62
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.57|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.8|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.57
12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.57
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
129366|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 % (3 ML) INTRA-CATHETER INJECTION SYRINGE|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53.19||||53.19|26.65|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.19||||53.19|18.67|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.19||||53.19|22.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53.19||||53.19|22.66|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53.19||||53.19|26.6|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.19||||53.19|34.57|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|53.19||||53.19|6.79|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53.19||||53.19|19.68|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|GEHA [1415]|GEHA [141500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.19||||53.19|22.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|53.19||||53.19|49.47|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.19||||53.19|31.91|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MULTIPLAN [1680]|HMA [168003]|53.19||||53.19|18.62|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|Self-pay|Self-pay|53.19||||53.19|15.96|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.19||||53.19|11.17|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.19||||53.19|5.98|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.19||||53.19|25.5|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|UMR [2035]|UMR OPTIONS [203501]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.19||||53.19|47.87|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53.19||||53.19|0|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53.19||||53.19|19.68|49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53.19||||53.19||49.47|5.98
129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53.19||||53.19|26.6|49.47|5.98
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|405.84||||405.84|203.33|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|405.84||||405.84|142.45|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|405.84||||405.84|174.51|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|405.84||||405.84|172.89|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|405.84||||405.84|202.92|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|405.84||||405.84|263.8|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CORESOURCE [1315]|CORESOURCE [131500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|405.84||||405.84|150.16|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|GEHA [1415]|GEHA [141500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHNET [1495]|HEALTHNET [149500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|405.84||||405.84|174.51|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|405.84||||405.84|377.43|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|405.84||||405.84|243.5|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MULTIPLAN [1680]|HMA [168003]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MULTIPLAN [1680]|IHC HS [168011]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|Self-pay|Self-pay|405.84||||405.84|121.75|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|405.84||||405.84|85.23|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|TRUSTMARK [2030]|STARMARK [203000]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|405.84||||405.84|194.6|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UMR [2035]|UMR OPTIONS [203501]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|405.84||||405.84|365.26|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|405.84||||405.84|0|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|405.84||||405.84|150.16|377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|405.84||||405.84||377.43|85.23
129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|405.84||||405.84|202.92|377.43|85.23
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|334||||334|167.33|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334||||334|117.23|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334||||334|143.62|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|334||||334|142.28|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|334||||334|167|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334||||334|217.1|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|334||||334|123.58|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|GEHA [1415]|GEHA [141500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334||||334|143.62|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|334||||334|310.62|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334||||334|200.4|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334||||334|167|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MULTIPLAN [1680]|HMA [168003]|334||||334|116.9|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MULTIPLAN [1680]|IHC HS [168011]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|Self-pay|Self-pay|334||||334|100.2|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334||||334|70.14|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|TRUSTMARK [2030]|STARMARK [203000]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334||||334|160.15|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|UMR [2035]|UMR OPTIONS [203501]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334||||334|300.6|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|334||||334|0|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|334||||334|123.58|310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|334||||334||310.62|70.14
129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|30 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|334||||334|167|310.62|70.14
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|377||||377|188.88|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|377||||377|132.33|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|377||||377|162.11|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|377||||377|160.6|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|377||||377|188.5|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|377||||377|245.05|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|377||||377|139.49|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|GEHA [1415]|GEHA [141500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|377||||377|162.11|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|377||||377|350.61|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|377||||377|226.2|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|377||||377|188.5|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MULTIPLAN [1680]|HMA [168003]|377||||377|131.95|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MULTIPLAN [1680]|IHC HS [168011]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|Self-pay|Self-pay|377||||377|113.1|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|377||||377|79.17|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|TRUSTMARK [2030]|STARMARK [203000]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|377||||377|180.77|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|UMR [2035]|UMR OPTIONS [203501]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|377||||377|339.3|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|377||||377|0|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|377||||377|139.49|350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|377||||377||350.61|79.17
129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|15 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|377||||377|188.5|350.61|79.17
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170.79||||170.79|85.57|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170.79||||170.79|59.95|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170.79||||170.79|73.44|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170.79||||170.79|72.76|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170.79||||170.79|85.4|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170.79||||170.79|111.01|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|170.79||||170.79|2.18|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170.79||||170.79|63.19|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|GEHA [1415]|GEHA [141500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170.79||||170.79|73.44|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|170.79||||170.79|158.83|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170.79||||170.79|102.47|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MULTIPLAN [1680]|HMA [168003]|170.79||||170.79|59.78|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MULTIPLAN [1680]|IHC HS [168011]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|Self-pay|Self-pay|170.79||||170.79|51.24|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170.79||||170.79|35.87|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170.79||||170.79|1.78|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|TRUSTMARK [2030]|STARMARK [203000]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170.79||||170.79|81.89|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|UMR [2035]|UMR OPTIONS [203501]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170.79||||170.79|153.71|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170.79||||170.79|0|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170.79||||170.79|63.19|158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170.79||||170.79||158.83|1.78
129651|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK REPACK|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170.79||||170.79|85.4|158.83|1.78
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|624||||624|312.62|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|624||||624|219.02|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|624||||624|268.32|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|624||||624|265.82|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|624||||624|312|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|624||||624|405.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|624||||624|230.88|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|GEHA [1415]|GEHA [141500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|624||||624|268.32|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|624||||624|580.32|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|624||||624|374.4|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|624||||624|312|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MULTIPLAN [1680]|HMA [168003]|624||||624|218.4|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MULTIPLAN [1680]|IHC HS [168011]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|Self-pay|Self-pay|624||||624|187.2|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|624||||624|131.04|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|TRUSTMARK [2030]|STARMARK [203000]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|624||||624|299.21|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|UMR [2035]|UMR OPTIONS [203501]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|624||||624|561.6|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|624||||624|0|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|624||||624|230.88|580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|624||||624||580.32|131.04
129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|25 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|624||||624|312|580.32|131.04
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1298|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) CHEWABLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|469||||469|234.97|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469||||469|164.62|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469||||469|201.67|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|469||||469|199.79|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|469||||469|234.5|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469||||469|304.85|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|469||||469|173.53|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|GEHA [1415]|GEHA [141500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469||||469|201.67|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|469||||469|436.17|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469||||469|281.4|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469||||469|234.5|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MULTIPLAN [1680]|HMA [168003]|469||||469|164.15|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MULTIPLAN [1680]|IHC HS [168011]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|Self-pay|Self-pay|469||||469|140.7|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469||||469|98.49|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|TRUSTMARK [2030]|STARMARK [203000]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469||||469|224.89|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|UMR [2035]|UMR OPTIONS [203501]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469||||469|422.1|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|469||||469|0|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|469||||469|173.53|436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|469||||469||436.17|98.49
130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|20 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|469||||469|234.5|436.17|98.49
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.78|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.01|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.78
130688|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML (1 ML) INJECTION SYRINGE|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.78
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|344||||344|172.34|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|344||||344|120.74|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|344||||344|147.92|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|344||||344|146.54|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|344||||344|172|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|344||||344|223.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|344||||344|127.28|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|GEHA [1415]|GEHA [141500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|344||||344|147.92|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|344||||344|319.92|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|344||||344|206.4|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|344||||344|172|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MULTIPLAN [1680]|HMA [168003]|344||||344|120.4|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MULTIPLAN [1680]|IHC HS [168011]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|Self-pay|Self-pay|344||||344|103.2|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|344||||344|72.24|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|TRUSTMARK [2030]|STARMARK [203000]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|344||||344|164.95|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|UMR [2035]|UMR OPTIONS [203501]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|344||||344|309.6|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|344||||344|0|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|344||||344|127.28|319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|344||||344||319.92|72.24
130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|10 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|344||||344|172|319.92|72.24
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|AETNA [1015]|AETNA ACO WILCO [101532]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40.6||||40.6|20.34|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40.6||||40.6|14.25|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40.6||||40.6|17.46|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40.6||||40.6|17.3|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40.6||||40.6|20.3|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40.6||||40.6|26.39|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|CORESOURCE [1315]|CORESOURCE [131500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40.6||||40.6|15.02|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|GEHA [1415]|GEHA [141500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HEALTHNET [1495]|HEALTHNET [149500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40.6||||40.6|17.46|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|40.6||||40.6|37.76|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40.6||||40.6|24.36|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MULTIPLAN [1680]|HMA [168003]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MULTIPLAN [1680]|IHC HS [168011]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|Self-pay|Self-pay|40.6||||40.6|12.18|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40.6||||40.6|8.53|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|TRUSTMARK [2030]|STARMARK [203000]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40.6||||40.6|19.47|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|UMR [2035]|UMR OPTIONS [203501]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40.6||||40.6|36.54|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40.6||||40.6|0|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40.6||||40.6|15.02|37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40.6||||40.6||37.76|8.53
131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|4 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40.6||||40.6|20.3|37.76|8.53
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15.02||||15.02|7.53|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.02||||15.02|5.27|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.02||||15.02|6.46|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15.02||||15.02|6.4|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15.02||||15.02|7.51|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.02||||15.02|9.76|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15.02||||15.02|5.56|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|GEHA [1415]|GEHA [141500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.02||||15.02|6.46|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|15.02||||15.02|13.97|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.02||||15.02|9.01|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|Self-pay|Self-pay|15.02||||15.02|4.51|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.02||||15.02|3.15|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.02||||15.02|7.2|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.02||||15.02|13.52|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15.02||||15.02|0|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15.02||||15.02|5.56|13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15.02||||15.02||13.97|3.15
13132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 1 GRAM TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15.02||||15.02|7.51|13.97|3.15
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.41||||13.41|6.72|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.41||||13.41|4.71|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.41||||13.41|5.77|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.41||||13.41|5.71|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.41||||13.41|6.71|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.41||||13.41|8.72|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.41||||13.41|4.96|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.41||||13.41|5.77|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|13.41||||13.41|12.47|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.41||||13.41|8.05|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|Self-pay|Self-pay|13.41||||13.41|4.02|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.41||||13.41|2.82|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.41||||13.41|6.43|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.41||||13.41|12.07|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.41||||13.41|0|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.41||||13.41|4.96|12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.41||||13.41||12.47|2.82
13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.41||||13.41|6.71|12.47|2.82
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|6 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1337||||1337|669.84|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1337||||1337|469.29|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1337||||1337|574.91|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1337||||1337|569.56|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1337||||1337|668.5|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1337||||1337|869.05|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1337||||1337|494.69|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|GEHA [1415]|GEHA [141500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1337||||1337|574.91|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|1337||||1337|1243.41|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1337||||1337|802.2|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1337||||1337|668.5|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MULTIPLAN [1680]|HMA [168003]|1337||||1337|467.95|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MULTIPLAN [1680]|IHC HS [168011]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|Self-pay|Self-pay|1337||||1337|401.1|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1337||||1337|280.77|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|TRUSTMARK [2030]|STARMARK [203000]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1337||||1337|641.09|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|UMR [2035]|UMR OPTIONS [203501]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1337||||1337|1203.3|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1337||||1337|0|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1337||||1337|494.69|1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1337||||1337||1243.41|280.77
132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|45 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1337||||1337|668.5|1243.41|280.77
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|254.4||||254.4|0|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.4||||254.4|20.52|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.4||||254.4|23.19|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.4||||254.4|23.19|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254.4||||254.4|127.45|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.4||||254.4|89.29|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.4||||254.4|109.39|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254.4||||254.4|108.37|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254.4||||254.4|127.2|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.4||||254.4|165.36|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|254.4||||254.4|0|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254.4||||254.4|94.13|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|GEHA [1415]|GEHA [141500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254.4||||254.4|45.27|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.4||||254.4|109.39|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|254.4||||254.4|236.59|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.4||||254.4|152.64|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.4||||254.4|22.13|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.4||||254.4|127.2|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.4||||254.4|22.4|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.4||||254.4|27.16|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.4||||254.4|20.52|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MULTIPLAN [1680]|HMA [168003]|254.4||||254.4|89.04|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MULTIPLAN [1680]|IHC HS [168011]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|254.4||||254.4|24.1|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.4||||254.4|22.13|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|Self-pay|Self-pay|254.4||||254.4|76.32|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.4||||254.4|53.42|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254.4||||254.4|19.72|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.4||||254.4|29.38|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|TRUSTMARK [2030]|STARMARK [203000]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.4||||254.4|121.98|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|UMR [2035]|UMR OPTIONS [203501]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.4||||254.4|21.33|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.4||||254.4|228.96|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254.4||||254.4|0|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254.4||||254.4|94.13|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254.4||||254.4|20.12|236.59|19.72
133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|1 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254.4||||254.4|127.2|236.59|19.72
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|108.42||||108.42|54.32|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108.42||||108.42|38.06|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108.42||||108.42|46.62|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|108.42||||108.42|46.19|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|108.42||||108.42|54.21|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108.42||||108.42|70.47|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|108.42||||108.42|3.24|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|108.42||||108.42|40.12|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|GEHA [1415]|GEHA [141500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108.42||||108.42|46.62|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|108.42||||108.42|100.83|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108.42||||108.42|65.05|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|108.42||||108.42|37.95|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|108.42||||108.42|32.53|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108.42||||108.42|22.77|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108.42||||108.42|4.11|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108.42||||108.42|51.99|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108.42||||108.42|97.58|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|108.42||||108.42|0|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|108.42||||108.42|40.12|100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|108.42||||108.42||100.83|3.24
133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|108.42||||108.42|54.21|100.83|3.24
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|208.85||||208.85|104.63|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208.85||||208.85|73.31|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208.85||||208.85|89.81|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|208.85||||208.85|88.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|208.85||||208.85|104.43|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208.85||||208.85|135.75|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|CORESOURCE [1315]|CORESOURCE [131500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|208.85||||208.85|77.27|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|GEHA [1415]|GEHA [141500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HEALTHNET [1495]|HEALTHNET [149500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.85||||208.85|89.81|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|208.85||||208.85|194.23|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208.85||||208.85|125.31|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MULTIPLAN [1680]|HMA [168003]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MULTIPLAN [1680]|IHC HS [168011]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|Self-pay|Self-pay|208.85||||208.85|62.65|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208.85||||208.85|43.86|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|TRUSTMARK [2030]|STARMARK [203000]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.85||||208.85|100.14|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|UMR [2035]|UMR OPTIONS [203501]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208.85||||208.85|187.97|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|208.85||||208.85|0|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|208.85||||208.85|77.27|194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|208.85||||208.85||194.23|43.86
134048|ERX|0250 - PHARMACY-GENERAL|NALOXONE 4 MG/ACTUATION NASAL SPRAY|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|208.85||||208.85|104.43|194.23|43.86
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|AETNA [1015]|AETNA ACO WILCO [101532]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30.57||||30.57|15.32|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.57||||30.57|10.73|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.57||||30.57|13.15|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30.57||||30.57|13.02|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30.57||||30.57|15.29|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.57||||30.57|19.87|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|CORESOURCE [1315]|CORESOURCE [131500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|CORVEL CORP [2235]|CORVEL CORP [223500]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30.57||||30.57|11.31|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|GEHA [1415]|GEHA [141500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HEALTHNET [1495]|HEALTHNET [149500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.57||||30.57|13.15|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HEALTHSMART [1505]|HEALTHSMART [150501]|30.57||||30.57|28.43|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.57||||30.57|18.34|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MULTIPLAN [1680]|HMA [168003]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MULTIPLAN [1680]|IHC HS [168011]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|Self-pay|Self-pay|30.57||||30.57|9.17|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.57||||30.57|6.42|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|TRUSTMARK [2030]|STARMARK [203000]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.57||||30.57|14.66|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|UMR [2035]|UMR OPTIONS [203501]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.57||||30.57|27.51|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30.57||||30.57|0|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30.57||||30.57|11.31|28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30.57||||30.57||28.43|6.42
1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|60 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30.57||||30.57|15.29|28.43|6.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7002||||7002|3508|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7002||||7002|2457.7|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7002||||7002|3010.86|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7002||||7002|2982.85|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7002||||7002|3501|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7002||||7002|4551.3|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7002||||7002|2590.74|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|GEHA [1415]|GEHA [141500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7002||||7002|3010.86|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|7002||||7002|6511.86|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7002||||7002|4201.2|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7002||||7002|3501|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MULTIPLAN [1680]|HMA [168003]|7002||||7002|2450.7|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MULTIPLAN [1680]|IHC HS [168011]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|Self-pay|Self-pay|7002||||7002|2100.6|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7002||||7002|1470.42|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|TRUSTMARK [2030]|STARMARK [203000]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7002||||7002|3357.46|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|UMR [2035]|UMR OPTIONS [203501]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7002||||7002|6301.8|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7002||||7002|0|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7002||||7002|2590.74|6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7002||||7002||6511.86|1470.42
13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|6 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7002||||7002|3501|6511.86|1470.42
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17.11||||17.11|8.57|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.11||||17.11|6.01|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.11||||17.11|7.36|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17.11||||17.11|7.29|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17.11||||17.11|8.56|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.11||||17.11|11.12|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17.11||||17.11|6.33|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|GEHA [1415]|GEHA [141500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.11||||17.11|7.36|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|17.11||||17.11|15.91|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.11||||17.11|10.27|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MULTIPLAN [1680]|HMA [168003]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|Self-pay|Self-pay|17.11||||17.11|5.13|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.11||||17.11|3.59|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.11||||17.11|8.2|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|UMR [2035]|UMR OPTIONS [203501]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.11||||17.11|15.4|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17.11||||17.11|0|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17.11||||17.11|6.33|15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17.11||||17.11||15.91|3.59
14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17.11||||17.11|8.56|15.91|3.59
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.62|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|Self-pay|Self-pay|29||||29|8.7|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.06|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.62
1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.62
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116.96||||116.96|58.6|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116.96||||116.96|41.05|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116.96||||116.96|50.29|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116.96||||116.96|49.82|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116.96||||116.96|58.48|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116.96||||116.96|76.02|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116.96||||116.96|43.28|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|GEHA [1415]|GEHA [141500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116.96||||116.96|50.29|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|116.96||||116.96|108.77|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116.96||||116.96|70.18|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MULTIPLAN [1680]|HMA [168003]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MULTIPLAN [1680]|IHC HS [168011]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|Self-pay|Self-pay|116.96||||116.96|35.09|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116.96||||116.96|24.56|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|TRUSTMARK [2030]|STARMARK [203000]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116.96||||116.96|56.08|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|UMR [2035]|UMR OPTIONS [203501]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116.96||||116.96|105.26|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116.96||||116.96|0|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116.96||||116.96|43.28|108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116.96||||116.96||108.77|24.56
14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116.96||||116.96|58.48|108.77|24.56
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.05|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|Self-pay|Self-pay|29||||29|8.7|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|2.05
1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|750 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|2.05
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|1.01|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.43|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.43
15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.43
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|AETNA [1015]|AETNA ACO WILCO [101532]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.24||||60.24|30.18|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.24||||60.24|21.14|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.24||||60.24|25.9|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.24||||60.24|25.66|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.24||||60.24|30.12|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.24||||60.24|39.16|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|CORESOURCE [1315]|CORESOURCE [131500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.24||||60.24|22.29|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|GEHA [1415]|GEHA [141500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HEALTHNET [1495]|HEALTHNET [149500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.24||||60.24|25.9|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|60.24||||60.24|56.02|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.24||||60.24|36.14|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MULTIPLAN [1680]|HMA [168003]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MULTIPLAN [1680]|IHC HS [168011]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|Self-pay|Self-pay|60.24||||60.24|18.07|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.24||||60.24|12.65|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|TRUSTMARK [2030]|STARMARK [203000]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.24||||60.24|28.89|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|UMR [2035]|UMR OPTIONS [203501]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.24||||60.24|54.22|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.24||||60.24|0|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.24||||60.24|22.29|56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.24||||60.24||56.02|12.65
1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|473 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.24||||60.24|30.12|56.02|12.65
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|AETNA [1015]|AETNA ACO WILCO [101532]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|250.18||||250.18|125.34|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250.18||||250.18|87.81|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250.18||||250.18|107.58|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|250.18||||250.18|106.58|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|250.18||||250.18|125.09|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250.18||||250.18|162.62|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|CORESOURCE [1315]|CORESOURCE [131500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|250.18||||250.18|92.57|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|GEHA [1415]|GEHA [141500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HEALTHNET [1495]|HEALTHNET [149500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250.18||||250.18|107.58|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|250.18||||250.18|232.67|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250.18||||250.18|150.11|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MULTIPLAN [1680]|HMA [168003]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MULTIPLAN [1680]|IHC HS [168011]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|Self-pay|Self-pay|250.18||||250.18|75.05|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250.18||||250.18|52.54|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|TRUSTMARK [2030]|STARMARK [203000]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250.18||||250.18|119.96|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|UMR [2035]|UMR OPTIONS [203501]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250.18||||250.18|225.16|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|250.18||||250.18|0|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|250.18||||250.18|92.57|232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|250.18||||250.18||232.67|52.54
15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|3.7 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|250.18||||250.18|125.09|232.67|52.54
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87.42||||87.42|43.8|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87.42||||87.42|30.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87.42||||87.42|37.59|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87.42||||87.42|37.24|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87.42||||87.42|43.71|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87.42||||87.42|56.82|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87.42||||87.42|32.35|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|GEHA [1415]|GEHA [141500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87.42||||87.42|37.59|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|87.42||||87.42|81.3|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87.42||||87.42|52.45|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MULTIPLAN [1680]|HMA [168003]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MULTIPLAN [1680]|IHC HS [168011]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|Self-pay|Self-pay|87.42||||87.42|26.23|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87.42||||87.42|18.36|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|TRUSTMARK [2030]|STARMARK [203000]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87.42||||87.42|41.92|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|UMR [2035]|UMR OPTIONS [203501]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87.42||||87.42|78.68|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87.42||||87.42|0|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87.42||||87.42|32.35|81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87.42||||87.42||81.3|18.36
15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87.42||||87.42|43.71|81.3|18.36
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|0.25 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|Self-pay|Self-pay|10||||10|3|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|28 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA ACO WILCO [101532]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31.14||||31.14|15.6|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.14||||31.14|10.93|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.14||||31.14|13.39|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31.14||||31.14|13.27|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31.14||||31.14|15.57|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.14||||31.14|20.24|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|CORESOURCE [1315]|CORESOURCE [131500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|CORVEL CORP [2235]|CORVEL CORP [223500]|31.14||||31.14|4.84|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31.14||||31.14|11.52|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|GEHA [1415]|GEHA [141500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHNET [1495]|HEALTHNET [149500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.14||||31.14|13.39|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART [150501]|31.14||||31.14|28.96|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.14||||31.14|18.68|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|HMA [168003]|31.14||||31.14|10.9|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|IHC HS [168011]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|Self-pay|Self-pay|31.14||||31.14|9.34|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.14||||31.14|6.54|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.14||||31.14|3.58|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|TRUSTMARK [2030]|STARMARK [203000]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.14||||31.14|14.93|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|UMR [2035]|UMR OPTIONS [203501]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.14||||31.14|28.03|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31.14||||31.14|0|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31.14||||31.14|11.52|28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31.14||||31.14||28.96|3.58
16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|1 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31.14||||31.14|15.57|28.96|3.58
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA ACO WILCO [101532]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.63||||54.63|27.37|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.63||||54.63|19.18|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.63||||54.63|23.49|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.63||||54.63|23.27|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.63||||54.63|27.32|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.63||||54.63|35.51|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|CORESOURCE [1315]|CORESOURCE [131500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|CORVEL CORP [2235]|CORVEL CORP [223500]|54.63||||54.63|9.67|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.63||||54.63|20.21|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|GEHA [1415]|GEHA [141500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHNET [1495]|HEALTHNET [149500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.63||||54.63|23.49|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART [150501]|54.63||||54.63|50.81|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.63||||54.63|32.78|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|HMA [168003]|54.63||||54.63|19.12|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|IHC HS [168011]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|Self-pay|Self-pay|54.63||||54.63|16.39|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.63||||54.63|11.47|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.63||||54.63|7.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|TRUSTMARK [2030]|STARMARK [203000]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.63||||54.63|26.2|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|UMR [2035]|UMR OPTIONS [203501]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.63||||54.63|49.17|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.63||||54.63|0|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.63||||54.63|20.21|50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.63||||54.63||50.81|7.17
16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|2 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.63||||54.63|27.32|50.81|7.17
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.23||||10.23|5.13|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.23||||10.23|3.59|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.23||||10.23|4.4|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.23||||10.23|4.36|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.23||||10.23|5.12|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.23||||10.23|6.65|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.23||||10.23|3.79|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|GEHA [1415]|GEHA [141500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.23||||10.23|4.4|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10.23||||10.23|9.51|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.23||||10.23|6.14|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MULTIPLAN [1680]|HMA [168003]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|Self-pay|Self-pay|10.23||||10.23|3.07|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.23||||10.23|2.15|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.23||||10.23|4.91|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.23||||10.23|9.21|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.23||||10.23|0|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.23||||10.23|3.79|9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.23||||10.23||9.51|2.15
165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.23||||10.23|5.12|9.51|2.15
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|24.07||||24.07|12.06|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.07||||24.07|8.45|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.07||||24.07|10.35|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|24.07||||24.07|10.25|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|24.07||||24.07|12.04|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.07||||24.07|15.65|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|24.07||||24.07|8.91|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.07||||24.07|10.35|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|24.07||||24.07|22.39|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.07||||24.07|14.44|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.07||||24.07|12.04|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|24.07||||24.07|7.22|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.07||||24.07|5.05|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.07||||24.07|11.54|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.07||||24.07|21.66|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|24.07||||24.07|0|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|24.07||||24.07|8.91|22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|24.07||||24.07||22.39|5.05
1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|24.07||||24.07|12.04|22.39|5.05
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23.66||||23.66|11.85|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.66||||23.66|8.3|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.66||||23.66|10.17|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23.66||||23.66|10.08|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23.66||||23.66|11.83|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.66||||23.66|15.38|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23.66||||23.66|8.75|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.66||||23.66|10.17|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|23.66||||23.66|22|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.66||||23.66|14.2|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.66||||23.66|11.83|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|Self-pay|Self-pay|23.66||||23.66|7.1|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.66||||23.66|4.97|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.66||||23.66|11.34|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.66||||23.66|21.29|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23.66||||23.66|0|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23.66||||23.66|8.75|22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23.66||||23.66||22|4.97
1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23.66||||23.66|11.83|22|4.97
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|152.14||||152.14|76.22|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152.14||||152.14|53.4|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152.14||||152.14|65.42|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|152.14||||152.14|64.81|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|152.14||||152.14|76.07|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152.14||||152.14|98.89|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|152.14||||152.14|56.29|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|GEHA [1415]|GEHA [141500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152.14||||152.14|65.42|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|152.14||||152.14|141.49|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152.14||||152.14|91.28|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MULTIPLAN [1680]|HMA [168003]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MULTIPLAN [1680]|IHC HS [168011]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|Self-pay|Self-pay|152.14||||152.14|45.64|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152.14||||152.14|31.95|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|TRUSTMARK [2030]|STARMARK [203000]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152.14||||152.14|72.95|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|UMR [2035]|UMR OPTIONS [203501]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152.14||||152.14|136.93|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|152.14||||152.14|0|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|152.14||||152.14|56.29|141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|152.14||||152.14||141.49|31.95
168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|152.14||||152.14|76.07|141.49|31.95
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.38||||10.38|5.2|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.38||||10.38|3.64|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.38||||10.38|4.46|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.38||||10.38|4.42|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.38||||10.38|5.19|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.38||||10.38|6.75|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.38||||10.38|3.84|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|GEHA [1415]|GEHA [141500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.38||||10.38|4.46|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10.38||||10.38|9.65|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.38||||10.38|6.23|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MULTIPLAN [1680]|HMA [168003]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|Self-pay|Self-pay|10.38||||10.38|3.11|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.38||||10.38|2.18|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.38||||10.38|4.98|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|UMR [2035]|UMR OPTIONS [203501]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.38||||10.38|9.34|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.38||||10.38|0|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.38||||10.38|3.84|9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.38||||10.38||9.65|2.18
171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.38||||10.38|5.19|9.65|2.18
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16.73||||16.73|8.38|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.73||||16.73|5.87|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.73||||16.73|7.19|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16.73||||16.73|7.13|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16.73||||16.73|8.37|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.73||||16.73|10.87|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|CORESOURCE [1315]|CORESOURCE [131500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16.73||||16.73|6.19|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|GEHA [1415]|GEHA [141500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HEALTHNET [1495]|HEALTHNET [149500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.73||||16.73|7.19|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|16.73||||16.73|15.56|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.73||||16.73|10.04|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MULTIPLAN [1680]|HMA [168003]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MULTIPLAN [1680]|IHC HS [168011]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|Self-pay|Self-pay|16.73||||16.73|5.02|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.73||||16.73|3.51|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|TRUSTMARK [2030]|STARMARK [203000]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.73||||16.73|8.02|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|UMR [2035]|UMR OPTIONS [203501]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.73||||16.73|15.06|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16.73||||16.73|0|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16.73||||16.73|6.19|15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16.73||||16.73||15.56|3.51
171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|2 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16.73||||16.73|8.37|15.56|3.51
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|183.1||||183.1|0|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.1||||183.1|60|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.1||||183.1|60|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|183.1||||183.1|91.73|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.1||||183.1|64.27|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.1||||183.1|78.73|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|183.1||||183.1|78|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|183.1||||183.1|91.55|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.1||||183.1|119.02|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|183.1||||183.1|0|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|183.1||||183.1|67.75|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.1||||183.1|78.73|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|183.1||||183.1|170.28|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.1||||183.1|109.86|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.1||||183.1|0|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.1||||183.1|58.06|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|183.1||||183.1|64.09|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|183.1||||183.1|62.36|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|183.1||||183.1|54.93|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.1||||183.1|38.45|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.1||||183.1|36.46|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.1||||183.1|87.8|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.1||||183.1|0|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183.1||||183.1|164.79|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|183.1||||183.1|0|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|183.1||||183.1|67.75|170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|183.1||||183.1||170.28|36.46
173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|183.1||||183.1|91.55|170.28|36.46
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|387.1||||387.1|0|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|387.1||||387.1|150|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|387.1||||387.1|150|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|387.1||||387.1|193.94|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|387.1||||387.1|135.87|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|387.1||||387.1|166.45|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|387.1||||387.1|164.9|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|387.1||||387.1|193.55|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|387.1||||387.1|251.62|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|387.1||||387.1|0|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|387.1||||387.1|143.23|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|387.1||||387.1|166.45|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|387.1||||387.1|360|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|387.1||||387.1|232.26|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|387.1||||387.1|0|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|387.1||||387.1|145.16|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|387.1||||387.1|135.49|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|387.1||||387.1|155.91|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|387.1||||387.1|116.13|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|387.1||||387.1|81.29|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|387.1||||387.1|91.16|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|387.1||||387.1|185.61|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|387.1||||387.1|0|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|387.1||||387.1|348.39|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|387.1||||387.1|0|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|387.1||||387.1|143.23|360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|387.1||||387.1||360|81.29
173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|387.1||||387.1|193.55|360|81.29
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.23||||20.23|10.14|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.23||||20.23|7.1|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.23||||20.23|8.7|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.23||||20.23|8.62|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.23||||20.23|10.12|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.23||||20.23|13.15|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.23||||20.23|7.49|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.23||||20.23|8.7|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|20.23||||20.23|18.81|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.23||||20.23|12.14|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|Self-pay|Self-pay|20.23||||20.23|6.07|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.23||||20.23|4.25|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.23||||20.23|9.7|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.23||||20.23|18.21|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.23||||20.23|0|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.23||||20.23|7.49|18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.23||||20.23||18.81|4.25
17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.23||||20.23|10.12|18.81|4.25
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86.81||||86.81|43.49|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86.81||||86.81|30.47|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86.81||||86.81|37.33|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86.81||||86.81|36.98|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86.81||||86.81|43.41|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86.81||||86.81|56.43|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|86.81||||86.81|52.33|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86.81||||86.81|32.12|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|GEHA [1415]|GEHA [141500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.81||||86.81|37.33|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|86.81||||86.81|80.73|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86.81||||86.81|52.09|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MULTIPLAN [1680]|HMA [168003]|86.81||||86.81|30.38|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MULTIPLAN [1680]|IHC HS [168011]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|Self-pay|Self-pay|86.81||||86.81|26.04|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86.81||||86.81|18.23|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86.81||||86.81|55.33|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|TRUSTMARK [2030]|STARMARK [203000]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.81||||86.81|41.63|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|UMR [2035]|UMR OPTIONS [203501]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86.81||||86.81|78.13|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86.81||||86.81|0|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86.81||||86.81|32.12|80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86.81||||86.81||80.73|18.23
17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86.81||||86.81|43.41|80.73|18.23
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36.05||||36.05|18.06|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.05||||36.05|12.65|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.05||||36.05|15.5|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36.05||||36.05|15.36|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36.05||||36.05|18.03|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.05||||36.05|23.43|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36.05||||36.05|13.34|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.05||||36.05|15.5|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|36.05||||36.05|33.53|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.05||||36.05|21.63|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|36.05||||36.05|10.81|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.05||||36.05|7.57|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.05||||36.05|17.29|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.05||||36.05|32.45|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36.05||||36.05|0|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36.05||||36.05|13.34|33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36.05||||36.05||33.53|7.57
174271|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36.05||||36.05|18.03|33.53|7.57
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|AETNA [1015]|AETNA ACO WILCO [101532]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|99.45||||99.45|49.82|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99.45||||99.45|34.91|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99.45||||99.45|42.76|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|99.45||||99.45|42.37|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|99.45||||99.45|49.73|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99.45||||99.45|64.64|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|CORESOURCE [1315]|CORESOURCE [131500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|CORVEL CORP [2235]|CORVEL CORP [223500]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|99.45||||99.45|36.8|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|GEHA [1415]|GEHA [141500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HEALTHNET [1495]|HEALTHNET [149500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99.45||||99.45|42.76|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HEALTHSMART [1505]|HEALTHSMART [150501]|99.45||||99.45|92.49|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99.45||||99.45|59.67|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MULTIPLAN [1680]|HMA [168003]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MULTIPLAN [1680]|IHC HS [168011]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|Self-pay|Self-pay|99.45||||99.45|29.83|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99.45||||99.45|20.88|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|TRUSTMARK [2030]|STARMARK [203000]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99.45||||99.45|47.69|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|UMR [2035]|UMR OPTIONS [203501]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99.45||||99.45|89.51|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|99.45||||99.45|0|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|99.45||||99.45|36.8|92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|99.45||||99.45||92.49|20.88
174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|60 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|99.45||||99.45|49.73|92.49|20.88
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|AETNA [1015]|AETNA ACO WILCO [101532]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83.42||||83.42|41.79|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83.42||||83.42|29.28|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83.42||||83.42|35.87|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83.42||||83.42|35.54|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83.42||||83.42|41.71|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83.42||||83.42|54.22|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|CORESOURCE [1315]|CORESOURCE [131500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|83.42||||83.42|12.45|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83.42||||83.42|30.87|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|GEHA [1415]|GEHA [141500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HEALTHNET [1495]|HEALTHNET [149500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.42||||83.42|35.87|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|83.42||||83.42|77.58|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83.42||||83.42|50.05|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MULTIPLAN [1680]|HMA [168003]|83.42||||83.42|29.2|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MULTIPLAN [1680]|IHC HS [168011]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|Self-pay|Self-pay|83.42||||83.42|25.03|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83.42||||83.42|17.52|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83.42||||83.42|8.81|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|TRUSTMARK [2030]|STARMARK [203000]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83.42||||83.42|40|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|UMR [2035]|UMR OPTIONS [203501]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83.42||||83.42|75.08|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83.42||||83.42|0|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83.42||||83.42|30.87|77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83.42||||83.42||77.58|8.81
175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|1,250 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83.42||||83.42|41.71|77.58|8.81
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|AETNA [1015]|AETNA ACO WILCO [101532]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186.52||||186.52|93.45|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186.52||||186.52|65.47|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186.52||||186.52|80.2|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186.52||||186.52|79.46|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186.52||||186.52|93.26|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186.52||||186.52|121.24|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|CORESOURCE [1315]|CORESOURCE [131500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|186.52||||186.52|8.3|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186.52||||186.52|69.01|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|GEHA [1415]|GEHA [141500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HEALTHNET [1495]|HEALTHNET [149500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186.52||||186.52|80.2|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|186.52||||186.52|173.46|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186.52||||186.52|111.91|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MULTIPLAN [1680]|HMA [168003]|186.52||||186.52|65.28|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MULTIPLAN [1680]|IHC HS [168011]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|Self-pay|Self-pay|186.52||||186.52|55.96|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186.52||||186.52|39.17|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186.52||||186.52|5.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|TRUSTMARK [2030]|STARMARK [203000]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186.52||||186.52|89.44|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|UMR [2035]|UMR OPTIONS [203501]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186.52||||186.52|167.87|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186.52||||186.52|0|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186.52||||186.52|69.01|173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186.52||||186.52||173.46|5.87
175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|200 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186.52||||186.52|93.26|173.46|5.87
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|371.66||||371.66|186.2|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371.66||||371.66|130.45|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371.66||||371.66|159.81|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|371.66||||371.66|158.33|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|371.66||||371.66|185.83|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371.66||||371.66|241.58|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|371.66||||371.66|11.76|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|371.66||||371.66|137.51|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|GEHA [1415]|GEHA [141500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371.66||||371.66|159.81|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|371.66||||371.66|345.64|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371.66||||371.66|223|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371.66||||371.66|185.83|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|HMA [168003]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|Self-pay|Self-pay|371.66||||371.66|111.5|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371.66||||371.66|78.05|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371.66||||371.66|10.6|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371.66||||371.66|178.21|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|UMR [2035]|UMR OPTIONS [203501]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371.66||||371.66|334.49|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|371.66||||371.66|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|371.66||||371.66|137.51|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|371.66||||371.66||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|371.66||||371.66|185.83|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|AETNA ACO WILCO [101532]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|523.27||||523.27|262.16|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|523.27||||523.27|183.67|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|523.27||||523.27|225.01|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|523.27||||523.27|222.91|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|523.27||||523.27|261.64|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|523.27||||523.27|340.13|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|CORESOURCE [1315]|CORESOURCE [131500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|523.27||||523.27|17.64|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|523.27||||523.27|193.61|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|GEHA [1415]|GEHA [141500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HEALTHNET [1495]|HEALTHNET [149500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|523.27||||523.27|225.01|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|523.27||||523.27|486.64|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|523.27||||523.27|313.96|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|523.27||||523.27|261.64|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MULTIPLAN [1680]|HMA [168003]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MULTIPLAN [1680]|IHC HS [168011]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|Self-pay|Self-pay|523.27||||523.27|156.98|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|523.27||||523.27|109.89|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|523.27||||523.27|15.9|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|TRUSTMARK [2030]|STARMARK [203000]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|523.27||||523.27|250.91|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|UMR [2035]|UMR OPTIONS [203501]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|523.27||||523.27|470.94|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|523.27||||523.27|0|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|523.27||||523.27|193.61|486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|523.27||||523.27||486.64|10.6
17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|150 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|523.27||||523.27|261.64|486.64|10.6
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104.92||||104.92|52.56|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.92||||104.92|36.83|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.92||||104.92|45.12|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104.92||||104.92|44.7|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104.92||||104.92|52.46|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.92||||104.92|68.2|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|104.92||||104.92|4.15|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104.92||||104.92|38.82|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|GEHA [1415]|GEHA [141500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.92||||104.92|45.12|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|104.92||||104.92|97.58|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.92||||104.92|62.95|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|104.92||||104.92|36.72|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|Self-pay|Self-pay|104.92||||104.92|31.48|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.92||||104.92|22.03|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.92||||104.92|2.94|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.92||||104.92|50.31|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.92||||104.92|94.43|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104.92||||104.92|0|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104.92||||104.92|38.82|97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104.92||||104.92||97.58|2.94
177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104.92||||104.92|52.46|97.58|2.94
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|585||||585|293.09|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|585||||585|205.34|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|585||||585|251.55|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|585||||585|249.21|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|585||||585|292.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|585||||585|380.25|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|585||||585|216.45|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|GEHA [1415]|GEHA [141500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|585||||585|251.55|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|585||||585|544.05|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|585||||585|351|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|585||||585|292.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MULTIPLAN [1680]|HMA [168003]|585||||585|204.75|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MULTIPLAN [1680]|IHC HS [168011]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|Self-pay|Self-pay|585||||585|175.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|585||||585|122.85|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|TRUSTMARK [2030]|STARMARK [203000]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|585||||585|280.51|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|UMR [2035]|UMR OPTIONS [203501]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|585||||585|526.5|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|585||||585|0|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|585||||585|216.45|544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|585||||585||544.05|122.85
177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|10 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|585||||585|292.5|544.05|122.85
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|AETNA [1015]|AETNA ACO WILCO [101532]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73.73||||73.73|36.94|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73.73||||73.73|25.88|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73.73||||73.73|31.7|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73.73||||73.73|31.41|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73.73||||73.73|36.87|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73.73||||73.73|47.92|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|CORESOURCE [1315]|CORESOURCE [131500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|CORVEL CORP [2235]|CORVEL CORP [223500]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73.73||||73.73|27.28|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|GEHA [1415]|GEHA [141500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HEALTHNET [1495]|HEALTHNET [149500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73.73||||73.73|31.7|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HEALTHSMART [1505]|HEALTHSMART [150501]|73.73||||73.73|68.57|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73.73||||73.73|44.24|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MULTIPLAN [1680]|HMA [168003]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MULTIPLAN [1680]|IHC HS [168011]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|Self-pay|Self-pay|73.73||||73.73|22.12|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73.73||||73.73|15.48|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|TRUSTMARK [2030]|STARMARK [203000]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73.73||||73.73|35.35|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|UMR [2035]|UMR OPTIONS [203501]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73.73||||73.73|66.36|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73.73||||73.73|0|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73.73||||73.73|27.28|68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73.73||||73.73||68.57|15.48
17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|8 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73.73||||73.73|36.87|68.57|15.48
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43.92||||43.92|22|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.92||||43.92|15.42|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.92||||43.92|18.89|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43.92||||43.92|18.71|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43.92||||43.92|21.96|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.92||||43.92|28.55|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43.92||||43.92|16.25|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.92||||43.92|18.89|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|43.92||||43.92|40.85|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.92||||43.92|26.35|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|Self-pay|Self-pay|43.92||||43.92|13.18|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.92||||43.92|9.22|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.92||||43.92|21.06|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.92||||43.92|39.53|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43.92||||43.92|0|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43.92||||43.92|16.25|40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43.92||||43.92||40.85|9.22
17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43.92||||43.92|21.96|40.85|9.22
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|AETNA [1015]|AETNA ACO WILCO [101532]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139.89||||139.89|70.08|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.89||||139.89|49.1|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.89||||139.89|60.15|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139.89||||139.89|59.59|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139.89||||139.89|69.95|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.89||||139.89|90.93|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|CORESOURCE [1315]|CORESOURCE [131500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|139.89||||139.89|8.3|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139.89||||139.89|51.76|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|GEHA [1415]|GEHA [141500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HEALTHNET [1495]|HEALTHNET [149500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.89||||139.89|60.15|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|139.89||||139.89|130.1|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.89||||139.89|83.93|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MULTIPLAN [1680]|HMA [168003]|139.89||||139.89|48.96|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MULTIPLAN [1680]|IHC HS [168011]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|Self-pay|Self-pay|139.89||||139.89|41.97|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.89||||139.89|29.38|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.89||||139.89|5.87|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|TRUSTMARK [2030]|STARMARK [203000]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.89||||139.89|67.08|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|UMR [2035]|UMR OPTIONS [203501]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.89||||139.89|125.9|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139.89||||139.89|0|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139.89||||139.89|51.76|130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139.89||||139.89||130.1|5.87
180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|150 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139.89||||139.89|69.95|130.1|5.87
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|221.5||||221.5|110.97|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|221.5||||221.5|77.75|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|221.5||||221.5|95.25|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|221.5||||221.5|94.36|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|221.5||||221.5|110.75|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|221.5||||221.5|143.98|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|CORESOURCE [1315]|CORESOURCE [131500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|221.5||||221.5|12.45|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|221.5||||221.5|81.96|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|GEHA [1415]|GEHA [141500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HEALTHNET [1495]|HEALTHNET [149500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|221.5||||221.5|95.25|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|221.5||||221.5|206|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|221.5||||221.5|132.9|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MULTIPLAN [1680]|HMA [168003]|221.5||||221.5|77.53|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MULTIPLAN [1680]|IHC HS [168011]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|Self-pay|Self-pay|221.5||||221.5|66.45|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|221.5||||221.5|46.52|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|221.5||||221.5|8.81|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|TRUSTMARK [2030]|STARMARK [203000]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|221.5||||221.5|106.21|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|UMR [2035]|UMR OPTIONS [203501]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|221.5||||221.5|199.35|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|221.5||||221.5|0|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|221.5||||221.5|81.96|206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|221.5||||221.5||206|8.81
180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|221.5||||221.5|110.75|206|8.81
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|72.13||||72.13|0|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72.13||||72.13|14.43|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72.13||||72.13|25.1|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72.13||||72.13|25.1|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72.13||||72.13|36.14|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72.13||||72.13|25.32|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72.13||||72.13|31.02|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72.13||||72.13|30.73|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72.13||||72.13|36.07|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72.13||||72.13|46.88|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|72.13||||72.13|18.65|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72.13||||72.13|26.69|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|GEHA [1415]|GEHA [141500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72.13||||72.13|17.85|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72.13||||72.13|31.02|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|72.13||||72.13|67.08|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72.13||||72.13|43.28|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72.13||||72.13|23.8|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72.13||||72.13|36.07|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72.13||||72.13|24.25|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72.13||||72.13|14.43|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72.13||||72.13|19.86|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MULTIPLAN [1680]|HMA [168003]|72.13||||72.13|25.25|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MULTIPLAN [1680]|IHC HS [168011]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|72.13||||72.13|26.09|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72.13||||72.13|23.8|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|Self-pay|Self-pay|72.13||||72.13|21.64|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72.13||||72.13|15.15|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72.13||||72.13|21.64|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72.13||||72.13|21.21|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72.13||||72.13|20.75|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|TRUSTMARK [2030]|STARMARK [203000]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72.13||||72.13|34.59|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|UMR [2035]|UMR OPTIONS [203501]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72.13||||72.13|23.1|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72.13||||72.13|19.48|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72.13||||72.13|64.92|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72.13||||72.13|0|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72.13||||72.13|21.64|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72.13||||72.13|26.69|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72.13||||72.13|21.64|67.08|14.43
182960|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2021-22(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|0.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72.13||||72.13|36.07|67.08|14.43
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|AETNA [1015]|AETNA ACO WILCO [101532]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|56.56||||56.56|28.34|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56.56||||56.56|19.85|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56.56||||56.56|24.32|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|56.56||||56.56|24.09|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|56.56||||56.56|28.28|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56.56||||56.56|36.76|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|CORESOURCE [1315]|CORESOURCE [131500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|CORVEL CORP [2235]|CORVEL CORP [223500]|56.56||||56.56|5.71|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|56.56||||56.56|20.93|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|GEHA [1415]|GEHA [141500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HEALTHNET [1495]|HEALTHNET [149500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56.56||||56.56|24.32|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HEALTHSMART [1505]|HEALTHSMART [150501]|56.56||||56.56|52.6|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56.56||||56.56|33.94|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MULTIPLAN [1680]|HMA [168003]|56.56||||56.56|19.8|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MULTIPLAN [1680]|IHC HS [168011]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|Self-pay|Self-pay|56.56||||56.56|16.97|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56.56||||56.56|11.88|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56.56||||56.56|5.25|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|TRUSTMARK [2030]|STARMARK [203000]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56.56||||56.56|27.12|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|UMR [2035]|UMR OPTIONS [203501]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56.56||||56.56|50.9|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|56.56||||56.56|0|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|56.56||||56.56|20.93|52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|56.56||||56.56||52.6|5.25
18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|3.375 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|56.56||||56.56|28.28|52.6|5.25
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46.99||||46.99|23.54|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.99||||46.99|16.49|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.99||||46.99|20.21|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46.99||||46.99|20.02|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46.99||||46.99|23.5|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.99||||46.99|30.54|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46.99||||46.99|17.39|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|GEHA [1415]|GEHA [141500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.99||||46.99|20.21|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|46.99||||46.99|43.7|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.99||||46.99|28.19|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MULTIPLAN [1680]|HMA [168003]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MULTIPLAN [1680]|IHC HS [168011]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|Self-pay|Self-pay|46.99||||46.99|14.1|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.99||||46.99|9.87|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|TRUSTMARK [2030]|STARMARK [203000]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.99||||46.99|22.53|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|UMR [2035]|UMR OPTIONS [203501]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.99||||46.99|42.29|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46.99||||46.99|0|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46.99||||46.99|17.39|43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46.99||||46.99||43.7|9.87
18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|2.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46.99||||46.99|23.5|43.7|9.87
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|132.13||||132.13|66.2|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.13||||132.13|46.38|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.13||||132.13|56.82|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|132.13||||132.13|56.29|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|132.13||||132.13|66.07|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.13||||132.13|85.88|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|132.13||||132.13|48.89|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.13||||132.13|56.82|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|132.13||||132.13|122.88|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.13||||132.13|79.28|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|Self-pay|Self-pay|132.13||||132.13|39.64|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.13||||132.13|27.75|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.13||||132.13|63.36|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.13||||132.13|118.92|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|132.13||||132.13|0|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|132.13||||132.13|48.89|122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|132.13||||132.13||122.88|27.75
19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|132.13||||132.13|66.07|122.88|27.75
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213.19||||213.19|106.81|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.19||||213.19|74.83|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.19||||213.19|91.67|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213.19||||213.19|90.82|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213.19||||213.19|106.6|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.19||||213.19|138.57|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213.19||||213.19|78.88|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.19||||213.19|91.67|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|213.19||||213.19|198.27|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.19||||213.19|127.91|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|Self-pay|Self-pay|213.19||||213.19|63.96|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.19||||213.19|44.77|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.19||||213.19|102.22|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.19||||213.19|191.87|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213.19||||213.19|0|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213.19||||213.19|78.88|198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213.19||||213.19||198.27|44.77
19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213.19||||213.19|106.6|198.27|44.77
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|214.26||||214.26|107.34|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|214.26||||214.26|75.21|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|214.26||||214.26|92.13|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|214.26||||214.26|91.27|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|214.26||||214.26|107.13|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|214.26||||214.26|139.27|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|214.26||||214.26|79.28|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|GEHA [1415]|GEHA [141500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|214.26||||214.26|92.13|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|214.26||||214.26|199.26|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|214.26||||214.26|128.56|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MULTIPLAN [1680]|HMA [168003]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MULTIPLAN [1680]|IHC HS [168011]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|Self-pay|Self-pay|214.26||||214.26|64.28|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|214.26||||214.26|44.99|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|TRUSTMARK [2030]|STARMARK [203000]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|214.26||||214.26|102.74|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|UMR [2035]|UMR OPTIONS [203501]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|214.26||||214.26|192.83|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|214.26||||214.26|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|214.26||||214.26|79.28|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|214.26||||214.26||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|214.26||||214.26|107.13|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.13||||107.13|53.67|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.13||||107.13|37.6|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.13||||107.13|46.07|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.13||||107.13|45.64|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.13||||107.13|53.57|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.13||||107.13|69.63|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.13||||107.13|39.64|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.13||||107.13|46.07|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|107.13||||107.13|99.63|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107.13||||107.13|64.28|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|Self-pay|Self-pay|107.13||||107.13|32.14|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.13||||107.13|22.5|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.13||||107.13|51.37|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.13||||107.13|96.42|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107.13||||107.13|0|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.13||||107.13|39.64|199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.13||||107.13||199.26|22.5
19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.13||||107.13|53.57|199.26|22.5
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55.98||||55.98|28.05|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.98||||55.98|19.65|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.98||||55.98|24.07|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55.98||||55.98|23.85|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55.98||||55.98|27.99|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.98||||55.98|36.39|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55.98||||55.98|20.71|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.98||||55.98|24.07|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|55.98||||55.98|52.06|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.98||||55.98|33.59|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|Self-pay|Self-pay|55.98||||55.98|16.79|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.98||||55.98|11.76|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.98||||55.98|26.84|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.98||||55.98|50.38|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55.98||||55.98|0|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55.98||||55.98|20.71|52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55.98||||55.98||52.06|11.76
19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55.98||||55.98|27.99|52.06|11.76
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.71|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|1.95|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.71
2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|0.1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.71
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|AETNA ACO WILCO [101532]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40.59||||40.59|20.34|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40.59||||40.59|14.25|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40.59||||40.59|17.45|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40.59||||40.59|17.29|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40.59||||40.59|20.3|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40.59||||40.59|26.38|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CORESOURCE [1315]|CORESOURCE [131500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|40.59||||40.59|2.71|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40.59||||40.59|15.02|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|GEHA [1415]|GEHA [141500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHNET [1495]|HEALTHNET [149500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40.59||||40.59|17.45|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|40.59||||40.59|37.75|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40.59||||40.59|24.35|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MULTIPLAN [1680]|HMA [168003]|40.59||||40.59|14.21|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MULTIPLAN [1680]|IHC HS [168011]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|Self-pay|Self-pay|40.59||||40.59|12.18|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40.59||||40.59|8.52|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40.59||||40.59|4.27|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRUSTMARK [2030]|STARMARK [203000]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40.59||||40.59|19.46|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UMR [2035]|UMR OPTIONS [203501]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40.59||||40.59|36.53|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40.59||||40.59|0|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40.59||||40.59|15.02|37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40.59||||40.59||37.75|2.71
21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40.59||||40.59|20.3|37.75|2.71
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|2.01|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.87|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.87
21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.87
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.5|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.71|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.5
22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|0.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.5
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.85||||20.85|10.45|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.85||||20.85|7.32|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.85||||20.85|8.97|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.85||||20.85|8.88|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.85||||20.85|10.43|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.85||||20.85|13.55|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.85||||20.85|7.71|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.85||||20.85|8.97|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|20.85||||20.85|19.39|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.85||||20.85|12.51|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|Self-pay|Self-pay|20.85||||20.85|6.25|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.85||||20.85|4.38|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.85||||20.85|10|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.85||||20.85|18.77|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.85||||20.85|0|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.85||||20.85|7.71|19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.85||||20.85||19.39|4.38
22992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.85||||20.85|10.43|19.39|4.38
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61.46||||61.46|30.79|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.46||||61.46|21.57|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.46||||61.46|26.43|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61.46||||61.46|26.18|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61.46||||61.46|30.73|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.46||||61.46|39.95|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|61.46||||61.46|4.7|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61.46||||61.46|22.74|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.46||||61.46|26.43|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|61.46||||61.46|57.16|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.46||||61.46|36.88|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|Self-pay|Self-pay|61.46||||61.46|18.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.46||||61.46|12.91|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.46||||61.46|29.47|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.46||||61.46|55.31|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61.46||||61.46|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61.46||||61.46|22.74|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61.46||||61.46||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61.46||||61.46|30.73|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|AETNA [1015]|AETNA ACO WILCO [101532]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87.15||||87.15|43.66|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87.15||||87.15|30.59|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87.15||||87.15|37.47|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87.15||||87.15|37.13|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87.15||||87.15|43.58|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87.15||||87.15|56.65|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|CORESOURCE [1315]|CORESOURCE [131500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|87.15||||87.15|9.41|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87.15||||87.15|32.25|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|GEHA [1415]|GEHA [141500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HEALTHNET [1495]|HEALTHNET [149500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87.15||||87.15|37.47|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|87.15||||87.15|81.05|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87.15||||87.15|52.29|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MULTIPLAN [1680]|HMA [168003]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MULTIPLAN [1680]|IHC HS [168011]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|Self-pay|Self-pay|87.15||||87.15|26.14|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87.15||||87.15|18.3|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|TRUSTMARK [2030]|STARMARK [203000]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87.15||||87.15|41.79|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|UMR [2035]|UMR OPTIONS [203501]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87.15||||87.15|78.44|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87.15||||87.15|0|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87.15||||87.15|32.25|81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87.15||||87.15||81.05|4.7
23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|20 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87.15||||87.15|43.58|81.05|4.7
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.97|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|1.7|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.97
2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.97
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.42|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.55|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.42
2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.42
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|Self-pay|Self-pay|90||||90|27|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|250 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|Self-pay|Self-pay|90||||90|27|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|500 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|4.47|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|4.26|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|4.26
2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|4.26
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|151.57||||151.57|75.94|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151.57||||151.57|53.2|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151.57||||151.57|65.18|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|151.57||||151.57|64.57|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|151.57||||151.57|75.79|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151.57||||151.57|98.52|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|151.57||||151.57|56.08|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151.57||||151.57|65.18|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|151.57||||151.57|140.96|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151.57||||151.57|90.94|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|Self-pay|Self-pay|151.57||||151.57|45.47|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151.57||||151.57|31.83|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151.57||||151.57|72.68|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151.57||||151.57|136.41|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|151.57||||151.57|0|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|151.57||||151.57|56.08|140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|151.57||||151.57||140.96|31.83
23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|151.57||||151.57|75.79|140.96|31.83
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|GEHA [1415]|GEHA [141500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|Self-pay|Self-pay|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|2 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11.99||||11.99|6.01|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.99||||11.99|4.21|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.99||||11.99|5.16|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11.99||||11.99|5.11|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11.99||||11.99|6|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.99||||11.99|7.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11.99||||11.99|4.44|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.99||||11.99|5.16|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|11.99||||11.99|11.15|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.99||||11.99|7.19|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|11.99||||11.99|3.6|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.99||||11.99|2.52|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.99||||11.99|5.75|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.99||||11.99|10.79|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11.99||||11.99|0|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11.99||||11.99|4.44|11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11.99||||11.99||11.15|2.52
24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11.99||||11.99|6|11.15|2.52
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.31||||10.31|5.17|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.31||||10.31|3.62|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.31||||10.31|4.43|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.31||||10.31|4.39|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.31||||10.31|5.16|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.31||||10.31|6.7|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.31||||10.31|3.81|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.31||||10.31|4.43|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10.31||||10.31|9.59|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.31||||10.31|6.19|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|Self-pay|Self-pay|10.31||||10.31|3.09|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.31||||10.31|2.17|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.31||||10.31|4.94|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.31||||10.31|9.28|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.31||||10.31|0|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.31||||10.31|3.81|9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.31||||10.31||9.59|2.17
24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.31||||10.31|5.16|9.59|2.17
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22.09||||22.09|11.07|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.09||||22.09|7.75|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.09||||22.09|9.5|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22.09||||22.09|9.41|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22.09||||22.09|11.05|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.09||||22.09|14.36|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22.09||||22.09|8.17|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.09||||22.09|9.5|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|22.09||||22.09|20.54|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.09||||22.09|13.25|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|Self-pay|Self-pay|22.09||||22.09|6.63|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.09||||22.09|4.64|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.09||||22.09|10.59|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.09||||22.09|19.88|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22.09||||22.09|0|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22.09||||22.09|8.17|20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22.09||||22.09||20.54|4.64
24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22.09||||22.09|11.05|20.54|4.64
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.57|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.8|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.57
24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.57
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131.97||||131.97|66.12|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131.97||||131.97|46.32|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131.97||||131.97|56.75|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131.97||||131.97|56.22|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131.97||||131.97|65.99|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131.97||||131.97|85.78|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|131.97||||131.97|9.53|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131.97||||131.97|48.83|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|GEHA [1415]|GEHA [141500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131.97||||131.97|56.75|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|131.97||||131.97|122.73|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131.97||||131.97|79.18|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MULTIPLAN [1680]|HMA [168003]|131.97||||131.97|46.19|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|Self-pay|Self-pay|131.97||||131.97|39.59|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131.97||||131.97|27.71|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131.97||||131.97|11.08|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131.97||||131.97|63.28|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|UMR [2035]|UMR OPTIONS [203501]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131.97||||131.97|118.77|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131.97||||131.97|0|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131.97||||131.97|48.83|122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131.97||||131.97||122.73|9.53
24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131.97||||131.97|65.99|122.73|9.53
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.53|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.69|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.53
2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|0.2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.53
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.26|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|5|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.26
2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.11||||13.11|6.57|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.11||||13.11|4.6|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.11||||13.11|5.64|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.11||||13.11|5.58|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.11||||13.11|6.56|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.11||||13.11|8.52|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|13.11||||13.11|0.26|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.11||||13.11|4.85|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|GEHA [1415]|GEHA [141500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.11||||13.11|5.64|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|13.11||||13.11|12.19|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.11||||13.11|7.87|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.11||||13.11|6.56|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MULTIPLAN [1680]|HMA [168003]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MULTIPLAN [1680]|IHC HS [168011]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|Self-pay|Self-pay|13.11||||13.11|3.93|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.11||||13.11|2.75|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|TRUSTMARK [2030]|STARMARK [203000]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.11||||13.11|6.29|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|UMR [2035]|UMR OPTIONS [203501]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.11||||13.11|11.8|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.11||||13.11|0|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.11||||13.11|4.85|12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.11||||13.11||12.19|0.26
2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.11||||13.11|6.56|12.19|0.26
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27.35||||27.35|13.7|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.35||||27.35|9.6|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.35||||27.35|11.76|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27.35||||27.35|11.65|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27.35||||27.35|13.68|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.35||||27.35|17.78|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27.35||||27.35|10.12|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.35||||27.35|11.76|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|27.35||||27.35|25.44|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.35||||27.35|16.41|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|Self-pay|Self-pay|27.35||||27.35|8.2|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.35||||27.35|5.74|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.35||||27.35|13.11|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.35||||27.35|24.62|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27.35||||27.35|0|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27.35||||27.35|10.12|25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27.35||||27.35||25.44|5.74
253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27.35||||27.35|13.68|25.44|5.74
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.98||||10.98|5.5|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.98||||10.98|3.85|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.98||||10.98|4.72|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.98||||10.98|4.68|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.98||||10.98|5.49|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.98||||10.98|7.14|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.98||||10.98|4.06|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.98||||10.98|4.72|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10.98||||10.98|10.21|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.98||||10.98|6.59|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|Self-pay|Self-pay|10.98||||10.98|3.29|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.98||||10.98|2.31|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.98||||10.98|5.26|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.98||||10.98|9.88|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.98||||10.98|0|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.98||||10.98|4.06|10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.98||||10.98||10.21|2.31
254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.98||||10.98|5.49|10.21|2.31
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
25519|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|AETNA [1015]|AETNA ACO WILCO [101532]|623||||623|0|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|623||||623|37.97|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|623||||623|33.86|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|623||||623|33.86|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|623||||623|36.88|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|623||||623|312.12|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|623||||623|218.67|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|623||||623|267.89|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|623||||623|265.4|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|623||||623|311.5|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|623||||623|404.95|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|CORESOURCE [1315]|CORESOURCE [131500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|623||||623|0|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|623||||623|230.51|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|GEHA [1415]|GEHA [141500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|623||||623|83.76|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HEALTHNET [1495]|HEALTHNET [149500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|623||||623|267.89|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|623||||623|579.39|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|623||||623|373.8|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|623||||623|40.56|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|623||||623|90.55|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|623||||623|32.71|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|623||||623|50.26|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|623||||623|37.54|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MULTIPLAN [1680]|HMA [168003]|623||||623|55.84|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MULTIPLAN [1680]|IHC HS [168011]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|623||||623|35.19|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|623||||623|40.56|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|Self-pay|Self-pay|623||||623|186.9|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|623||||623|130.83|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|623||||623|36.48|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|623||||623|54.35|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|TRUSTMARK [2030]|STARMARK [203000]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|623||||623|298.73|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|UMR [2035]|UMR OPTIONS [203501]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|623||||623|31.15|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|623||||623|560.7|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|623||||623|0|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|623||||623|230.51|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|623||||623|37.23|579.39|31.15
26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|623||||623|311.5|579.39|31.15
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|AETNA [1015]|AETNA ACO WILCO [101532]|1192||||1192|0|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1192||||1192|193.18|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1192||||1192|167.25|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1192||||1192|167.25|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1192||||1192|187.61|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1192||||1192|597.19|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1192||||1192|418.39|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1192||||1192|512.56|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1192||||1192|507.79|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1192||||1192|596|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1192||||1192|774.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|CORESOURCE [1315]|CORESOURCE [131500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1192||||1192|0|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1192||||1192|441.04|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|GEHA [1415]|GEHA [141500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1192||||1192|426.14|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HEALTHNET [1495]|HEALTHNET [149500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1192||||1192|512.56|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1192||||1192|1108.56|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1192||||1192|715.2|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1192||||1192|187.26|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1192||||1192|206.37|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1192||||1192|447.39|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1192||||1192|161.54|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1192||||1192|252.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1192||||1192|191|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MULTIPLAN [1680]|HMA [168003]|1192||||1192|284.09|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MULTIPLAN [1680]|IHC HS [168011]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1192||||1192|173.84|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1192||||1192|206.37|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|Self-pay|Self-pay|1192||||1192|357.6|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1192||||1192|250.32|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1192||||1192|183.51|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1192||||1192|276.52|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|TRUSTMARK [2030]|STARMARK [203000]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1192||||1192|571.56|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|UMR [2035]|UMR OPTIONS [203501]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1192||||1192|153.84|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1192||||1192|1072.8|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1192||||1192|0|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1192||||1192|441.04|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1192||||1192|189.4|1108.56|153.84
26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1192||||1192|596|1108.56|153.84
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|AETNA [1015]|AETNA ACO WILCO [101532]|623||||623|0|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|623||||623|37.97|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|623||||623|33.86|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|623||||623|33.86|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|623||||623|36.88|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|623||||623|312.12|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|623||||623|218.67|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|623||||623|267.89|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|623||||623|265.4|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|623||||623|311.5|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|623||||623|404.95|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|CORESOURCE [1315]|CORESOURCE [131500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|623||||623|0|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|623||||623|230.51|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|GEHA [1415]|GEHA [141500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|623||||623|83.76|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HEALTHNET [1495]|HEALTHNET [149500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|623||||623|267.89|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|623||||623|579.39|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|623||||623|373.8|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|623||||623|36.81|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|623||||623|40.56|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|623||||623|90.55|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|623||||623|32.71|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|623||||623|49.69|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|623||||623|37.54|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MULTIPLAN [1680]|HMA [168003]|623||||623|55.84|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MULTIPLAN [1680]|IHC HS [168011]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|623||||623|35.19|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|623||||623|40.56|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|Self-pay|Self-pay|623||||623|186.9|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|623||||623|130.83|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|623||||623|36.07|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|623||||623|54.35|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|TRUSTMARK [2030]|STARMARK [203000]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|623||||623|298.73|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|UMR [2035]|UMR OPTIONS [203501]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|623||||623|31.15|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|623||||623|560.7|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|623||||623|0|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|623||||623|230.51|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|623||||623|37.23|579.39|31.15
26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|623||||623|311.5|579.39|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|310||||310|0|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|310||||310|58.28|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|310||||310|33.86|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|310||||310|33.86|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|310||||310|155.31|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|310||||310|108.81|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|310||||310|133.3|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|310||||310|132.06|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|310||||310|155|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|310||||310|201.5|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|CORESOURCE [1315]|CORESOURCE [131500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|310||||310|0|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|310||||310|114.7|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|GEHA [1415]|GEHA [141500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|310||||310|128.56|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HEALTHNET [1495]|HEALTHNET [149500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|310||||310|133.3|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|310||||310|288.3|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|310||||310|186|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|310||||310|62.85|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|310||||310|142.82|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|310||||310|32.71|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|310||||310|77.13|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|310||||310|58.28|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MULTIPLAN [1680]|HMA [168003]|310||||310|85.7|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MULTIPLAN [1680]|IHC HS [168011]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|310||||310|35.19|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|310||||310|62.85|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|Self-pay|Self-pay|310||||310|93|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|310||||310|65.1|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|310||||310|55.99|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|310||||310|83.42|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|TRUSTMARK [2030]|STARMARK [203000]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|310||||310|148.65|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|UMR [2035]|UMR OPTIONS [203501]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|310||||310|31.15|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|310||||310|279|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|310||||310|0|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|310||||310|114.7|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|310||||310|57.14|288.3|31.15
26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|310||||310|155|288.3|31.15
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|AETNA [1015]|AETNA ACO WILCO [101532]|469||||469|0|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469||||469|193.18|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469||||469|49.39|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469||||469|49.39|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469||||469|187.61|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|469||||469|234.97|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469||||469|164.62|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469||||469|201.67|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|469||||469|199.79|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|469||||469|234.5|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469||||469|304.85|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|CORESOURCE [1315]|CORESOURCE [131500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|469||||469|0|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|469||||469|173.53|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|GEHA [1415]|GEHA [141500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|469||||469|426.14|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HEALTHNET [1495]|HEALTHNET [149500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469||||469|201.67|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|469||||469|436.17|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469||||469|281.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469||||469|206.37|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469||||469|447.39|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469||||469|47.71|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469||||469|255.68|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469||||469|191|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MULTIPLAN [1680]|HMA [168003]|469||||469|284.09|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MULTIPLAN [1680]|IHC HS [168011]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|469||||469|51.33|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469||||469|206.37|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|Self-pay|Self-pay|469||||469|140.7|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469||||469|98.49|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|469||||469|185.61|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469||||469|276.52|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|TRUSTMARK [2030]|STARMARK [203000]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469||||469|224.89|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|UMR [2035]|UMR OPTIONS [203501]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469||||469|45.43|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469||||469|422.1|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|469||||469|0|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|469||||469|173.53|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|469||||469|189.4|447.39|45.43
26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|469||||469|234.5|447.39|45.43
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|AETNA [1015]|AETNA ACO WILCO [101532]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|431||||431|215.93|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|431||||431|151.28|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|431||||431|185.33|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|431||||431|183.61|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|431||||431|215.5|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|431||||431|280.15|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|CORESOURCE [1315]|CORESOURCE [131500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|431||||431|159.47|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|GEHA [1415]|GEHA [141500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HEALTHNET [1495]|HEALTHNET [149500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|431||||431|185.33|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|431||||431|400.83|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|431||||431|258.6|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|431||||431|215.5|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MULTIPLAN [1680]|HMA [168003]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MULTIPLAN [1680]|IHC HS [168011]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|Self-pay|Self-pay|431||||431|129.3|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|431||||431|90.51|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|TRUSTMARK [2030]|STARMARK [203000]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|431||||431|206.66|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|UMR [2035]|UMR OPTIONS [203501]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|431||||431|387.9|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|431||||431|0|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|431||||431|159.47|400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|431||||431||400.83|90.51
26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|431||||431|215.5|400.83|90.51
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|AETNA [1015]|AETNA ACO WILCO [101532]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109.27||||109.27|54.74|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109.27||||109.27|38.35|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109.27||||109.27|46.99|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109.27||||109.27|46.55|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109.27||||109.27|54.64|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109.27||||109.27|71.03|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|CORESOURCE [1315]|CORESOURCE [131500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109.27||||109.27|40.43|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|GEHA [1415]|GEHA [141500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HEALTHNET [1495]|HEALTHNET [149500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109.27||||109.27|46.99|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|109.27||||109.27|101.62|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109.27||||109.27|65.56|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MULTIPLAN [1680]|HMA [168003]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MULTIPLAN [1680]|IHC HS [168011]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|Self-pay|Self-pay|109.27||||109.27|32.78|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109.27||||109.27|22.95|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|TRUSTMARK [2030]|STARMARK [203000]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109.27||||109.27|52.39|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|UMR [2035]|UMR OPTIONS [203501]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109.27||||109.27|98.34|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109.27||||109.27|0|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109.27||||109.27|40.43|101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109.27||||109.27||101.62|22.95
2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|100 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109.27||||109.27|54.64|101.62|22.95
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|14.5|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
26226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION|40 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16.84||||16.84|8.44|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.84||||16.84|5.91|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.84||||16.84|7.24|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16.84||||16.84|7.17|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16.84||||16.84|8.42|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.84||||16.84|10.95|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16.84||||16.84|6.23|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.84||||16.84|7.24|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|16.84||||16.84|15.66|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.84||||16.84|10.1|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|Self-pay|Self-pay|16.84||||16.84|5.05|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.84||||16.84|3.54|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.84||||16.84|8.07|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.84||||16.84|15.16|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16.84||||16.84|0|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16.84||||16.84|6.23|15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16.84||||16.84||15.66|3.54
2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16.84||||16.84|8.42|15.66|3.54
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50.76||||50.76|25.43|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.76||||50.76|17.82|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.76||||50.76|21.83|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50.76||||50.76|21.62|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50.76||||50.76|25.38|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.76||||50.76|32.99|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50.76||||50.76|18.78|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.76||||50.76|21.83|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|50.76||||50.76|47.21|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.76||||50.76|30.46|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|Self-pay|Self-pay|50.76||||50.76|15.23|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.76||||50.76|10.66|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.76||||50.76|24.34|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.76||||50.76|45.68|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50.76||||50.76|0|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50.76||||50.76|18.78|47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50.76||||50.76||47.21|10.66
26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50.76||||50.76|25.38|47.21|10.66
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|24.93||||24.93|12.49|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.93||||24.93|8.75|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.93||||24.93|10.72|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|24.93||||24.93|10.62|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|24.93||||24.93|12.47|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.93||||24.93|16.2|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|24.93||||24.93|9.22|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.93||||24.93|10.72|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|24.93||||24.93|23.18|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.93||||24.93|14.96|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|Self-pay|Self-pay|24.93||||24.93|7.48|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.93||||24.93|5.24|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.93||||24.93|11.95|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.93||||24.93|22.44|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|24.93||||24.93|0|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|24.93||||24.93|9.22|23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|24.93||||24.93||23.18|5.24
26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|24.93||||24.93|12.47|23.18|5.24
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12||||12|6.01|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12||||12|4.21|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12||||12|5.16|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12||||12|5.11|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12||||12|6|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12||||12|7.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|CORESOURCE [1315]|CORESOURCE [131500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12||||12|4.44|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|GEHA [1415]|GEHA [141500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HEALTHNET [1495]|HEALTHNET [149500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12||||12|5.16|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|12||||12|11.16|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12||||12|7.2|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MULTIPLAN [1680]|HMA [168003]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MULTIPLAN [1680]|IHC HS [168011]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|Self-pay|Self-pay|12||||12|3.6|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12||||12|2.52|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|TRUSTMARK [2030]|STARMARK [203000]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12||||12|5.75|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|UMR [2035]|UMR OPTIONS [203501]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12||||12|10.8|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12||||12|0|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12||||12|4.44|11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12||||12||11.16|2.52
27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12||||12|6|11.16|2.52
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34||||34|17.03|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34||||34|11.93|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34||||34|14.62|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34||||34|14.48|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34||||34|17|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34||||34|22.1|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34||||34|12.58|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|GEHA [1415]|GEHA [141500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34||||34|14.62|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34||||34|31.62|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34||||34|20.4|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MULTIPLAN [1680]|HMA [168003]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MULTIPLAN [1680]|IHC HS [168011]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|Self-pay|Self-pay|34||||34|10.2|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34||||34|7.14|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|TRUSTMARK [2030]|STARMARK [203000]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34||||34|16.3|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|UMR [2035]|UMR OPTIONS [203501]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34||||34|30.6|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34||||34|0|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34||||34|12.58|31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34||||34||31.62|7.14
27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34||||34|17|31.62|7.14
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12||||12|6.01|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12||||12|4.21|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12||||12|5.16|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12||||12|5.11|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12||||12|6|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12||||12|7.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|CORESOURCE [1315]|CORESOURCE [131500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12||||12|4.44|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|GEHA [1415]|GEHA [141500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HEALTHNET [1495]|HEALTHNET [149500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12||||12|5.16|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|12||||12|11.16|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12||||12|7.2|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MULTIPLAN [1680]|HMA [168003]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MULTIPLAN [1680]|IHC HS [168011]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|Self-pay|Self-pay|12||||12|3.6|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12||||12|2.52|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|TRUSTMARK [2030]|STARMARK [203000]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12||||12|5.75|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|UMR [2035]|UMR OPTIONS [203501]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12||||12|10.8|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12||||12|0|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12||||12|4.44|11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12||||12||11.16|2.52
27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12||||12|6|11.16|2.52
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|AETNA [1015]|AETNA ACO WILCO [101532]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|92||||92|46.09|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92||||92|32.29|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92||||92|39.56|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|92||||92|39.19|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|92||||92|46|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92||||92|59.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|CORESOURCE [1315]|CORESOURCE [131500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|92||||92|34.04|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|GEHA [1415]|GEHA [141500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HEALTHNET [1495]|HEALTHNET [149500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92||||92|39.56|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|92||||92|85.56|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92||||92|55.2|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MULTIPLAN [1680]|HMA [168003]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MULTIPLAN [1680]|IHC HS [168011]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|Self-pay|Self-pay|92||||92|27.6|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92||||92|19.32|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|TRUSTMARK [2030]|STARMARK [203000]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92||||92|44.11|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|UMR [2035]|UMR OPTIONS [203501]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92||||92|82.8|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|92||||92|0|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|92||||92|34.04|85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|92||||92||85.56|19.32
27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|92||||92|46|85.56|19.32
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|AETNA [1015]|AETNA ACO WILCO [101532]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|77||||77|38.58|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77||||77|27.03|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77||||77|33.11|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|77||||77|32.8|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|77||||77|38.5|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77||||77|50.05|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|CORESOURCE [1315]|CORESOURCE [131500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|77||||77|28.49|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|GEHA [1415]|GEHA [141500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HEALTHNET [1495]|HEALTHNET [149500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77||||77|33.11|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|77||||77|71.61|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77||||77|46.2|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MULTIPLAN [1680]|HMA [168003]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MULTIPLAN [1680]|IHC HS [168011]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|Self-pay|Self-pay|77||||77|23.1|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77||||77|16.17|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|TRUSTMARK [2030]|STARMARK [203000]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77||||77|36.92|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|UMR [2035]|UMR OPTIONS [203501]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77||||77|69.3|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|77||||77|0|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|77||||77|28.49|71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|77||||77||71.61|16.17
27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|77||||77|38.5|71.61|16.17
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6||||6|3.01|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6||||6|2.11|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6||||6|2.58|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6||||6|2.56|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6||||6|3|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6||||6|3.9|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|CORESOURCE [1315]|CORESOURCE [131500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6||||6|2.22|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|GEHA [1415]|GEHA [141500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HEALTHNET [1495]|HEALTHNET [149500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6||||6|2.58|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6||||6|5.58|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6||||6|3.6|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MULTIPLAN [1680]|HMA [168003]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MULTIPLAN [1680]|IHC HS [168011]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|Self-pay|Self-pay|6||||6|1.8|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6||||6|1.26|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|TRUSTMARK [2030]|STARMARK [203000]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6||||6|2.88|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|UMR [2035]|UMR OPTIONS [203501]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6||||6|5.4|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6||||6|0|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6||||6|2.22|5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6||||6||5.58|1.26
27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6||||6|3|5.58|1.26
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|263||||263|131.76|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263||||263|92.31|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263||||263|113.09|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|263||||263|112.04|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|263||||263|131.5|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263||||263|170.95|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|263||||263|97.31|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|GEHA [1415]|GEHA [141500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263||||263|113.09|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|263||||263|244.59|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263||||263|157.8|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MULTIPLAN [1680]|HMA [168003]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MULTIPLAN [1680]|IHC HS [168011]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|Self-pay|Self-pay|263||||263|78.9|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263||||263|55.23|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|TRUSTMARK [2030]|STARMARK [203000]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263||||263|126.11|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|UMR [2035]|UMR OPTIONS [203501]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263||||263|236.7|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|263||||263|0|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|263||||263|97.31|244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|263||||263||244.59|55.23
27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN/DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|263||||263|131.5|244.59|55.23
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46||||46|23.05|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46||||46|16.15|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46||||46|19.78|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46||||46|19.6|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46||||46|23|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46||||46|29.9|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|CORESOURCE [1315]|CORESOURCE [131500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46||||46|17.02|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|GEHA [1415]|GEHA [141500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HEALTHNET [1495]|HEALTHNET [149500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46||||46|19.78|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46||||46|42.78|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46||||46|27.6|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MULTIPLAN [1680]|HMA [168003]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MULTIPLAN [1680]|IHC HS [168011]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|Self-pay|Self-pay|46||||46|13.8|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46||||46|9.66|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|TRUSTMARK [2030]|STARMARK [203000]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46||||46|22.06|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|UMR [2035]|UMR OPTIONS [203501]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46||||46|41.4|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46||||46|0|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46||||46|17.02|42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46||||46||42.78|9.66
27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46||||46|23|42.78|9.66
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|AETNA [1015]|AETNA ACO WILCO [101532]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|206||||206|103.21|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206||||206|72.31|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206||||206|88.58|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|206||||206|87.76|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|206||||206|103|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206||||206|133.9|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|CORESOURCE [1315]|CORESOURCE [131500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|206||||206|76.22|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|GEHA [1415]|GEHA [141500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HEALTHNET [1495]|HEALTHNET [149500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206||||206|88.58|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|206||||206|191.58|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206||||206|123.6|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MULTIPLAN [1680]|HMA [168003]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MULTIPLAN [1680]|IHC HS [168011]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|Self-pay|Self-pay|206||||206|61.8|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206||||206|43.26|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|TRUSTMARK [2030]|STARMARK [203000]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206||||206|98.78|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|UMR [2035]|UMR OPTIONS [203501]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206||||206|185.4|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|206||||206|0|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|206||||206|76.22|191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|206||||206||191.58|43.26
27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|206||||206|103|191.58|43.26
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31||||31|15.53|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31||||31|10.88|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31||||31|13.33|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31||||31|13.21|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31||||31|15.5|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31||||31|20.15|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31||||31|11.47|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|GEHA [1415]|GEHA [141500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31||||31|13.33|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31||||31|28.83|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31||||31|18.6|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MULTIPLAN [1680]|HMA [168003]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MULTIPLAN [1680]|IHC HS [168011]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|Self-pay|Self-pay|31||||31|9.3|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31||||31|6.51|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|TRUSTMARK [2030]|STARMARK [203000]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31||||31|14.86|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|UMR [2035]|UMR OPTIONS [203501]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31||||31|27.9|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31||||31|0|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31||||31|11.47|28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31||||31||28.83|6.51
27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31||||31|15.5|28.83|6.51
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39||||39|19.54|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39||||39|13.69|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39||||39|16.77|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39||||39|16.61|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39||||39|19.5|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39||||39|25.35|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39||||39|14.43|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|GEHA [1415]|GEHA [141500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39||||39|16.77|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39||||39|36.27|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39||||39|23.4|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MULTIPLAN [1680]|HMA [168003]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MULTIPLAN [1680]|IHC HS [168011]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|Self-pay|Self-pay|39||||39|11.7|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39||||39|8.19|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|TRUSTMARK [2030]|STARMARK [203000]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39||||39|18.7|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|UMR [2035]|UMR OPTIONS [203501]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39||||39|35.1|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39||||39|0|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39||||39|14.43|36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39||||39||36.27|8.19
27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39||||39|19.5|36.27|8.19
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|AETNA [1015]|AETNA ACO WILCO [101532]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|413||||413|206.91|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|413||||413|144.96|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|413||||413|177.59|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|413||||413|175.94|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|413||||413|206.5|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|413||||413|268.45|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|CORESOURCE [1315]|CORESOURCE [131500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|413||||413|152.81|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|GEHA [1415]|GEHA [141500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HEALTHNET [1495]|HEALTHNET [149500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|413||||413|177.59|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|413||||413|384.09|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|413||||413|247.8|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MULTIPLAN [1680]|HMA [168003]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MULTIPLAN [1680]|IHC HS [168011]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|Self-pay|Self-pay|413||||413|123.9|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|413||||413|86.73|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|TRUSTMARK [2030]|STARMARK [203000]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|413||||413|198.03|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|UMR [2035]|UMR OPTIONS [203501]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|413||||413|371.7|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|413||||413|0|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|413||||413|152.81|384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|413||||413||384.09|86.73
27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|413||||413|206.5|384.09|86.73
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|AETNA [1015]|AETNA ACO WILCO [101532]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55||||55|27.56|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55||||55|19.31|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55||||55|23.65|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55||||55|23.43|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55||||55|27.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55||||55|35.75|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|CORESOURCE [1315]|CORESOURCE [131500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55||||55|20.35|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|GEHA [1415]|GEHA [141500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HEALTHNET [1495]|HEALTHNET [149500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55||||55|23.65|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55||||55|51.15|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55||||55|33|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MULTIPLAN [1680]|HMA [168003]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MULTIPLAN [1680]|IHC HS [168011]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|Self-pay|Self-pay|55||||55|16.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55||||55|11.55|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|TRUSTMARK [2030]|STARMARK [203000]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55||||55|26.37|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|UMR [2035]|UMR OPTIONS [203501]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55||||55|49.5|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55||||55|0|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55||||55|20.35|51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55||||55||51.15|11.55
27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55||||55|27.5|51.15|11.55
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48||||48|24.05|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48||||48|16.85|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48||||48|20.64|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48||||48|20.45|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48||||48|24|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48||||48|31.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|CORESOURCE [1315]|CORESOURCE [131500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48||||48|17.76|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|GEHA [1415]|GEHA [141500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HEALTHNET [1495]|HEALTHNET [149500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48||||48|20.64|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48||||48|44.64|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48||||48|28.8|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MULTIPLAN [1680]|HMA [168003]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MULTIPLAN [1680]|IHC HS [168011]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|Self-pay|Self-pay|48||||48|14.4|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48||||48|10.08|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|TRUSTMARK [2030]|STARMARK [203000]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48||||48|23.02|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|UMR [2035]|UMR OPTIONS [203501]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48||||48|43.2|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48||||48|0|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48||||48|17.76|44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48||||48||44.64|10.08
27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48||||48|24|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|AETNA [1015]|AETNA ACO WILCO [101532]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48||||48|24.05|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48||||48|16.85|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48||||48|20.64|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48||||48|20.45|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48||||48|24|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48||||48|31.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|CORESOURCE [1315]|CORESOURCE [131500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48||||48|17.76|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|GEHA [1415]|GEHA [141500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HEALTHNET [1495]|HEALTHNET [149500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48||||48|20.64|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48||||48|44.64|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48||||48|28.8|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MULTIPLAN [1680]|HMA [168003]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MULTIPLAN [1680]|IHC HS [168011]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|Self-pay|Self-pay|48||||48|14.4|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48||||48|10.08|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|TRUSTMARK [2030]|STARMARK [203000]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48||||48|23.02|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|UMR [2035]|UMR OPTIONS [203501]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48||||48|43.2|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48||||48|0|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48||||48|17.76|44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48||||48||44.64|10.08
27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48||||48|24|44.64|10.08
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|AETNA [1015]|AETNA ACO WILCO [101532]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19||||19|9.52|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19||||19|6.67|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19||||19|8.17|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19||||19|8.09|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19||||19|9.5|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19||||19|12.35|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|CORESOURCE [1315]|CORESOURCE [131500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19||||19|7.03|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|GEHA [1415]|GEHA [141500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HEALTHNET [1495]|HEALTHNET [149500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19||||19|8.17|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19||||19|17.67|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19||||19|11.4|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MULTIPLAN [1680]|HMA [168003]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MULTIPLAN [1680]|IHC HS [168011]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|Self-pay|Self-pay|19||||19|5.7|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19||||19|3.99|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|TRUSTMARK [2030]|STARMARK [203000]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19||||19|9.11|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|UMR [2035]|UMR OPTIONS [203501]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19||||19|17.1|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19||||19|0|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19||||19|7.03|17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19||||19||17.67|3.99
27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19||||19|9.5|17.67|3.99
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|AETNA [1015]|AETNA ACO WILCO [101532]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84||||84|42.08|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84||||84|29.48|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84||||84|36.12|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84||||84|35.78|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84||||84|42|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84||||84|54.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|CORESOURCE [1315]|CORESOURCE [131500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84||||84|31.08|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|GEHA [1415]|GEHA [141500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HEALTHNET [1495]|HEALTHNET [149500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84||||84|36.12|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84||||84|78.12|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84||||84|50.4|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MULTIPLAN [1680]|HMA [168003]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MULTIPLAN [1680]|IHC HS [168011]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|Self-pay|Self-pay|84||||84|25.2|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84||||84|17.64|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|TRUSTMARK [2030]|STARMARK [203000]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84||||84|40.28|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|UMR [2035]|UMR OPTIONS [203501]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84||||84|75.6|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84||||84|0|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84||||84|31.08|78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84||||84||78.12|17.64
27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84||||84|42|78.12|17.64
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|AETNA [1015]|AETNA ACO WILCO [101532]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|150||||150|75.15|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150||||150|52.65|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150||||150|64.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|150||||150|63.9|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|150||||150|75|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150||||150|97.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|CORESOURCE [1315]|CORESOURCE [131500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|150||||150|55.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|GEHA [1415]|GEHA [141500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HEALTHNET [1495]|HEALTHNET [149500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150||||150|64.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|150||||150|139.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150||||150|90|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150||||150|75|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MULTIPLAN [1680]|HMA [168003]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MULTIPLAN [1680]|IHC HS [168011]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|Self-pay|Self-pay|150||||150|45|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150||||150|31.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|TRUSTMARK [2030]|STARMARK [203000]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150||||150|71.93|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|UMR [2035]|UMR OPTIONS [203501]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150||||150|135|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|150||||150|0|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|150||||150|55.5|139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|150||||150||139.5|31.5
27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|150||||150|75|139.5|31.5
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|AETNA [1015]|AETNA ACO WILCO [101532]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|935||||935|468.44|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|935||||935|328.19|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|935||||935|402.05|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|935||||935|398.31|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|935||||935|467.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|935||||935|607.75|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|CORESOURCE [1315]|CORESOURCE [131500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|935||||935|458.15|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|935||||935|12.12|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|GEHA [1415]|GEHA [141500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HEALTHNET [1495]|HEALTHNET [149500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|935||||935|402.05|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|935||||935|869.55|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|935||||935|561|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|935||||935|467.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MULTIPLAN [1680]|HMA [168003]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MULTIPLAN [1680]|IHC HS [168011]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|Self-pay|Self-pay|935||||935|280.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|935||||935|196.35|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|TRUSTMARK [2030]|STARMARK [203000]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|935||||935|448.33|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|UMR [2035]|UMR OPTIONS [203501]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|935||||935|841.5|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|935||||935|0|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|935||||935|12.12|869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|935||||935||869.55|12.12
27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|935||||935|467.5|869.55|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|AETNA [1015]|AETNA ACO WILCO [101532]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1241||||1241|621.74|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1241||||1241|435.59|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1241||||1241|533.63|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1241||||1241|528.67|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1241||||1241|620.5|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1241||||1241|806.65|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|CORESOURCE [1315]|CORESOURCE [131500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1241||||1241|608.09|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1241||||1241|12.12|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|GEHA [1415]|GEHA [141500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HEALTHNET [1495]|HEALTHNET [149500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1241||||1241|533.63|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1241||||1241|1154.13|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1241||||1241|744.6|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1241||||1241|620.5|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MULTIPLAN [1680]|HMA [168003]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MULTIPLAN [1680]|IHC HS [168011]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|Self-pay|Self-pay|1241||||1241|372.3|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1241||||1241|260.61|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|TRUSTMARK [2030]|STARMARK [203000]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1241||||1241|595.06|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|UMR [2035]|UMR OPTIONS [203501]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1241||||1241|1116.9|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1241||||1241|0|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1241||||1241|12.12|1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1241||||1241||1154.13|12.12
27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1241||||1241|620.5|1154.13|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1175||||1175|588.68|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1175||||1175|412.43|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1175||||1175|505.25|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1175||||1175|500.55|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1175||||1175|587.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1175||||1175|763.75|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|CORESOURCE [1315]|CORESOURCE [131500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1175||||1175|575.75|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1175||||1175|12.12|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|GEHA [1415]|GEHA [141500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HEALTHNET [1495]|HEALTHNET [149500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1175||||1175|505.25|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1175||||1175|1092.75|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1175||||1175|705|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1175||||1175|587.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MULTIPLAN [1680]|HMA [168003]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MULTIPLAN [1680]|IHC HS [168011]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|Self-pay|Self-pay|1175||||1175|352.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1175||||1175|246.75|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|TRUSTMARK [2030]|STARMARK [203000]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1175||||1175|563.41|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|UMR [2035]|UMR OPTIONS [203501]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1175||||1175|1057.5|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1175||||1175|0|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1175||||1175|12.12|1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1175||||1175||1092.75|12.12
27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1175||||1175|587.5|1092.75|12.12
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17||||17|8.52|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17||||17|5.97|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17||||17|7.31|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17||||17|7.24|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17||||17|8.5|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17||||17|11.05|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|CORESOURCE [1315]|CORESOURCE [131500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17||||17|6.29|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|GEHA [1415]|GEHA [141500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HEALTHNET [1495]|HEALTHNET [149500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17||||17|7.31|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|17||||17|15.81|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17||||17|10.2|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MULTIPLAN [1680]|HMA [168003]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MULTIPLAN [1680]|IHC HS [168011]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|Self-pay|Self-pay|17||||17|5.1|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17||||17|3.57|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|TRUSTMARK [2030]|STARMARK [203000]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17||||17|8.15|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|UMR [2035]|UMR OPTIONS [203501]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17||||17|15.3|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17||||17|0|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17||||17|6.29|15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17||||17||15.81|3.57
27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17||||17|8.5|15.81|3.57
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|AETNA [1015]|AETNA ACO WILCO [101532]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37||||37|18.54|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37||||37|12.99|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37||||37|15.91|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37||||37|15.76|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37||||37|18.5|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37||||37|24.05|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|CORESOURCE [1315]|CORESOURCE [131500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37||||37|13.69|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|GEHA [1415]|GEHA [141500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HEALTHNET [1495]|HEALTHNET [149500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37||||37|15.91|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37||||37|34.41|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37||||37|22.2|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MULTIPLAN [1680]|HMA [168003]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MULTIPLAN [1680]|IHC HS [168011]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|Self-pay|Self-pay|37||||37|11.1|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37||||37|7.77|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|TRUSTMARK [2030]|STARMARK [203000]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37||||37|17.74|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|UMR [2035]|UMR OPTIONS [203501]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37||||37|33.3|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37||||37|0|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37||||37|13.69|34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37||||37||34.41|7.77
27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37||||37|18.5|34.41|7.77
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|AETNA [1015]|AETNA ACO WILCO [101532]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32||||32|16.03|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32||||32|11.23|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32||||32|13.76|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32||||32|13.63|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32||||32|16|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32||||32|20.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|CORESOURCE [1315]|CORESOURCE [131500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32||||32|11.84|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|GEHA [1415]|GEHA [141500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HEALTHNET [1495]|HEALTHNET [149500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32||||32|13.76|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32||||32|29.76|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32||||32|19.2|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MULTIPLAN [1680]|HMA [168003]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MULTIPLAN [1680]|IHC HS [168011]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|Self-pay|Self-pay|32||||32|9.6|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32||||32|6.72|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|TRUSTMARK [2030]|STARMARK [203000]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32||||32|15.34|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|UMR [2035]|UMR OPTIONS [203501]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32||||32|28.8|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32||||32|0|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32||||32|11.84|29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32||||32||29.76|6.72
27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32||||32|16|29.76|6.72
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20||||20|10.02|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20||||20|7.02|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20||||20|8.6|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20||||20|8.52|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20||||20|10|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20||||20|13|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|CORESOURCE [1315]|CORESOURCE [131500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20||||20|7.4|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|GEHA [1415]|GEHA [141500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HEALTHNET [1495]|HEALTHNET [149500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20||||20|8.6|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|20||||20|18.6|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20||||20|12|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MULTIPLAN [1680]|HMA [168003]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MULTIPLAN [1680]|IHC HS [168011]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|Self-pay|Self-pay|20||||20|6|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20||||20|4.2|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|TRUSTMARK [2030]|STARMARK [203000]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20||||20|9.59|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|UMR [2035]|UMR OPTIONS [203501]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20||||20|18|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20||||20|0|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20||||20|7.4|18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20||||20||18.6|4.2
27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20||||20|10|18.6|4.2
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46||||46|23.05|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46||||46|16.15|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46||||46|19.78|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46||||46|19.6|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46||||46|23|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46||||46|29.9|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46||||46|17.02|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|GEHA [1415]|GEHA [141500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46||||46|19.78|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46||||46|42.78|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46||||46|27.6|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MULTIPLAN [1680]|HMA [168003]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|Self-pay|Self-pay|46||||46|13.8|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46||||46|9.66|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46||||46|22.06|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|UMR [2035]|UMR OPTIONS [203501]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46||||46|41.4|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46||||46|0|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46||||46|17.02|42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46||||46||42.78|9.66
27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46||||46|23|42.78|9.66
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104||||104|52.1|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104||||104|36.5|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104||||104|44.72|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104||||104|44.3|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104||||104|52|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104||||104|67.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|CORESOURCE [1315]|CORESOURCE [131500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104||||104|38.48|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|GEHA [1415]|GEHA [141500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HEALTHNET [1495]|HEALTHNET [149500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104||||104|44.72|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|104||||104|96.72|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104||||104|62.4|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MULTIPLAN [1680]|HMA [168003]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MULTIPLAN [1680]|IHC HS [168011]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|Self-pay|Self-pay|104||||104|31.2|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104||||104|21.84|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|TRUSTMARK [2030]|STARMARK [203000]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104||||104|49.87|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|UMR [2035]|UMR OPTIONS [203501]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104||||104|93.6|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104||||104|0|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104||||104|38.48|96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104||||104||96.72|21.84
27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104||||104|52|96.72|21.84
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|138||||138|69.14|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138||||138|48.44|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138||||138|59.34|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|138||||138|58.79|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|138||||138|69|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138||||138|89.7|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|CORESOURCE [1315]|CORESOURCE [131500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|138||||138|51.06|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|GEHA [1415]|GEHA [141500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HEALTHNET [1495]|HEALTHNET [149500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138||||138|59.34|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|138||||138|128.34|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138||||138|82.8|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MULTIPLAN [1680]|HMA [168003]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MULTIPLAN [1680]|IHC HS [168011]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|Self-pay|Self-pay|138||||138|41.4|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138||||138|28.98|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|TRUSTMARK [2030]|STARMARK [203000]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138||||138|66.17|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|UMR [2035]|UMR OPTIONS [203501]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138||||138|124.2|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|138||||138|0|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|138||||138|51.06|128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|138||||138||128.34|28.98
27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|138||||138|69|128.34|28.98
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26||||26|13.03|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26||||26|9.13|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26||||26|11.18|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26||||26|11.08|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26||||26|13|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26||||26|16.9|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|CORESOURCE [1315]|CORESOURCE [131500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26||||26|9.62|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|GEHA [1415]|GEHA [141500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HEALTHNET [1495]|HEALTHNET [149500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26||||26|11.18|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26||||26|24.18|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26||||26|15.6|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MULTIPLAN [1680]|HMA [168003]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MULTIPLAN [1680]|IHC HS [168011]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|Self-pay|Self-pay|26||||26|7.8|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26||||26|5.46|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|TRUSTMARK [2030]|STARMARK [203000]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26||||26|12.47|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|UMR [2035]|UMR OPTIONS [203501]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26||||26|23.4|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26||||26|0|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26||||26|9.62|24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26||||26||24.18|5.46
27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26||||26|13|24.18|5.46
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64||||64|32.06|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64||||64|22.46|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64||||64|27.52|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64||||64|27.26|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64||||64|32|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64||||64|41.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|CORESOURCE [1315]|CORESOURCE [131500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64||||64|23.68|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|GEHA [1415]|GEHA [141500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HEALTHNET [1495]|HEALTHNET [149500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64||||64|27.52|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64||||64|59.52|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64||||64|38.4|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MULTIPLAN [1680]|HMA [168003]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MULTIPLAN [1680]|IHC HS [168011]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|Self-pay|Self-pay|64||||64|19.2|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64||||64|13.44|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|TRUSTMARK [2030]|STARMARK [203000]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64||||64|30.69|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|UMR [2035]|UMR OPTIONS [203501]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64||||64|57.6|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64||||64|0|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64||||64|23.68|59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64||||64||59.52|13.44
27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64||||64|32|59.52|13.44
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|AETNA [1015]|AETNA ACO WILCO [101532]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6||||6|3.01|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6||||6|2.11|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6||||6|2.58|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6||||6|2.56|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6||||6|3|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6||||6|3.9|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|CORESOURCE [1315]|CORESOURCE [131500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6||||6|2.22|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|GEHA [1415]|GEHA [141500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HEALTHNET [1495]|HEALTHNET [149500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6||||6|2.58|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6||||6|5.58|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6||||6|3.6|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MULTIPLAN [1680]|HMA [168003]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MULTIPLAN [1680]|IHC HS [168011]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|Self-pay|Self-pay|6||||6|1.8|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6||||6|1.26|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|TRUSTMARK [2030]|STARMARK [203000]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6||||6|2.88|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|UMR [2035]|UMR OPTIONS [203501]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6||||6|5.4|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6||||6|0|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6||||6|2.22|5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6||||6||5.58|1.26
27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6||||6|3|5.58|1.26
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142||||142|71.14|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142||||142|49.84|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142||||142|61.06|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142||||142|60.49|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142||||142|71|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142||||142|92.3|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|CORESOURCE [1315]|CORESOURCE [131500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142||||142|52.54|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|GEHA [1415]|GEHA [141500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HEALTHNET [1495]|HEALTHNET [149500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142||||142|61.06|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142||||142|132.06|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142||||142|85.2|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MULTIPLAN [1680]|HMA [168003]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MULTIPLAN [1680]|IHC HS [168011]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|Self-pay|Self-pay|142||||142|42.6|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142||||142|29.82|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|TRUSTMARK [2030]|STARMARK [203000]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142||||142|68.09|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|UMR [2035]|UMR OPTIONS [203501]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142||||142|127.8|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142||||142|0|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142||||142|52.54|132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142||||142||132.06|29.82
27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142||||142|71|132.06|29.82
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|167||||167|83.67|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167||||167|58.62|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167||||167|71.81|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|167||||167|71.14|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|167||||167|83.5|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167||||167|108.55|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|CORESOURCE [1315]|CORESOURCE [131500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|167||||167|61.79|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|GEHA [1415]|GEHA [141500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HEALTHNET [1495]|HEALTHNET [149500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167||||167|71.81|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|167||||167|155.31|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167||||167|100.2|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MULTIPLAN [1680]|HMA [168003]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MULTIPLAN [1680]|IHC HS [168011]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|Self-pay|Self-pay|167||||167|50.1|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167||||167|35.07|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|TRUSTMARK [2030]|STARMARK [203000]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167||||167|80.08|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|UMR [2035]|UMR OPTIONS [203501]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167||||167|150.3|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|167||||167|0|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|167||||167|61.79|155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|167||||167||155.31|35.07
27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|167||||167|83.5|155.31|35.07
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|AETNA [1015]|AETNA ACO WILCO [101532]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19||||19|9.52|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19||||19|6.67|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19||||19|8.17|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19||||19|8.09|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19||||19|9.5|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19||||19|12.35|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|CORESOURCE [1315]|CORESOURCE [131500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19||||19|7.03|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|GEHA [1415]|GEHA [141500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HEALTHNET [1495]|HEALTHNET [149500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19||||19|8.17|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19||||19|17.67|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19||||19|11.4|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MULTIPLAN [1680]|HMA [168003]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MULTIPLAN [1680]|IHC HS [168011]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|Self-pay|Self-pay|19||||19|5.7|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19||||19|3.99|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|TRUSTMARK [2030]|STARMARK [203000]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19||||19|9.11|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|UMR [2035]|UMR OPTIONS [203501]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19||||19|17.1|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19||||19|0|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19||||19|7.03|17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19||||19||17.67|3.99
27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19||||19|9.5|17.67|3.99
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|AETNA [1015]|AETNA ACO WILCO [101532]|9||||9|0|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9||||9|25.25|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9||||9|25.25|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9||||9|4.51|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9||||9|3.16|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9||||9|3.87|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9||||9|3.83|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9||||9|4.5|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9||||9|5.85|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|CORESOURCE [1315]|CORESOURCE [131500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9||||9|0|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9||||9|3.33|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|GEHA [1415]|GEHA [141500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HEALTHNET [1495]|HEALTHNET [149500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9||||9|3.87|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9||||9|8.37|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9||||9|5.4|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9||||9|4.5|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9||||9|9|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MULTIPLAN [1680]|HMA [168003]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MULTIPLAN [1680]|IHC HS [168011]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9||||9|9|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|Self-pay|Self-pay|9||||9|2.7|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9||||9|1.89|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|TRUSTMARK [2030]|STARMARK [203000]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9||||9|4.32|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|UMR [2035]|UMR OPTIONS [203501]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9||||9|9|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9||||9|8.1|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9||||9|0|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9||||9|3.33|25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9||||9||25.25|1.89
27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9||||9|4.5|25.25|1.89
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|AETNA [1015]|AETNA ACO WILCO [101532]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57||||57|28.56|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57||||57|20.01|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57||||57|24.51|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57||||57|24.28|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57||||57|28.5|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57||||57|37.05|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|CORESOURCE [1315]|CORESOURCE [131500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57||||57|21.09|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|GEHA [1415]|GEHA [141500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HEALTHNET [1495]|HEALTHNET [149500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57||||57|24.51|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|57||||57|53.01|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57||||57|34.2|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MULTIPLAN [1680]|HMA [168003]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MULTIPLAN [1680]|IHC HS [168011]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|Self-pay|Self-pay|57||||57|17.1|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57||||57|11.97|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|TRUSTMARK [2030]|STARMARK [203000]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57||||57|27.33|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|UMR [2035]|UMR OPTIONS [203501]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57||||57|51.3|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57||||57|0|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57||||57|21.09|53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57||||57||53.01|11.97
27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57||||57|28.5|53.01|11.97
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9||||9|4.51|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9||||9|3.16|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9||||9|3.87|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9||||9|3.83|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9||||9|4.5|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9||||9|5.85|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9||||9|3.33|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|GEHA [1415]|GEHA [141500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9||||9|3.87|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9||||9|8.37|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9||||9|5.4|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MULTIPLAN [1680]|HMA [168003]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|Self-pay|Self-pay|9||||9|2.7|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9||||9|1.89|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9||||9|4.32|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|UMR [2035]|UMR OPTIONS [203501]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9||||9|8.1|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9||||9|0|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9||||9|3.33|8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9||||9||8.37|1.89
27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9||||9|4.5|8.37|1.89
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15||||15|7.52|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15||||15|5.27|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15||||15|6.45|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15||||15|6.39|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15||||15|7.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15||||15|9.75|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|CORESOURCE [1315]|CORESOURCE [131500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15||||15|5.55|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|GEHA [1415]|GEHA [141500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HEALTHNET [1495]|HEALTHNET [149500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15||||15|6.45|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15||||15|13.95|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15||||15|9|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MULTIPLAN [1680]|HMA [168003]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MULTIPLAN [1680]|IHC HS [168011]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|Self-pay|Self-pay|15||||15|4.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15||||15|3.15|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|TRUSTMARK [2030]|STARMARK [203000]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15||||15|7.19|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|UMR [2035]|UMR OPTIONS [203501]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15||||15|13.5|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15||||15|0|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15||||15|5.55|13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15||||15||13.95|3.15
27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15||||15|7.5|13.95|3.15
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|AETNA [1015]|AETNA ACO WILCO [101532]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27||||27|13.53|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27||||27|9.48|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27||||27|11.61|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27||||27|11.5|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27||||27|13.5|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27||||27|17.55|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|CORESOURCE [1315]|CORESOURCE [131500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27||||27|9.99|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|GEHA [1415]|GEHA [141500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HEALTHNET [1495]|HEALTHNET [149500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27||||27|11.61|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27||||27|25.11|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27||||27|16.2|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MULTIPLAN [1680]|HMA [168003]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MULTIPLAN [1680]|IHC HS [168011]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|Self-pay|Self-pay|27||||27|8.1|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27||||27|5.67|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|TRUSTMARK [2030]|STARMARK [203000]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27||||27|12.95|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|UMR [2035]|UMR OPTIONS [203501]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27||||27|24.3|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27||||27|0|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27||||27|9.99|25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27||||27||25.11|5.67
27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27||||27|13.5|25.11|5.67
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|AETNA [1015]|AETNA ACO WILCO [101532]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2||||2|1|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2||||2|0.7|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2||||2|0.86|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2||||2|0.85|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2||||2|1|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2||||2|1.3|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|CORESOURCE [1315]|CORESOURCE [131500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2||||2|0.74|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|GEHA [1415]|GEHA [141500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HEALTHNET [1495]|HEALTHNET [149500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2||||2|0.86|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2||||2|1.86|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2||||2|1.2|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MULTIPLAN [1680]|HMA [168003]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MULTIPLAN [1680]|IHC HS [168011]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|Self-pay|Self-pay|2||||2|0.6|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2||||2|0.42|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|TRUSTMARK [2030]|STARMARK [203000]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2||||2|0.96|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|UMR [2035]|UMR OPTIONS [203501]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2||||2|1.8|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2||||2|0|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2||||2|0.74|1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2||||2||1.86|0.42
27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2||||2|1|1.86|0.42
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4||||4|2|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4||||4|1.4|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4||||4|1.72|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4||||4|1.7|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4||||4|2|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4||||4|2.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4||||4|1.48|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|GEHA [1415]|GEHA [141500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4||||4|1.72|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4||||4|3.72|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4||||4|2.4|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MULTIPLAN [1680]|HMA [168003]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|Self-pay|Self-pay|4||||4|1.2|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4||||4|0.84|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4||||4|1.92|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|UMR [2035]|UMR OPTIONS [203501]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4||||4|3.6|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4||||4|0|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4||||4|1.48|3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4||||4||3.72|0.84
27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4||||4|2|3.72|0.84
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8||||8|4.01|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8||||8|2.81|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8||||8|3.44|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8||||8|3.41|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8||||8|4|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8||||8|5.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|CORESOURCE [1315]|CORESOURCE [131500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8||||8|2.96|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|GEHA [1415]|GEHA [141500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HEALTHNET [1495]|HEALTHNET [149500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8||||8|3.44|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8||||8|7.44|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8||||8|4.8|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MULTIPLAN [1680]|HMA [168003]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MULTIPLAN [1680]|IHC HS [168011]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|Self-pay|Self-pay|8||||8|2.4|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8||||8|1.68|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|TRUSTMARK [2030]|STARMARK [203000]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8||||8|3.84|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|UMR [2035]|UMR OPTIONS [203501]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8||||8|7.2|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8||||8|0|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8||||8|2.96|7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8||||8||7.44|1.68
27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8||||8|4|7.44|1.68
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36||||36|18.04|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36||||36|12.64|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36||||36|15.48|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36||||36|15.34|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36||||36|18|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36||||36|23.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|CORESOURCE [1315]|CORESOURCE [131500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36||||36|13.32|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|GEHA [1415]|GEHA [141500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HEALTHNET [1495]|HEALTHNET [149500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36||||36|15.48|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36||||36|33.48|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36||||36|21.6|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MULTIPLAN [1680]|HMA [168003]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MULTIPLAN [1680]|IHC HS [168011]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|Self-pay|Self-pay|36||||36|10.8|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36||||36|7.56|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|TRUSTMARK [2030]|STARMARK [203000]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36||||36|17.26|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|UMR [2035]|UMR OPTIONS [203501]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36||||36|32.4|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36||||36|0|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36||||36|13.32|33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36||||36||33.48|7.56
27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36||||36|18|33.48|7.56
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|177||||177|88.68|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177||||177|62.13|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177||||177|76.11|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|177||||177|75.4|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|177||||177|88.5|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177||||177|115.05|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|CORESOURCE [1315]|CORESOURCE [131500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|177||||177|65.49|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|GEHA [1415]|GEHA [141500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HEALTHNET [1495]|HEALTHNET [149500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177||||177|76.11|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|177||||177|164.61|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177||||177|106.2|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MULTIPLAN [1680]|HMA [168003]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MULTIPLAN [1680]|IHC HS [168011]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|Self-pay|Self-pay|177||||177|53.1|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177||||177|37.17|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|TRUSTMARK [2030]|STARMARK [203000]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177||||177|84.87|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|UMR [2035]|UMR OPTIONS [203501]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177||||177|159.3|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|177||||177|0|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|177||||177|65.49|164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|177||||177||164.61|37.17
27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|177||||177|88.5|164.61|37.17
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|281||||281|140.78|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281||||281|98.63|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281||||281|120.83|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|281||||281|119.71|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|281||||281|140.5|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281||||281|182.65|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|CORESOURCE [1315]|CORESOURCE [131500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|281||||281|103.97|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|GEHA [1415]|GEHA [141500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HEALTHNET [1495]|HEALTHNET [149500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281||||281|120.83|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|281||||281|261.33|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281||||281|168.6|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MULTIPLAN [1680]|HMA [168003]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MULTIPLAN [1680]|IHC HS [168011]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|Self-pay|Self-pay|281||||281|84.3|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281||||281|59.01|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|TRUSTMARK [2030]|STARMARK [203000]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281||||281|134.74|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|UMR [2035]|UMR OPTIONS [203501]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281||||281|252.9|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|281||||281|0|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|281||||281|103.97|261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|281||||281||261.33|59.01
27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|281||||281|140.5|261.33|59.01
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|176||||176|88.18|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176||||176|61.78|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176||||176|75.68|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|176||||176|74.98|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|176||||176|88|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176||||176|114.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|CORESOURCE [1315]|CORESOURCE [131500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|176||||176|65.12|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|GEHA [1415]|GEHA [141500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HEALTHNET [1495]|HEALTHNET [149500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176||||176|75.68|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|176||||176|163.68|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176||||176|105.6|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MULTIPLAN [1680]|HMA [168003]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MULTIPLAN [1680]|IHC HS [168011]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|Self-pay|Self-pay|176||||176|52.8|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176||||176|36.96|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|TRUSTMARK [2030]|STARMARK [203000]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176||||176|84.39|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|UMR [2035]|UMR OPTIONS [203501]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176||||176|158.4|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|176||||176|0|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|176||||176|65.12|163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|176||||176||163.68|36.96
27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|176||||176|88|163.68|36.96
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22||||22|11.02|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22||||22|7.72|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22||||22|9.46|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22||||22|9.37|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22||||22|11|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22||||22|14.3|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|CORESOURCE [1315]|CORESOURCE [131500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22||||22|8.14|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|GEHA [1415]|GEHA [141500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HEALTHNET [1495]|HEALTHNET [149500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22||||22|9.46|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|22||||22|20.46|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22||||22|13.2|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MULTIPLAN [1680]|HMA [168003]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MULTIPLAN [1680]|IHC HS [168011]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|Self-pay|Self-pay|22||||22|6.6|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22||||22|4.62|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|TRUSTMARK [2030]|STARMARK [203000]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22||||22|10.55|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|UMR [2035]|UMR OPTIONS [203501]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22||||22|19.8|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22||||22|0|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22||||22|8.14|20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22||||22||20.46|4.62
27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22||||22|11|20.46|4.62
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123||||123|61.62|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123||||123|43.17|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123||||123|52.89|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123||||123|52.4|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123||||123|61.5|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123||||123|79.95|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|CORESOURCE [1315]|CORESOURCE [131500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123||||123|45.51|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|GEHA [1415]|GEHA [141500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HEALTHNET [1495]|HEALTHNET [149500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123||||123|52.89|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|123||||123|114.39|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123||||123|73.8|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MULTIPLAN [1680]|HMA [168003]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MULTIPLAN [1680]|IHC HS [168011]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|Self-pay|Self-pay|123||||123|36.9|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123||||123|25.83|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|TRUSTMARK [2030]|STARMARK [203000]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123||||123|58.98|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|UMR [2035]|UMR OPTIONS [203501]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123||||123|110.7|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123||||123|0|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123||||123|45.51|114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123||||123||114.39|25.83
27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123||||123|61.5|114.39|25.83
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|521||||521|261.02|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521||||521|182.87|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521||||521|224.03|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|521||||521|221.95|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|521||||521|260.5|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521||||521|338.65|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|CORESOURCE [1315]|CORESOURCE [131500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|521||||521|192.77|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|GEHA [1415]|GEHA [141500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HEALTHNET [1495]|HEALTHNET [149500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521||||521|224.03|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|521||||521|484.53|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|521||||521|312.6|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MULTIPLAN [1680]|HMA [168003]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MULTIPLAN [1680]|IHC HS [168011]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|Self-pay|Self-pay|521||||521|156.3|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521||||521|109.41|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|TRUSTMARK [2030]|STARMARK [203000]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521||||521|249.82|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|UMR [2035]|UMR OPTIONS [203501]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521||||521|468.9|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|521||||521|0|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|521||||521|192.77|484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|521||||521||484.53|109.41
27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|521||||521|260.5|484.53|109.41
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|98||||98|49.1|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98||||98|34.4|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98||||98|42.14|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|98||||98|41.75|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|98||||98|49|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98||||98|63.7|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|CORESOURCE [1315]|CORESOURCE [131500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|98||||98|36.26|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|GEHA [1415]|GEHA [141500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HEALTHNET [1495]|HEALTHNET [149500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98||||98|42.14|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|98||||98|91.14|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98||||98|58.8|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MULTIPLAN [1680]|HMA [168003]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MULTIPLAN [1680]|IHC HS [168011]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|Self-pay|Self-pay|98||||98|29.4|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98||||98|20.58|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|TRUSTMARK [2030]|STARMARK [203000]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98||||98|46.99|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|UMR [2035]|UMR OPTIONS [203501]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98||||98|88.2|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|98||||98|0|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|98||||98|36.26|91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|98||||98||91.14|20.58
27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|98||||98|49|91.14|20.58
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|194||||194|97.19|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194||||194|68.09|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194||||194|83.42|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|194||||194|82.64|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|194||||194|97|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194||||194|126.1|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|CORESOURCE [1315]|CORESOURCE [131500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|194||||194|71.78|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|GEHA [1415]|GEHA [141500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HEALTHNET [1495]|HEALTHNET [149500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194||||194|83.42|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|194||||194|180.42|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194||||194|116.4|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MULTIPLAN [1680]|HMA [168003]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MULTIPLAN [1680]|IHC HS [168011]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|Self-pay|Self-pay|194||||194|58.2|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194||||194|40.74|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|TRUSTMARK [2030]|STARMARK [203000]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194||||194|93.02|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|UMR [2035]|UMR OPTIONS [203501]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194||||194|174.6|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|194||||194|0|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|194||||194|71.78|180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|194||||194||180.42|40.74
27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|194||||194|97|180.42|40.74
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|Self-pay|Self-pay|90||||90|27|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43||||43|21.54|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43||||43|15.09|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43||||43|18.49|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43||||43|18.32|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43||||43|21.5|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43||||43|27.95|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|CORESOURCE [1315]|CORESOURCE [131500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43||||43|15.91|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|GEHA [1415]|GEHA [141500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HEALTHNET [1495]|HEALTHNET [149500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43||||43|18.49|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43||||43|39.99|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43||||43|25.8|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MULTIPLAN [1680]|HMA [168003]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MULTIPLAN [1680]|IHC HS [168011]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|Self-pay|Self-pay|43||||43|12.9|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43||||43|9.03|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|TRUSTMARK [2030]|STARMARK [203000]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43||||43|20.62|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|UMR [2035]|UMR OPTIONS [203501]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43||||43|38.7|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43||||43|0|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43||||43|15.91|39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43||||43||39.99|9.03
27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43||||43|21.5|39.99|9.03
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|154||||154|77.15|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154||||154|54.05|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154||||154|66.22|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|154||||154|65.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|154||||154|77|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154||||154|100.1|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|CORESOURCE [1315]|CORESOURCE [131500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|154||||154|56.98|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|GEHA [1415]|GEHA [141500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HEALTHNET [1495]|HEALTHNET [149500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154||||154|66.22|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|154||||154|143.22|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154||||154|92.4|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MULTIPLAN [1680]|HMA [168003]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MULTIPLAN [1680]|IHC HS [168011]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|Self-pay|Self-pay|154||||154|46.2|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154||||154|32.34|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|TRUSTMARK [2030]|STARMARK [203000]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154||||154|73.84|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|UMR [2035]|UMR OPTIONS [203501]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154||||154|138.6|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|154||||154|0|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|154||||154|56.98|143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|154||||154||143.22|32.34
27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|154||||154|77|143.22|32.34
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|AETNA [1015]|AETNA ACO WILCO [101532]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|173||||173|86.67|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173||||173|60.72|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173||||173|74.39|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|173||||173|73.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|173||||173|86.5|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173||||173|112.45|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|CORESOURCE [1315]|CORESOURCE [131500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|173||||173|64.01|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|GEHA [1415]|GEHA [141500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HEALTHNET [1495]|HEALTHNET [149500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173||||173|74.39|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|173||||173|160.89|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173||||173|103.8|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MULTIPLAN [1680]|HMA [168003]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MULTIPLAN [1680]|IHC HS [168011]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|Self-pay|Self-pay|173||||173|51.9|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173||||173|36.33|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|TRUSTMARK [2030]|STARMARK [203000]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173||||173|82.95|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|UMR [2035]|UMR OPTIONS [203501]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173||||173|155.7|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|173||||173|0|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|173||||173|64.01|160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|173||||173||160.89|36.33
27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|173||||173|86.5|160.89|36.33
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|236||||236|118.24|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236||||236|82.84|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236||||236|101.48|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|236||||236|100.54|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|236||||236|118|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236||||236|153.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|236||||236|87.32|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|GEHA [1415]|GEHA [141500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236||||236|101.48|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|236||||236|219.48|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236||||236|141.6|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MULTIPLAN [1680]|HMA [168003]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|Self-pay|Self-pay|236||||236|70.8|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236||||236|49.56|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236||||236|113.16|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|UMR [2035]|UMR OPTIONS [203501]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236||||236|212.4|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|236||||236|0|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|236||||236|87.32|219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|236||||236||219.48|49.56
27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|236||||236|118|219.48|49.56
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63||||63|31.56|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63||||63|22.11|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63||||63|27.09|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63||||63|26.84|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63||||63|31.5|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63||||63|40.95|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|CORESOURCE [1315]|CORESOURCE [131500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63||||63|23.31|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|GEHA [1415]|GEHA [141500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HEALTHNET [1495]|HEALTHNET [149500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63||||63|27.09|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63||||63|58.59|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63||||63|37.8|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MULTIPLAN [1680]|HMA [168003]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MULTIPLAN [1680]|IHC HS [168011]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|Self-pay|Self-pay|63||||63|18.9|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63||||63|13.23|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|TRUSTMARK [2030]|STARMARK [203000]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63||||63|30.21|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|UMR [2035]|UMR OPTIONS [203501]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63||||63|56.7|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63||||63|0|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63||||63|23.31|58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63||||63||58.59|13.23
27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63||||63|31.5|58.59|13.23
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50||||50|25.05|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50||||50|17.55|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50||||50|21.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50||||50|21.3|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50||||50|25|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50||||50|32.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|CORESOURCE [1315]|CORESOURCE [131500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50||||50|18.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|GEHA [1415]|GEHA [141500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HEALTHNET [1495]|HEALTHNET [149500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50||||50|21.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50||||50|46.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50||||50|30|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MULTIPLAN [1680]|HMA [168003]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MULTIPLAN [1680]|IHC HS [168011]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|Self-pay|Self-pay|50||||50|15|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50||||50|10.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|TRUSTMARK [2030]|STARMARK [203000]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50||||50|23.98|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|UMR [2035]|UMR OPTIONS [203501]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50||||50|45|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50||||50|0|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50||||50|18.5|46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50||||50||46.5|10.5
27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50||||50|25|46.5|10.5
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|AETNA [1015]|AETNA ACO WILCO [101532]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22||||22|11.02|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22||||22|7.72|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22||||22|9.46|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22||||22|9.37|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22||||22|11|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22||||22|14.3|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|CORESOURCE [1315]|CORESOURCE [131500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|CORVEL CORP [2235]|CORVEL CORP [223500]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22||||22|8.14|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|GEHA [1415]|GEHA [141500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HEALTHNET [1495]|HEALTHNET [149500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22||||22|9.46|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HEALTHSMART [1505]|HEALTHSMART [150501]|22||||22|20.46|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22||||22|13.2|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MULTIPLAN [1680]|HMA [168003]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MULTIPLAN [1680]|IHC HS [168011]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|Self-pay|Self-pay|22||||22|6.6|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22||||22|4.62|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|TRUSTMARK [2030]|STARMARK [203000]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22||||22|10.55|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|UMR [2035]|UMR OPTIONS [203501]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22||||22|19.8|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22||||22|0|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22||||22|8.14|20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22||||22||20.46|4.62
27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22||||22|11|20.46|4.62
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|AETNA [1015]|AETNA ACO WILCO [101532]|28||||28|0|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28||||28|25.25|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28||||28|25.25|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28||||28|14.03|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28||||28|9.83|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28||||28|12.04|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28||||28|11.93|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28||||28|14|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28||||28|18.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|CORESOURCE [1315]|CORESOURCE [131500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28||||28|0|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28||||28|10.36|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|GEHA [1415]|GEHA [141500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HEALTHNET [1495]|HEALTHNET [149500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28||||28|12.04|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28||||28|26.04|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28||||28|16.8|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28||||28|14|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28||||28|24.34|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MULTIPLAN [1680]|HMA [168003]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MULTIPLAN [1680]|IHC HS [168011]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28||||28|26.24|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|Self-pay|Self-pay|28||||28|8.4|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28||||28|5.88|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|TRUSTMARK [2030]|STARMARK [203000]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28||||28|13.43|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|UMR [2035]|UMR OPTIONS [203501]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28||||28|23.18|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28||||28|25.2|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28||||28|0|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28||||28|10.36|26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28||||28||26.24|5.88
27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28||||28|14|26.24|5.88
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|AETNA [1015]|AETNA ACO WILCO [101532]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14||||14|7.01|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14||||14|4.91|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14||||14|6.02|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14||||14|5.96|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14||||14|7|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14||||14|9.1|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|CORESOURCE [1315]|CORESOURCE [131500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14||||14|5.18|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|GEHA [1415]|GEHA [141500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HEALTHNET [1495]|HEALTHNET [149500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14||||14|6.02|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14||||14|13.02|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14||||14|8.4|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MULTIPLAN [1680]|HMA [168003]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MULTIPLAN [1680]|IHC HS [168011]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|Self-pay|Self-pay|14||||14|4.2|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14||||14|2.94|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|TRUSTMARK [2030]|STARMARK [203000]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14||||14|6.71|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|UMR [2035]|UMR OPTIONS [203501]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14||||14|12.6|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14||||14|0|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14||||14|5.18|13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14||||14||13.02|2.94
27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14||||14|7|13.02|2.94
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34||||34|17.03|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34||||34|11.93|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34||||34|14.62|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34||||34|14.48|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34||||34|17|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34||||34|22.1|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34||||34|12.58|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|GEHA [1415]|GEHA [141500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34||||34|14.62|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34||||34|31.62|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34||||34|20.4|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MULTIPLAN [1680]|HMA [168003]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|Self-pay|Self-pay|34||||34|10.2|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34||||34|7.14|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34||||34|16.3|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|UMR [2035]|UMR OPTIONS [203501]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34||||34|30.6|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34||||34|0|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34||||34|12.58|31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34||||34||31.62|7.14
27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34||||34|17|31.62|7.14
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|AETNA [1015]|AETNA ACO WILCO [101532]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27||||27|13.53|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27||||27|9.48|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27||||27|11.61|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27||||27|11.5|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27||||27|13.5|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27||||27|17.55|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|CORESOURCE [1315]|CORESOURCE [131500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27||||27|9.99|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|GEHA [1415]|GEHA [141500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HEALTHNET [1495]|HEALTHNET [149500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27||||27|11.61|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27||||27|25.11|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27||||27|16.2|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MULTIPLAN [1680]|HMA [168003]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MULTIPLAN [1680]|IHC HS [168011]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|Self-pay|Self-pay|27||||27|8.1|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27||||27|5.67|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|TRUSTMARK [2030]|STARMARK [203000]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27||||27|12.95|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|UMR [2035]|UMR OPTIONS [203501]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27||||27|24.3|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27||||27|0|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27||||27|9.99|25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27||||27||25.11|5.67
27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27||||27|13.5|25.11|5.67
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22||||22|11.02|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22||||22|7.72|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22||||22|9.46|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22||||22|9.37|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22||||22|11|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22||||22|14.3|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|CORESOURCE [1315]|CORESOURCE [131500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22||||22|8.14|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|GEHA [1415]|GEHA [141500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HEALTHNET [1495]|HEALTHNET [149500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22||||22|9.46|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|22||||22|20.46|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22||||22|13.2|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MULTIPLAN [1680]|HMA [168003]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MULTIPLAN [1680]|IHC HS [168011]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|Self-pay|Self-pay|22||||22|6.6|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22||||22|4.62|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|TRUSTMARK [2030]|STARMARK [203000]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22||||22|10.55|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|UMR [2035]|UMR OPTIONS [203501]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22||||22|19.8|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22||||22|0|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22||||22|8.14|20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22||||22||20.46|4.62
27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22||||22|11|20.46|4.62
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|AETNA [1015]|AETNA ACO WILCO [101532]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16||||16|8.02|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16||||16|5.62|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16||||16|6.88|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16||||16|6.82|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16||||16|8|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16||||16|10.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|CORESOURCE [1315]|CORESOURCE [131500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|CORVEL CORP [2235]|CORVEL CORP [223500]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16||||16|5.92|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|GEHA [1415]|GEHA [141500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HEALTHNET [1495]|HEALTHNET [149500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16||||16|6.88|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HEALTHSMART [1505]|HEALTHSMART [150501]|16||||16|14.88|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16||||16|9.6|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MULTIPLAN [1680]|HMA [168003]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MULTIPLAN [1680]|IHC HS [168011]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|Self-pay|Self-pay|16||||16|4.8|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16||||16|3.36|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|TRUSTMARK [2030]|STARMARK [203000]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16||||16|7.67|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|UMR [2035]|UMR OPTIONS [203501]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16||||16|14.4|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16||||16|0|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16||||16|5.92|14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16||||16||14.88|3.36
27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16||||16|8|14.88|3.36
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37||||37|18.54|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37||||37|12.99|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37||||37|15.91|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37||||37|15.76|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37||||37|18.5|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37||||37|24.05|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37||||37|13.69|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|GEHA [1415]|GEHA [141500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37||||37|15.91|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37||||37|34.41|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37||||37|22.2|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MULTIPLAN [1680]|HMA [168003]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|Self-pay|Self-pay|37||||37|11.1|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37||||37|7.77|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37||||37|17.74|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|UMR [2035]|UMR OPTIONS [203501]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37||||37|33.3|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37||||37|0|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37||||37|13.69|34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37||||37||34.41|7.77
27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37||||37|18.5|34.41|7.77
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28||||28|14.03|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28||||28|9.83|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28||||28|12.04|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28||||28|11.93|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28||||28|14|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28||||28|18.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28||||28|10.36|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|GEHA [1415]|GEHA [141500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28||||28|12.04|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28||||28|26.04|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28||||28|16.8|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MULTIPLAN [1680]|HMA [168003]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|Self-pay|Self-pay|28||||28|8.4|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28||||28|5.88|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28||||28|13.43|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|UMR [2035]|UMR OPTIONS [203501]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28||||28|25.2|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28||||28|0|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28||||28|10.36|26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28||||28||26.04|5.88
27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28||||28|14|26.04|5.88
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39||||39|19.54|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39||||39|13.69|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39||||39|16.77|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39||||39|16.61|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39||||39|19.5|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39||||39|25.35|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|CORESOURCE [1315]|CORESOURCE [131500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39||||39|14.43|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|GEHA [1415]|GEHA [141500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HEALTHNET [1495]|HEALTHNET [149500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39||||39|16.77|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39||||39|36.27|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39||||39|23.4|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MULTIPLAN [1680]|HMA [168003]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MULTIPLAN [1680]|IHC HS [168011]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|Self-pay|Self-pay|39||||39|11.7|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39||||39|8.19|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|TRUSTMARK [2030]|STARMARK [203000]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39||||39|18.7|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|UMR [2035]|UMR OPTIONS [203501]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39||||39|35.1|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39||||39|0|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39||||39|14.43|36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39||||39||36.27|8.19
27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39||||39|19.5|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39||||39|19.54|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39||||39|13.69|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39||||39|16.77|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39||||39|16.61|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39||||39|19.5|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39||||39|25.35|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39||||39|14.43|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|GEHA [1415]|GEHA [141500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39||||39|16.77|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39||||39|36.27|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39||||39|23.4|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MULTIPLAN [1680]|HMA [168003]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MULTIPLAN [1680]|IHC HS [168011]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|Self-pay|Self-pay|39||||39|11.7|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39||||39|8.19|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|TRUSTMARK [2030]|STARMARK [203000]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39||||39|18.7|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|UMR [2035]|UMR OPTIONS [203501]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39||||39|35.1|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39||||39|0|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39||||39|14.43|36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39||||39||36.27|8.19
27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39||||39|19.5|36.27|8.19
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19||||19|9.52|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19||||19|6.67|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19||||19|8.17|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19||||19|8.09|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19||||19|9.5|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19||||19|12.35|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19||||19|7.03|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|GEHA [1415]|GEHA [141500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19||||19|8.17|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19||||19|17.67|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19||||19|11.4|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MULTIPLAN [1680]|HMA [168003]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MULTIPLAN [1680]|IHC HS [168011]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|Self-pay|Self-pay|19||||19|5.7|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19||||19|3.99|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|TRUSTMARK [2030]|STARMARK [203000]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19||||19|9.11|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|UMR [2035]|UMR OPTIONS [203501]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19||||19|17.1|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19||||19|0|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19||||19|7.03|17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19||||19||17.67|3.99
27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19||||19|9.5|17.67|3.99
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|AETNA [1015]|AETNA ACO WILCO [101532]|26||||26|0|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26||||26|12.79|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26||||26|12.79|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26||||26|13.03|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26||||26|9.13|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26||||26|11.18|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26||||26|11.08|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26||||26|13|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26||||26|16.9|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|CORESOURCE [1315]|CORESOURCE [131500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26||||26|0|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26||||26|9.62|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|GEHA [1415]|GEHA [141500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HEALTHNET [1495]|HEALTHNET [149500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26||||26|11.18|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26||||26|24.18|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26||||26|15.6|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26||||26|13|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26||||26|12.35|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MULTIPLAN [1680]|HMA [168003]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MULTIPLAN [1680]|IHC HS [168011]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26||||26|13.29|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|Self-pay|Self-pay|26||||26|7.8|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26||||26|5.46|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|TRUSTMARK [2030]|STARMARK [203000]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26||||26|12.47|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|UMR [2035]|UMR OPTIONS [203501]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26||||26|11.77|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26||||26|23.4|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26||||26|0|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26||||26|9.62|24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26||||26||24.18|5.46
27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26||||26|13|24.18|5.46
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46||||46|23.05|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46||||46|16.15|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46||||46|19.78|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46||||46|19.6|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46||||46|23|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46||||46|29.9|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46||||46|17.02|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|GEHA [1415]|GEHA [141500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46||||46|19.78|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46||||46|42.78|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46||||46|27.6|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MULTIPLAN [1680]|HMA [168003]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MULTIPLAN [1680]|IHC HS [168011]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|Self-pay|Self-pay|46||||46|13.8|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46||||46|9.66|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|TRUSTMARK [2030]|STARMARK [203000]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46||||46|22.06|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|UMR [2035]|UMR OPTIONS [203501]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46||||46|41.4|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46||||46|0|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46||||46|17.02|42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46||||46||42.78|9.66
27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46||||46|23|42.78|9.66
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53||||53|26.55|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53||||53|18.6|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53||||53|22.79|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53||||53|22.58|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53||||53|26.5|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53||||53|34.45|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53||||53|19.61|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|GEHA [1415]|GEHA [141500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53||||53|22.79|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53||||53|49.29|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53||||53|31.8|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MULTIPLAN [1680]|HMA [168003]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MULTIPLAN [1680]|IHC HS [168011]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|Self-pay|Self-pay|53||||53|15.9|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53||||53|11.13|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|TRUSTMARK [2030]|STARMARK [203000]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53||||53|25.41|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|UMR [2035]|UMR OPTIONS [203501]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53||||53|47.7|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53||||53|0|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53||||53|19.61|49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53||||53||49.29|11.13
27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53||||53|26.5|49.29|11.13
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25||||25|12.53|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25||||25|8.78|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25||||25|10.75|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25||||25|10.65|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25||||25|12.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25||||25|16.25|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25||||25|9.25|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|GEHA [1415]|GEHA [141500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25||||25|10.75|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25||||25|23.25|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25||||25|15|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MULTIPLAN [1680]|HMA [168003]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MULTIPLAN [1680]|IHC HS [168011]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|Self-pay|Self-pay|25||||25|7.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25||||25|5.25|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|TRUSTMARK [2030]|STARMARK [203000]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25||||25|11.99|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|UMR [2035]|UMR OPTIONS [203501]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25||||25|22.5|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25||||25|0|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25||||25|9.25|23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25||||25||23.25|5.25
27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25||||25|12.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25||||25|12.53|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25||||25|8.78|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25||||25|10.75|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25||||25|10.65|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25||||25|12.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25||||25|16.25|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|CORESOURCE [1315]|CORESOURCE [131500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25||||25|9.25|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|GEHA [1415]|GEHA [141500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HEALTHNET [1495]|HEALTHNET [149500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25||||25|10.75|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25||||25|23.25|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25||||25|15|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MULTIPLAN [1680]|HMA [168003]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MULTIPLAN [1680]|IHC HS [168011]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|Self-pay|Self-pay|25||||25|7.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25||||25|5.25|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|TRUSTMARK [2030]|STARMARK [203000]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25||||25|11.99|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|UMR [2035]|UMR OPTIONS [203501]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25||||25|22.5|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25||||25|0|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25||||25|9.25|23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25||||25||23.25|5.25
27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25||||25|12.5|23.25|5.25
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15||||15|7.52|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15||||15|5.27|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15||||15|6.45|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15||||15|6.39|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15||||15|7.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15||||15|9.75|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|CORESOURCE [1315]|CORESOURCE [131500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15||||15|5.55|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|GEHA [1415]|GEHA [141500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HEALTHNET [1495]|HEALTHNET [149500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15||||15|6.45|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15||||15|13.95|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15||||15|9|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MULTIPLAN [1680]|HMA [168003]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MULTIPLAN [1680]|IHC HS [168011]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|Self-pay|Self-pay|15||||15|4.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15||||15|3.15|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|TRUSTMARK [2030]|STARMARK [203000]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15||||15|7.19|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|UMR [2035]|UMR OPTIONS [203501]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15||||15|13.5|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15||||15|0|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15||||15|5.55|13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15||||15||13.95|3.15
27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15||||15|7.5|13.95|3.15
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32||||32|16.03|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32||||32|11.23|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32||||32|13.76|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32||||32|13.63|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32||||32|16|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32||||32|20.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|CORESOURCE [1315]|CORESOURCE [131500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32||||32|11.84|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|GEHA [1415]|GEHA [141500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HEALTHNET [1495]|HEALTHNET [149500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32||||32|13.76|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32||||32|29.76|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32||||32|19.2|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MULTIPLAN [1680]|HMA [168003]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MULTIPLAN [1680]|IHC HS [168011]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|Self-pay|Self-pay|32||||32|9.6|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32||||32|6.72|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|TRUSTMARK [2030]|STARMARK [203000]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32||||32|15.34|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|UMR [2035]|UMR OPTIONS [203501]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32||||32|28.8|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32||||32|0|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32||||32|11.84|29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32||||32||29.76|6.72
27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32||||32|16|29.76|6.72
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|AETNA [1015]|AETNA ACO WILCO [101532]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31||||31|15.53|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31||||31|10.88|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31||||31|13.33|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31||||31|13.21|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31||||31|15.5|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31||||31|20.15|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|CORESOURCE [1315]|CORESOURCE [131500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31||||31|11.47|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|GEHA [1415]|GEHA [141500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HEALTHNET [1495]|HEALTHNET [149500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31||||31|13.33|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31||||31|28.83|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31||||31|18.6|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MULTIPLAN [1680]|HMA [168003]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MULTIPLAN [1680]|IHC HS [168011]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|Self-pay|Self-pay|31||||31|9.3|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31||||31|6.51|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|TRUSTMARK [2030]|STARMARK [203000]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31||||31|14.86|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|UMR [2035]|UMR OPTIONS [203501]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31||||31|27.9|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31||||31|0|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31||||31|11.47|28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31||||31||28.83|6.51
27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31||||31|15.5|28.83|6.51
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|AETNA [1015]|AETNA ACO WILCO [101532]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6||||6|3.01|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6||||6|2.11|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6||||6|2.58|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6||||6|2.56|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6||||6|3|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6||||6|3.9|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|CORESOURCE [1315]|CORESOURCE [131500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6||||6|2.22|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|GEHA [1415]|GEHA [141500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HEALTHNET [1495]|HEALTHNET [149500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6||||6|2.58|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6||||6|5.58|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6||||6|3.6|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MULTIPLAN [1680]|HMA [168003]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MULTIPLAN [1680]|IHC HS [168011]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|Self-pay|Self-pay|6||||6|1.8|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6||||6|1.26|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|TRUSTMARK [2030]|STARMARK [203000]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6||||6|2.88|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|UMR [2035]|UMR OPTIONS [203501]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6||||6|5.4|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6||||6|0|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6||||6|2.22|5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6||||6||5.58|1.26
27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6||||6|3|5.58|1.26
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41||||41|20.54|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41||||41|14.39|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41||||41|17.63|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41||||41|17.47|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41||||41|20.5|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41||||41|26.65|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|CORESOURCE [1315]|CORESOURCE [131500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41||||41|15.17|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|GEHA [1415]|GEHA [141500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HEALTHNET [1495]|HEALTHNET [149500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41||||41|17.63|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41||||41|38.13|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41||||41|24.6|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MULTIPLAN [1680]|HMA [168003]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MULTIPLAN [1680]|IHC HS [168011]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|Self-pay|Self-pay|41||||41|12.3|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41||||41|8.61|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|TRUSTMARK [2030]|STARMARK [203000]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41||||41|19.66|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|UMR [2035]|UMR OPTIONS [203501]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41||||41|36.9|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41||||41|0|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41||||41|15.17|38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41||||41||38.13|8.61
27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41||||41|20.5|38.13|8.61
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35||||35|17.54|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35||||35|12.29|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35||||35|15.05|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35||||35|14.91|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35||||35|17.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35||||35|22.75|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35||||35|12.95|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|GEHA [1415]|GEHA [141500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35||||35|15.05|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35||||35|32.55|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35||||35|21|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MULTIPLAN [1680]|HMA [168003]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|Self-pay|Self-pay|35||||35|10.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35||||35|7.35|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35||||35|16.78|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35||||35|31.5|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35||||35|0|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35||||35|12.95|32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35||||35||32.55|7.35
27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35||||35|17.5|32.55|7.35
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123||||123|61.62|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123||||123|43.17|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123||||123|52.89|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123||||123|52.4|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123||||123|61.5|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123||||123|79.95|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123||||123|45.51|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|GEHA [1415]|GEHA [141500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123||||123|52.89|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|123||||123|114.39|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123||||123|73.8|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MULTIPLAN [1680]|HMA [168003]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|Self-pay|Self-pay|123||||123|36.9|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123||||123|25.83|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123||||123|58.98|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123||||123|110.7|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123||||123|0|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123||||123|45.51|114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123||||123||114.39|25.83
27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123||||123|61.5|114.39|25.83
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139||||139|69.64|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139||||139|48.79|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139||||139|59.77|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139||||139|59.21|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139||||139|69.5|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139||||139|90.35|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139||||139|51.43|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|GEHA [1415]|GEHA [141500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139||||139|59.77|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139||||139|129.27|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139||||139|83.4|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MULTIPLAN [1680]|HMA [168003]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|Self-pay|Self-pay|139||||139|41.7|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139||||139|29.19|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139||||139|66.65|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139||||139|125.1|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139||||139|0|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139||||139|51.43|129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139||||139||129.27|29.19
27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139||||139|69.5|129.27|29.19
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95||||95|47.6|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95||||95|33.35|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95||||95|40.85|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95||||95|40.47|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95||||95|47.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95||||95|61.75|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|CORESOURCE [1315]|CORESOURCE [131500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95||||95|35.15|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|GEHA [1415]|GEHA [141500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HEALTHNET [1495]|HEALTHNET [149500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95||||95|40.85|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95||||95|88.35|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95||||95|57|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MULTIPLAN [1680]|HMA [168003]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MULTIPLAN [1680]|IHC HS [168011]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|Self-pay|Self-pay|95||||95|28.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95||||95|19.95|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|TRUSTMARK [2030]|STARMARK [203000]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95||||95|45.55|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|UMR [2035]|UMR OPTIONS [203501]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95||||95|85.5|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95||||95|0|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95||||95|35.15|88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95||||95||88.35|19.95
27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95||||95|47.5|88.35|19.95
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61||||61|30.56|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61||||61|21.41|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61||||61|26.23|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61||||61|25.99|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61||||61|30.5|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61||||61|39.65|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61||||61|22.57|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|GEHA [1415]|GEHA [141500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61||||61|26.23|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61||||61|56.73|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61||||61|36.6|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MULTIPLAN [1680]|HMA [168003]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|Self-pay|Self-pay|61||||61|18.3|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61||||61|12.81|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61||||61|29.25|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61||||61|54.9|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61||||61|0|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61||||61|22.57|56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61||||61||56.73|12.81
27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61||||61|30.5|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61||||61|30.56|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61||||61|21.41|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61||||61|26.23|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61||||61|25.99|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61||||61|30.5|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61||||61|39.65|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61||||61|22.57|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|GEHA [1415]|GEHA [141500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61||||61|26.23|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61||||61|56.73|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61||||61|36.6|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MULTIPLAN [1680]|HMA [168003]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|Self-pay|Self-pay|61||||61|18.3|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61||||61|12.81|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61||||61|29.25|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61||||61|54.9|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61||||61|0|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61||||61|22.57|56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61||||61||56.73|12.81
27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61||||61|30.5|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61||||61|30.56|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61||||61|21.41|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61||||61|26.23|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61||||61|25.99|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61||||61|30.5|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61||||61|39.65|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61||||61|22.57|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|GEHA [1415]|GEHA [141500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61||||61|26.23|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61||||61|56.73|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61||||61|36.6|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MULTIPLAN [1680]|HMA [168003]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|Self-pay|Self-pay|61||||61|18.3|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61||||61|12.81|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61||||61|29.25|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61||||61|54.9|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61||||61|0|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61||||61|22.57|56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61||||61||56.73|12.81
27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61||||61|30.5|56.73|12.81
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55||||55|27.56|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55||||55|19.31|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55||||55|23.65|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55||||55|23.43|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55||||55|27.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55||||55|35.75|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|CORESOURCE [1315]|CORESOURCE [131500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55||||55|20.35|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|GEHA [1415]|GEHA [141500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HEALTHNET [1495]|HEALTHNET [149500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55||||55|23.65|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55||||55|51.15|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55||||55|33|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MULTIPLAN [1680]|HMA [168003]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MULTIPLAN [1680]|IHC HS [168011]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|Self-pay|Self-pay|55||||55|16.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55||||55|11.55|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|TRUSTMARK [2030]|STARMARK [203000]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55||||55|26.37|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|UMR [2035]|UMR OPTIONS [203501]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55||||55|49.5|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55||||55|0|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55||||55|20.35|51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55||||55||51.15|11.55
27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55||||55|27.5|51.15|11.55
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|AETNA [1015]|AETNA ACO WILCO [101532]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17||||17|8.52|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17||||17|5.97|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17||||17|7.31|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17||||17|7.24|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17||||17|8.5|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17||||17|11.05|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|CORESOURCE [1315]|CORESOURCE [131500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17||||17|6.29|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|GEHA [1415]|GEHA [141500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HEALTHNET [1495]|HEALTHNET [149500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17||||17|7.31|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|17||||17|15.81|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17||||17|10.2|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MULTIPLAN [1680]|HMA [168003]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MULTIPLAN [1680]|IHC HS [168011]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|Self-pay|Self-pay|17||||17|5.1|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17||||17|3.57|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|TRUSTMARK [2030]|STARMARK [203000]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17||||17|8.15|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|UMR [2035]|UMR OPTIONS [203501]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17||||17|15.3|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17||||17|0|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17||||17|6.29|15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17||||17||15.81|3.57
27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17||||17|8.5|15.81|3.57
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|AETNA [1015]|AETNA ACO WILCO [101532]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41||||41|20.54|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41||||41|14.39|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41||||41|17.63|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41||||41|17.47|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41||||41|20.5|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41||||41|26.65|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|CORESOURCE [1315]|CORESOURCE [131500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41||||41|15.17|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|GEHA [1415]|GEHA [141500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HEALTHNET [1495]|HEALTHNET [149500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41||||41|17.63|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41||||41|38.13|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41||||41|24.6|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MULTIPLAN [1680]|HMA [168003]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MULTIPLAN [1680]|IHC HS [168011]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|Self-pay|Self-pay|41||||41|12.3|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41||||41|8.61|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|TRUSTMARK [2030]|STARMARK [203000]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41||||41|19.66|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|UMR [2035]|UMR OPTIONS [203501]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41||||41|36.9|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41||||41|0|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41||||41|15.17|38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41||||41||38.13|8.61
27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41||||41|20.5|38.13|8.61
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95||||95|47.6|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95||||95|33.35|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95||||95|40.85|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95||||95|40.47|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95||||95|47.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95||||95|61.75|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|CORESOURCE [1315]|CORESOURCE [131500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95||||95|35.15|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|GEHA [1415]|GEHA [141500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HEALTHNET [1495]|HEALTHNET [149500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95||||95|40.85|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95||||95|88.35|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95||||95|57|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MULTIPLAN [1680]|HMA [168003]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MULTIPLAN [1680]|IHC HS [168011]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|Self-pay|Self-pay|95||||95|28.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95||||95|19.95|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|TRUSTMARK [2030]|STARMARK [203000]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95||||95|45.55|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|UMR [2035]|UMR OPTIONS [203501]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95||||95|85.5|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95||||95|0|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95||||95|35.15|88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95||||95||88.35|19.95
27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95||||95|47.5|88.35|19.95
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|AETNA [1015]|AETNA ACO WILCO [101532]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35||||35|17.54|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35||||35|12.29|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35||||35|15.05|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35||||35|14.91|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35||||35|17.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35||||35|22.75|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|CORESOURCE [1315]|CORESOURCE [131500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35||||35|12.95|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|GEHA [1415]|GEHA [141500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HEALTHNET [1495]|HEALTHNET [149500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35||||35|15.05|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35||||35|32.55|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35||||35|21|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MULTIPLAN [1680]|HMA [168003]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MULTIPLAN [1680]|IHC HS [168011]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|Self-pay|Self-pay|35||||35|10.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35||||35|7.35|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|TRUSTMARK [2030]|STARMARK [203000]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35||||35|16.78|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|UMR [2035]|UMR OPTIONS [203501]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35||||35|31.5|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35||||35|0|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35||||35|12.95|32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35||||35||32.55|7.35
27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35||||35|17.5|32.55|7.35
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95||||95|47.6|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95||||95|33.35|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95||||95|40.85|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95||||95|40.47|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95||||95|47.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95||||95|61.75|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95||||95|35.15|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|GEHA [1415]|GEHA [141500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95||||95|40.85|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95||||95|88.35|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95||||95|57|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MULTIPLAN [1680]|HMA [168003]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|Self-pay|Self-pay|95||||95|28.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95||||95|19.95|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95||||95|45.55|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95||||95|85.5|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95||||95|0|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95||||95|35.15|88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95||||95||88.35|19.95
27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95||||95|47.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95||||95|47.6|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95||||95|33.35|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95||||95|40.85|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95||||95|40.47|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95||||95|47.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95||||95|61.75|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|CORESOURCE [1315]|CORESOURCE [131500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95||||95|35.15|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|GEHA [1415]|GEHA [141500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HEALTHNET [1495]|HEALTHNET [149500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95||||95|40.85|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95||||95|88.35|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95||||95|57|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MULTIPLAN [1680]|HMA [168003]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MULTIPLAN [1680]|IHC HS [168011]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|Self-pay|Self-pay|95||||95|28.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95||||95|19.95|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|TRUSTMARK [2030]|STARMARK [203000]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95||||95|45.55|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|UMR [2035]|UMR OPTIONS [203501]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95||||95|85.5|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95||||95|0|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95||||95|35.15|88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95||||95||88.35|19.95
27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95||||95|47.5|88.35|19.95
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49||||49|24.55|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49||||49|17.2|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49||||49|21.07|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49||||49|20.87|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49||||49|24.5|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49||||49|31.85|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|CORESOURCE [1315]|CORESOURCE [131500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49||||49|18.13|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|GEHA [1415]|GEHA [141500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HEALTHNET [1495]|HEALTHNET [149500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49||||49|21.07|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49||||49|45.57|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49||||49|29.4|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MULTIPLAN [1680]|HMA [168003]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MULTIPLAN [1680]|IHC HS [168011]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|Self-pay|Self-pay|49||||49|14.7|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49||||49|10.29|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|TRUSTMARK [2030]|STARMARK [203000]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49||||49|23.5|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|UMR [2035]|UMR OPTIONS [203501]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49||||49|44.1|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49||||49|0|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49||||49|18.13|45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49||||49||45.57|10.29
27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49||||49|24.5|45.57|10.29
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118||||118|59.12|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118||||118|41.42|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118||||118|50.74|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118||||118|50.27|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118||||118|59|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118||||118|76.7|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118||||118|43.66|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|GEHA [1415]|GEHA [141500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118||||118|50.74|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118||||118|109.74|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118||||118|70.8|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MULTIPLAN [1680]|HMA [168003]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MULTIPLAN [1680]|IHC HS [168011]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|Self-pay|Self-pay|118||||118|35.4|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118||||118|24.78|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|TRUSTMARK [2030]|STARMARK [203000]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118||||118|56.58|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|UMR [2035]|UMR OPTIONS [203501]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118||||118|106.2|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118||||118|0|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118||||118|43.66|109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118||||118||109.74|24.78
27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118||||118|59|109.74|24.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|AETNA [1015]|AETNA ACO WILCO [101532]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25||||25|12.53|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25||||25|8.78|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25||||25|10.75|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25||||25|10.65|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25||||25|12.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25||||25|16.25|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|CORESOURCE [1315]|CORESOURCE [131500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25||||25|9.25|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|GEHA [1415]|GEHA [141500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HEALTHNET [1495]|HEALTHNET [149500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25||||25|10.75|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25||||25|23.25|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25||||25|15|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MULTIPLAN [1680]|HMA [168003]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MULTIPLAN [1680]|IHC HS [168011]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|Self-pay|Self-pay|25||||25|7.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25||||25|5.25|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|TRUSTMARK [2030]|STARMARK [203000]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25||||25|11.99|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|UMR [2035]|UMR OPTIONS [203501]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25||||25|22.5|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25||||25|0|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25||||25|9.25|23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25||||25||23.25|5.25
27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25||||25|12.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25||||25|12.53|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25||||25|8.78|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25||||25|10.75|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25||||25|10.65|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25||||25|12.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25||||25|16.25|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|CORESOURCE [1315]|CORESOURCE [131500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25||||25|9.25|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|GEHA [1415]|GEHA [141500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HEALTHNET [1495]|HEALTHNET [149500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25||||25|10.75|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25||||25|23.25|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25||||25|15|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MULTIPLAN [1680]|HMA [168003]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MULTIPLAN [1680]|IHC HS [168011]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|Self-pay|Self-pay|25||||25|7.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25||||25|5.25|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|TRUSTMARK [2030]|STARMARK [203000]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25||||25|11.99|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|UMR [2035]|UMR OPTIONS [203501]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25||||25|22.5|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25||||25|0|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25||||25|9.25|23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25||||25||23.25|5.25
27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25||||25|12.5|23.25|5.25
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15||||15|7.52|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15||||15|5.27|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15||||15|6.45|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15||||15|6.39|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15||||15|7.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15||||15|9.75|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|CORESOURCE [1315]|CORESOURCE [131500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15||||15|5.55|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|GEHA [1415]|GEHA [141500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HEALTHNET [1495]|HEALTHNET [149500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15||||15|6.45|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15||||15|13.95|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15||||15|9|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MULTIPLAN [1680]|HMA [168003]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MULTIPLAN [1680]|IHC HS [168011]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|Self-pay|Self-pay|15||||15|4.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15||||15|3.15|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|TRUSTMARK [2030]|STARMARK [203000]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15||||15|7.19|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|UMR [2035]|UMR OPTIONS [203501]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15||||15|13.5|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15||||15|0|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15||||15|5.55|13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15||||15||13.95|3.15
27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15||||15|7.5|13.95|3.15
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58||||58|29.06|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58||||58|20.36|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58||||58|24.94|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58||||58|24.71|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58||||58|29|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58||||58|37.7|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58||||58|21.46|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|GEHA [1415]|GEHA [141500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58||||58|24.94|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58||||58|53.94|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58||||58|34.8|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MULTIPLAN [1680]|HMA [168003]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MULTIPLAN [1680]|IHC HS [168011]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|Self-pay|Self-pay|58||||58|17.4|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58||||58|12.18|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|TRUSTMARK [2030]|STARMARK [203000]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58||||58|27.81|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|UMR [2035]|UMR OPTIONS [203501]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58||||58|52.2|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58||||58|0|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58||||58|21.46|53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58||||58||53.94|12.18
27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58||||58|29|53.94|12.18
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|AETNA [1015]|AETNA ACO WILCO [101532]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41||||41|20.54|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41||||41|14.39|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41||||41|17.63|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41||||41|17.47|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41||||41|20.5|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41||||41|26.65|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|CORESOURCE [1315]|CORESOURCE [131500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41||||41|15.17|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|GEHA [1415]|GEHA [141500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HEALTHNET [1495]|HEALTHNET [149500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41||||41|17.63|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41||||41|38.13|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41||||41|24.6|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MULTIPLAN [1680]|HMA [168003]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MULTIPLAN [1680]|IHC HS [168011]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|Self-pay|Self-pay|41||||41|12.3|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41||||41|8.61|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|TRUSTMARK [2030]|STARMARK [203000]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41||||41|19.66|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|UMR [2035]|UMR OPTIONS [203501]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41||||41|36.9|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41||||41|0|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41||||41|15.17|38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41||||41||38.13|8.61
27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41||||41|20.5|38.13|8.61
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66||||66|33.07|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66||||66|23.17|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66||||66|28.38|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66||||66|28.12|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66||||66|33|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66||||66|42.9|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66||||66|24.42|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|GEHA [1415]|GEHA [141500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66||||66|28.38|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66||||66|61.38|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66||||66|39.6|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MULTIPLAN [1680]|HMA [168003]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MULTIPLAN [1680]|IHC HS [168011]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|Self-pay|Self-pay|66||||66|19.8|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66||||66|13.86|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|TRUSTMARK [2030]|STARMARK [203000]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66||||66|31.65|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|UMR [2035]|UMR OPTIONS [203501]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66||||66|59.4|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66||||66|0|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66||||66|24.42|61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66||||66||61.38|13.86
27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66||||66|33|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66||||66|33.07|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66||||66|23.17|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66||||66|28.38|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66||||66|28.12|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66||||66|33|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66||||66|42.9|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66||||66|24.42|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|GEHA [1415]|GEHA [141500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66||||66|28.38|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66||||66|61.38|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66||||66|39.6|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MULTIPLAN [1680]|HMA [168003]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MULTIPLAN [1680]|IHC HS [168011]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|Self-pay|Self-pay|66||||66|19.8|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66||||66|13.86|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|TRUSTMARK [2030]|STARMARK [203000]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66||||66|31.65|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|UMR [2035]|UMR OPTIONS [203501]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66||||66|59.4|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66||||66|0|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66||||66|24.42|61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66||||66||61.38|13.86
27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66||||66|33|61.38|13.86
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106||||106|53.11|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106||||106|37.21|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106||||106|45.58|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106||||106|45.16|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106||||106|53|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106||||106|68.9|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106||||106|39.22|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|GEHA [1415]|GEHA [141500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106||||106|45.58|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106||||106|98.58|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106||||106|63.6|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MULTIPLAN [1680]|HMA [168003]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MULTIPLAN [1680]|IHC HS [168011]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|Self-pay|Self-pay|106||||106|31.8|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106||||106|22.26|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|TRUSTMARK [2030]|STARMARK [203000]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106||||106|50.83|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|UMR [2035]|UMR OPTIONS [203501]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106||||106|95.4|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106||||106|0|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106||||106|39.22|98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106||||106||98.58|22.26
27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106||||106|53|98.58|22.26
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43||||43|21.54|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43||||43|15.09|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43||||43|18.49|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43||||43|18.32|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43||||43|21.5|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43||||43|27.95|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43||||43|15.91|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|GEHA [1415]|GEHA [141500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43||||43|18.49|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43||||43|39.99|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43||||43|25.8|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MULTIPLAN [1680]|HMA [168003]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MULTIPLAN [1680]|IHC HS [168011]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|Self-pay|Self-pay|43||||43|12.9|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43||||43|9.03|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|TRUSTMARK [2030]|STARMARK [203000]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43||||43|20.62|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|UMR [2035]|UMR OPTIONS [203501]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43||||43|38.7|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43||||43|0|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43||||43|15.91|39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43||||43||39.99|9.03
27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43||||43|21.5|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43||||43|21.54|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43||||43|15.09|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43||||43|18.49|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43||||43|18.32|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43||||43|21.5|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43||||43|27.95|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43||||43|15.91|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|GEHA [1415]|GEHA [141500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43||||43|18.49|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43||||43|39.99|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43||||43|25.8|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MULTIPLAN [1680]|HMA [168003]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MULTIPLAN [1680]|IHC HS [168011]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|Self-pay|Self-pay|43||||43|12.9|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43||||43|9.03|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|TRUSTMARK [2030]|STARMARK [203000]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43||||43|20.62|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|UMR [2035]|UMR OPTIONS [203501]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43||||43|38.7|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43||||43|0|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43||||43|15.91|39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43||||43||39.99|9.03
27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43||||43|21.5|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43||||43|21.54|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43||||43|15.09|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43||||43|18.49|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43||||43|18.32|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43||||43|21.5|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43||||43|27.95|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43||||43|15.91|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|GEHA [1415]|GEHA [141500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43||||43|18.49|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43||||43|39.99|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43||||43|25.8|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MULTIPLAN [1680]|HMA [168003]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MULTIPLAN [1680]|IHC HS [168011]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|Self-pay|Self-pay|43||||43|12.9|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43||||43|9.03|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|TRUSTMARK [2030]|STARMARK [203000]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43||||43|20.62|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|UMR [2035]|UMR OPTIONS [203501]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43||||43|38.7|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43||||43|0|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43||||43|15.91|39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43||||43||39.99|9.03
27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43||||43|21.5|39.99|9.03
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|AETNA [1015]|AETNA ACO WILCO [101532]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|98||||98|49.1|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98||||98|34.4|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98||||98|42.14|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|98||||98|41.75|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|98||||98|49|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98||||98|63.7|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|CORESOURCE [1315]|CORESOURCE [131500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|98||||98|36.26|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|GEHA [1415]|GEHA [141500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HEALTHNET [1495]|HEALTHNET [149500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98||||98|42.14|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|98||||98|91.14|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98||||98|58.8|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MULTIPLAN [1680]|HMA [168003]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MULTIPLAN [1680]|IHC HS [168011]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|Self-pay|Self-pay|98||||98|29.4|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98||||98|20.58|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|TRUSTMARK [2030]|STARMARK [203000]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98||||98|46.99|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|UMR [2035]|UMR OPTIONS [203501]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98||||98|88.2|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|98||||98|0|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|98||||98|36.26|91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|98||||98||91.14|20.58
27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|98||||98|49|91.14|20.58
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43||||43|21.54|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43||||43|15.09|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43||||43|18.49|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43||||43|18.32|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43||||43|21.5|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43||||43|27.95|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|CORESOURCE [1315]|CORESOURCE [131500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43||||43|15.91|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|GEHA [1415]|GEHA [141500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HEALTHNET [1495]|HEALTHNET [149500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43||||43|18.49|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43||||43|39.99|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43||||43|25.8|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MULTIPLAN [1680]|HMA [168003]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MULTIPLAN [1680]|IHC HS [168011]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|Self-pay|Self-pay|43||||43|12.9|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43||||43|9.03|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|TRUSTMARK [2030]|STARMARK [203000]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43||||43|20.62|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|UMR [2035]|UMR OPTIONS [203501]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43||||43|38.7|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43||||43|0|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43||||43|15.91|39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43||||43||39.99|9.03
27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43||||43|21.5|39.99|9.03
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|31||||31|0|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31||||31|11.48|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31||||31|11.48|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31||||31|15.53|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31||||31|10.88|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31||||31|13.33|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31||||31|13.21|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31||||31|15.5|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31||||31|20.15|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|CORESOURCE [1315]|CORESOURCE [131500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31||||31|0|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31||||31|11.47|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|GEHA [1415]|GEHA [141500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HEALTHNET [1495]|HEALTHNET [149500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31||||31|13.33|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31||||31|28.83|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31||||31|18.6|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31||||31|15.5|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31||||31|11.07|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MULTIPLAN [1680]|HMA [168003]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MULTIPLAN [1680]|IHC HS [168011]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31||||31|11.93|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|Self-pay|Self-pay|31||||31|9.3|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31||||31|6.51|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|TRUSTMARK [2030]|STARMARK [203000]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31||||31|14.86|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|UMR [2035]|UMR OPTIONS [203501]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31||||31|10.54|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31||||31|27.9|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31||||31|0|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31||||31|11.47|28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31||||31||28.83|6.51
27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31||||31|15.5|28.83|6.51
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|AETNA [1015]|AETNA ACO WILCO [101532]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6||||6|3.01|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6||||6|2.11|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6||||6|2.58|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6||||6|2.56|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6||||6|3|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6||||6|3.9|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|CORESOURCE [1315]|CORESOURCE [131500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6||||6|2.22|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|GEHA [1415]|GEHA [141500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HEALTHNET [1495]|HEALTHNET [149500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6||||6|2.58|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6||||6|5.58|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6||||6|3.6|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MULTIPLAN [1680]|HMA [168003]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MULTIPLAN [1680]|IHC HS [168011]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|Self-pay|Self-pay|6||||6|1.8|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6||||6|1.26|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|TRUSTMARK [2030]|STARMARK [203000]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6||||6|2.88|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|UMR [2035]|UMR OPTIONS [203501]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6||||6|5.4|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6||||6|0|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6||||6|2.22|5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6||||6||5.58|1.26
27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6||||6|3|5.58|1.26
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|AETNA [1015]|AETNA ACO WILCO [101532]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13||||13|6.51|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13||||13|4.56|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13||||13|5.59|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13||||13|5.54|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13||||13|6.5|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13||||13|8.45|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|CORESOURCE [1315]|CORESOURCE [131500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13||||13|4.81|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|GEHA [1415]|GEHA [141500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HEALTHNET [1495]|HEALTHNET [149500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13||||13|5.59|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13||||13|12.09|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13||||13|7.8|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MULTIPLAN [1680]|HMA [168003]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MULTIPLAN [1680]|IHC HS [168011]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|Self-pay|Self-pay|13||||13|3.9|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13||||13|2.73|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|TRUSTMARK [2030]|STARMARK [203000]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13||||13|6.23|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|UMR [2035]|UMR OPTIONS [203501]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13||||13|11.7|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13||||13|0|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13||||13|4.81|12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13||||13||12.09|2.73
27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13||||13|6.5|12.09|2.73
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|AETNA [1015]|AETNA ACO WILCO [101532]|19||||19|0|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19||||19|12.79|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19||||19|12.79|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19||||19|9.52|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19||||19|6.67|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19||||19|8.17|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19||||19|8.09|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19||||19|9.5|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19||||19|12.35|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|CORESOURCE [1315]|CORESOURCE [131500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19||||19|0|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19||||19|7.03|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|GEHA [1415]|GEHA [141500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HEALTHNET [1495]|HEALTHNET [149500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19||||19|8.17|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19||||19|17.67|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19||||19|11.4|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19||||19|9.5|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19||||19|12.35|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MULTIPLAN [1680]|HMA [168003]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MULTIPLAN [1680]|IHC HS [168011]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19||||19|13.29|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|Self-pay|Self-pay|19||||19|5.7|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19||||19|3.99|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|TRUSTMARK [2030]|STARMARK [203000]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19||||19|9.11|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|UMR [2035]|UMR OPTIONS [203501]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19||||19|11.77|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19||||19|17.1|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19||||19|0|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19||||19|7.03|17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19||||19||17.67|3.99
27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19||||19|9.5|17.67|3.99
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|AETNA [1015]|AETNA ACO WILCO [101532]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15||||15|7.52|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15||||15|5.27|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15||||15|6.45|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15||||15|6.39|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15||||15|7.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15||||15|9.75|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|CORESOURCE [1315]|CORESOURCE [131500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15||||15|5.55|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|GEHA [1415]|GEHA [141500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HEALTHNET [1495]|HEALTHNET [149500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15||||15|6.45|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15||||15|13.95|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15||||15|9|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MULTIPLAN [1680]|HMA [168003]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MULTIPLAN [1680]|IHC HS [168011]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|Self-pay|Self-pay|15||||15|4.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15||||15|3.15|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|TRUSTMARK [2030]|STARMARK [203000]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15||||15|7.19|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|UMR [2035]|UMR OPTIONS [203501]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15||||15|13.5|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15||||15|0|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15||||15|5.55|13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15||||15||13.95|3.15
27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15||||15|7.5|13.95|3.15
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|AETNA [1015]|AETNA ACO WILCO [101532]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21||||21|10.52|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21||||21|7.37|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21||||21|9.03|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21||||21|8.95|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21||||21|10.5|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21||||21|13.65|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|CORESOURCE [1315]|CORESOURCE [131500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21||||21|7.77|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|GEHA [1415]|GEHA [141500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HEALTHNET [1495]|HEALTHNET [149500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21||||21|9.03|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|21||||21|19.53|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21||||21|12.6|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MULTIPLAN [1680]|HMA [168003]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MULTIPLAN [1680]|IHC HS [168011]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|Self-pay|Self-pay|21||||21|6.3|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21||||21|4.41|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|TRUSTMARK [2030]|STARMARK [203000]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21||||21|10.07|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|UMR [2035]|UMR OPTIONS [203501]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21||||21|18.9|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21||||21|0|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21||||21|7.77|19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21||||21||19.53|4.41
27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21||||21|10.5|19.53|4.41
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|AETNA [1015]|AETNA ACO WILCO [101532]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54||||54|27.05|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54||||54|18.95|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54||||54|23.22|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54||||54|23|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54||||54|27|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54||||54|35.1|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|CORESOURCE [1315]|CORESOURCE [131500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54||||54|19.98|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|GEHA [1415]|GEHA [141500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HEALTHNET [1495]|HEALTHNET [149500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54||||54|23.22|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|54||||54|50.22|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54||||54|32.4|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MULTIPLAN [1680]|HMA [168003]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MULTIPLAN [1680]|IHC HS [168011]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|Self-pay|Self-pay|54||||54|16.2|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54||||54|11.34|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|TRUSTMARK [2030]|STARMARK [203000]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54||||54|25.89|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|UMR [2035]|UMR OPTIONS [203501]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54||||54|48.6|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54||||54|0|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54||||54|19.98|50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54||||54||50.22|11.34
27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54||||54|27|50.22|11.34
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|AETNA [1015]|AETNA ACO WILCO [101532]|15||||15|0|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15||||15|12.79|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15||||15|12.79|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15||||15|7.52|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15||||15|5.27|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15||||15|6.45|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15||||15|6.39|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15||||15|7.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15||||15|9.75|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|CORESOURCE [1315]|CORESOURCE [131500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15||||15|0|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15||||15|5.55|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|GEHA [1415]|GEHA [141500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HEALTHNET [1495]|HEALTHNET [149500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15||||15|6.45|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15||||15|13.95|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15||||15|9|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15||||15|7.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15||||15|12.35|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MULTIPLAN [1680]|HMA [168003]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MULTIPLAN [1680]|IHC HS [168011]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15||||15|13.29|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|Self-pay|Self-pay|15||||15|4.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15||||15|3.15|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|TRUSTMARK [2030]|STARMARK [203000]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15||||15|7.19|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|UMR [2035]|UMR OPTIONS [203501]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15||||15|11.77|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15||||15|13.5|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15||||15|0|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15||||15|5.55|13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15||||15||13.95|3.15
27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15||||15|7.5|13.95|3.15
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|AETNA [1015]|AETNA ACO WILCO [101532]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23||||23|11.52|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23||||23|8.07|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23||||23|9.89|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23||||23|9.8|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23||||23|11.5|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23||||23|14.95|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|CORESOURCE [1315]|CORESOURCE [131500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23||||23|8.51|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|GEHA [1415]|GEHA [141500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HEALTHNET [1495]|HEALTHNET [149500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23||||23|9.89|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23||||23|21.39|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23||||23|13.8|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MULTIPLAN [1680]|HMA [168003]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MULTIPLAN [1680]|IHC HS [168011]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|Self-pay|Self-pay|23||||23|6.9|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23||||23|4.83|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|TRUSTMARK [2030]|STARMARK [203000]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23||||23|11.03|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|UMR [2035]|UMR OPTIONS [203501]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23||||23|20.7|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23||||23|0|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23||||23|8.51|21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23||||23||21.39|4.83
27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23||||23|11.5|21.39|4.83
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|AETNA [1015]|AETNA ACO WILCO [101532]|5||||5|0|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5||||5|11.31|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5||||5|11.31|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5||||5|2.51|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5||||5|1.76|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5||||5|2.15|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5||||5|2.13|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5||||5|2.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5||||5|3.25|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|CORESOURCE [1315]|CORESOURCE [131500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5||||5|0|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5||||5|1.85|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|GEHA [1415]|GEHA [141500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HEALTHNET [1495]|HEALTHNET [149500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5||||5|2.15|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5||||5|4.65|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5||||5|3|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5||||5|2.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5||||5|5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MULTIPLAN [1680]|HMA [168003]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MULTIPLAN [1680]|IHC HS [168011]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5||||5|5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|Self-pay|Self-pay|5||||5|1.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5||||5|1.05|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|TRUSTMARK [2030]|STARMARK [203000]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5||||5|2.4|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|UMR [2035]|UMR OPTIONS [203501]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5||||5|5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5||||5|4.5|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5||||5|0|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5||||5|1.85|11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5||||5||11.31|1.05
27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5||||5|2.5|11.31|1.05
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|7.74|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|6.66|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|7.74|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MULTIPLAN [1680]|HMA [168003]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|0|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|6.66|16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18||16.74|3.78
27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.78
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|AETNA [1015]|AETNA ACO WILCO [101532]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13||||13|6.51|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13||||13|4.56|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13||||13|5.59|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13||||13|5.54|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13||||13|6.5|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13||||13|8.45|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|CORESOURCE [1315]|CORESOURCE [131500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13||||13|4.81|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|GEHA [1415]|GEHA [141500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HEALTHNET [1495]|HEALTHNET [149500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13||||13|5.59|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13||||13|12.09|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13||||13|7.8|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MULTIPLAN [1680]|HMA [168003]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MULTIPLAN [1680]|IHC HS [168011]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|Self-pay|Self-pay|13||||13|3.9|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13||||13|2.73|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|TRUSTMARK [2030]|STARMARK [203000]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13||||13|6.23|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|UMR [2035]|UMR OPTIONS [203501]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13||||13|11.7|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13||||13|0|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13||||13|4.81|12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13||||13||12.09|2.73
27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13||||13|6.5|12.09|2.73
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|AETNA [1015]|AETNA ACO WILCO [101532]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23||||23|11.52|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23||||23|8.07|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23||||23|9.89|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23||||23|9.8|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23||||23|11.5|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23||||23|14.95|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|CORESOURCE [1315]|CORESOURCE [131500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23||||23|8.51|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|GEHA [1415]|GEHA [141500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HEALTHNET [1495]|HEALTHNET [149500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23||||23|9.89|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23||||23|21.39|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23||||23|13.8|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MULTIPLAN [1680]|HMA [168003]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MULTIPLAN [1680]|IHC HS [168011]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|Self-pay|Self-pay|23||||23|6.9|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23||||23|4.83|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|TRUSTMARK [2030]|STARMARK [203000]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23||||23|11.03|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|UMR [2035]|UMR OPTIONS [203501]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23||||23|20.7|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23||||23|0|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23||||23|8.51|21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23||||23||21.39|4.83
27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23||||23|11.5|21.39|4.83
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|AETNA [1015]|AETNA ACO WILCO [101532]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52||||52|26.05|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52||||52|18.25|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52||||52|22.36|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52||||52|22.15|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52||||52|26|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52||||52|33.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|CORESOURCE [1315]|CORESOURCE [131500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52||||52|19.24|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|GEHA [1415]|GEHA [141500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HEALTHNET [1495]|HEALTHNET [149500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52||||52|22.36|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52||||52|48.36|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52||||52|31.2|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MULTIPLAN [1680]|HMA [168003]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MULTIPLAN [1680]|IHC HS [168011]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|Self-pay|Self-pay|52||||52|15.6|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52||||52|10.92|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|TRUSTMARK [2030]|STARMARK [203000]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52||||52|24.93|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|UMR [2035]|UMR OPTIONS [203501]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52||||52|46.8|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52||||52|0|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52||||52|19.24|48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52||||52||48.36|10.92
27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52||||52|26|48.36|10.92
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|AETNA [1015]|AETNA ACO WILCO [101532]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28||||28|14.03|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28||||28|9.83|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28||||28|12.04|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28||||28|11.93|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28||||28|14|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28||||28|18.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|CORESOURCE [1315]|CORESOURCE [131500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28||||28|10.36|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|GEHA [1415]|GEHA [141500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HEALTHNET [1495]|HEALTHNET [149500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28||||28|12.04|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28||||28|26.04|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28||||28|16.8|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MULTIPLAN [1680]|HMA [168003]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MULTIPLAN [1680]|IHC HS [168011]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|Self-pay|Self-pay|28||||28|8.4|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28||||28|5.88|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|TRUSTMARK [2030]|STARMARK [203000]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28||||28|13.43|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|UMR [2035]|UMR OPTIONS [203501]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28||||28|25.2|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28||||28|0|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28||||28|10.36|26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28||||28||26.04|5.88
27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF  .75 X 18|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28||||28|14|26.04|5.88
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|AETNA [1015]|AETNA ACO WILCO [101532]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9||||9|4.51|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9||||9|3.16|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9||||9|3.87|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9||||9|3.83|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9||||9|4.5|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9||||9|5.85|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|CORESOURCE [1315]|CORESOURCE [131500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9||||9|3.33|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|GEHA [1415]|GEHA [141500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HEALTHNET [1495]|HEALTHNET [149500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9||||9|3.87|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9||||9|8.37|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9||||9|5.4|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MULTIPLAN [1680]|HMA [168003]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MULTIPLAN [1680]|IHC HS [168011]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|Self-pay|Self-pay|9||||9|2.7|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9||||9|1.89|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|TRUSTMARK [2030]|STARMARK [203000]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9||||9|4.32|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|UMR [2035]|UMR OPTIONS [203501]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9||||9|8.1|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9||||9|0|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9||||9|3.33|8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9||||9||8.37|1.89
27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9||||9|4.5|8.37|1.89
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|AETNA [1015]|AETNA ACO WILCO [101532]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49.97||||49.97|25.03|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.97||||49.97|17.54|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.97||||49.97|21.49|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49.97||||49.97|21.29|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49.97||||49.97|24.99|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.97||||49.97|32.48|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|CORESOURCE [1315]|CORESOURCE [131500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|CORVEL CORP [2235]|CORVEL CORP [223500]|49.97||||49.97|5.13|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49.97||||49.97|18.49|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|GEHA [1415]|GEHA [141500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HEALTHNET [1495]|HEALTHNET [149500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.97||||49.97|21.49|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HEALTHSMART [1505]|HEALTHSMART [150501]|49.97||||49.97|46.47|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.97||||49.97|29.98|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MULTIPLAN [1680]|HMA [168003]|49.97||||49.97|17.49|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MULTIPLAN [1680]|IHC HS [168011]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|Self-pay|Self-pay|49.97||||49.97|14.99|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.97||||49.97|10.49|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.97||||49.97|5.6|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|TRUSTMARK [2030]|STARMARK [203000]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.97||||49.97|23.96|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|UMR [2035]|UMR OPTIONS [203501]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.97||||49.97|44.97|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49.97||||49.97|0|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49.97||||49.97|18.49|46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49.97||||49.97||46.47|5.13
27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|3 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49.97||||49.97|24.99|46.47|5.13
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|AETNA [1015]|AETNA ACO WILCO [101532]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27.67||||27.67|13.86|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.67||||27.67|9.71|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.67||||27.67|11.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27.67||||27.67|11.79|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27.67||||27.67|13.84|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.67||||27.67|17.99|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|CORESOURCE [1315]|CORESOURCE [131500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27.67||||27.67|10.24|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|GEHA [1415]|GEHA [141500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HEALTHNET [1495]|HEALTHNET [149500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.67||||27.67|11.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|27.67||||27.67|25.73|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.67||||27.67|16.6|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MULTIPLAN [1680]|HMA [168003]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MULTIPLAN [1680]|IHC HS [168011]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|Self-pay|Self-pay|27.67||||27.67|8.3|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.67||||27.67|5.81|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|TRUSTMARK [2030]|STARMARK [203000]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.67||||27.67|13.27|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|UMR [2035]|UMR OPTIONS [203501]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.67||||27.67|24.9|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27.67||||27.67|0|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27.67||||27.67|10.24|25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27.67||||27.67||25.73|5.81
27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|94 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27.67||||27.67|13.84|25.73|5.81
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|Self-pay|Self-pay|10||||10|3|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149.08||||149.08|74.69|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.08||||149.08|52.33|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.08||||149.08|64.1|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149.08||||149.08|63.51|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149.08||||149.08|74.54|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.08||||149.08|96.9|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149.08||||149.08|55.16|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.08||||149.08|64.1|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|149.08||||149.08|138.64|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.08||||149.08|89.45|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|149.08||||149.08|44.72|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.08||||149.08|31.31|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.08||||149.08|71.48|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.08||||149.08|134.17|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149.08||||149.08|0|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149.08||||149.08|55.16|138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149.08||||149.08||138.64|31.31
27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149.08||||149.08|74.54|138.64|31.31
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14.6||||14.6|7.31|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.6||||14.6|5.12|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.6||||14.6|6.28|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14.6||||14.6|6.22|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14.6||||14.6|7.3|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.6||||14.6|9.49|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14.6||||14.6|5.4|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|GEHA [1415]|GEHA [141500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.6||||14.6|6.28|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|14.6||||14.6|13.58|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.6||||14.6|8.76|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|Self-pay|Self-pay|14.6||||14.6|4.38|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.6||||14.6|3.07|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.6||||14.6|7|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.6||||14.6|13.14|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14.6||||14.6|0|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14.6||||14.6|5.4|13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14.6||||14.6||13.58|3.07
27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14.6||||14.6|7.3|13.58|3.07
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.1|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|5|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.1
27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.1
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|309.19||||309.19|154.9|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|309.19||||309.19|108.53|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|309.19||||309.19|132.95|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|309.19||||309.19|131.71|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|309.19||||309.19|154.6|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|309.19||||309.19|200.97|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|309.19||||309.19|11.76|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|309.19||||309.19|114.4|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|GEHA [1415]|GEHA [141500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|309.19||||309.19|132.95|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|309.19||||309.19|287.55|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|309.19||||309.19|185.51|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|309.19||||309.19|154.6|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|HMA [168003]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|Self-pay|Self-pay|309.19||||309.19|92.76|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|309.19||||309.19|64.93|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|309.19||||309.19|10.6|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|309.19||||309.19|148.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|UMR [2035]|UMR OPTIONS [203501]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|309.19||||309.19|278.27|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|309.19||||309.19|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|309.19||||309.19|114.4|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|309.19||||309.19||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|309.19||||309.19|154.6|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|AETNA ACO WILCO [101532]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|450.62||||450.62|225.76|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|450.62||||450.62|158.17|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|450.62||||450.62|193.77|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|450.62||||450.62|191.96|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|450.62||||450.62|225.31|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|450.62||||450.62|292.9|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|CORESOURCE [1315]|CORESOURCE [131500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|450.62||||450.62|17.64|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|450.62||||450.62|166.73|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|GEHA [1415]|GEHA [141500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HEALTHNET [1495]|HEALTHNET [149500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|450.62||||450.62|193.77|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|450.62||||450.62|419.08|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|450.62||||450.62|270.37|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|450.62||||450.62|225.31|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MULTIPLAN [1680]|HMA [168003]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MULTIPLAN [1680]|IHC HS [168011]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|Self-pay|Self-pay|450.62||||450.62|135.19|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|450.62||||450.62|94.63|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|450.62||||450.62|15.9|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|TRUSTMARK [2030]|STARMARK [203000]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|450.62||||450.62|216.07|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|UMR [2035]|UMR OPTIONS [203501]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|450.62||||450.62|405.56|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|450.62||||450.62|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|450.62||||450.62|166.73|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|450.62||||450.62||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|150 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|450.62||||450.62|225.31|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186.96||||186.96|93.67|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186.96||||186.96|93.67|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186.96||||186.96|65.62|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186.96||||186.96|65.62|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186.96||||186.96|80.39|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186.96||||186.96|80.39|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186.96||||186.96|79.64|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186.96||||186.96|79.64|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186.96||||186.96|93.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186.96||||186.96|93.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186.96||||186.96|121.52|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186.96||||186.96|121.52|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|186.96||||186.96|5.88|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|186.96||||186.96|5.88|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186.96||||186.96|69.18|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186.96||||186.96|69.18|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186.96||||186.96|80.39|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186.96||||186.96|80.39|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|186.96||||186.96|173.87|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|186.96||||186.96|173.87|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186.96||||186.96|112.18|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186.96||||186.96|112.18|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186.96||||186.96|93.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186.96||||186.96|93.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|186.96||||186.96|56.09|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|186.96||||186.96|56.09|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186.96||||186.96|39.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186.96||||186.96|39.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186.96||||186.96|5.3|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186.96||||186.96|5.3|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186.96||||186.96|89.65|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186.96||||186.96|89.65|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186.96||||186.96|168.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186.96||||186.96|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186.96||||186.96|69.18|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186.96||||186.96|69.18|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186.96||||186.96||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186.96||||186.96|93.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186.96||||186.96|93.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|AETNA [1015]|AETNA ACO WILCO [101532]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|297.54||||297.54|149.07|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297.54||||297.54|104.44|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297.54||||297.54|127.94|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|297.54||||297.54|126.75|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|297.54||||297.54|148.77|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297.54||||297.54|193.4|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|CORESOURCE [1315]|CORESOURCE [131500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|297.54||||297.54|7.06|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|297.54||||297.54|110.09|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|GEHA [1415]|GEHA [141500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HEALTHNET [1495]|HEALTHNET [149500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297.54||||297.54|127.94|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|297.54||||297.54|276.71|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297.54||||297.54|178.52|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297.54||||297.54|148.77|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MULTIPLAN [1680]|HMA [168003]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MULTIPLAN [1680]|IHC HS [168011]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|Self-pay|Self-pay|297.54||||297.54|89.26|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297.54||||297.54|62.48|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297.54||||297.54|6.36|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|TRUSTMARK [2030]|STARMARK [203000]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297.54||||297.54|142.67|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|UMR [2035]|UMR OPTIONS [203501]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297.54||||297.54|267.79|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|297.54||||297.54|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|297.54||||297.54|110.09|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|297.54||||297.54||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|60 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|297.54||||297.54|148.77|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|AETNA [1015]|AETNA ACO WILCO [101532]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|303.16||||303.16|151.88|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|303.16||||303.16|106.41|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|303.16||||303.16|130.36|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|303.16||||303.16|129.15|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|303.16||||303.16|151.58|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|303.16||||303.16|197.05|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|CORESOURCE [1315]|CORESOURCE [131500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|303.16||||303.16|8.82|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|303.16||||303.16|112.17|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|GEHA [1415]|GEHA [141500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HEALTHNET [1495]|HEALTHNET [149500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|303.16||||303.16|130.36|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|303.16||||303.16|281.94|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|303.16||||303.16|181.9|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|303.16||||303.16|151.58|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MULTIPLAN [1680]|HMA [168003]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MULTIPLAN [1680]|IHC HS [168011]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|Self-pay|Self-pay|303.16||||303.16|90.95|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|303.16||||303.16|63.66|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|303.16||||303.16|7.95|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|TRUSTMARK [2030]|STARMARK [203000]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|303.16||||303.16|145.37|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|UMR [2035]|UMR OPTIONS [203501]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|303.16||||303.16|272.84|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|303.16||||303.16|0|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|303.16||||303.16|112.17|419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|303.16||||303.16||419.08|5.3
27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|75 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|303.16||||303.16|151.58|419.08|5.3
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|AETNA [1015]|AETNA ACO WILCO [101532]|45600||||45600|15960|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45600||||45600|17745.59|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45600||||45600|20817.15|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45600||||45600|20817.15|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|45600||||45600|22845.6|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45600||||45600|16005.6|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45600||||45600|19608|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|45600||||45600|19425.6|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|45600||||45600|22800|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45600||||45600|29640|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|CORESOURCE [1315]|CORESOURCE [131500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|45600||||45600|22344|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|45600||||45600|22476.49|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|GEHA [1415]|GEHA [141500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|45600||||45600|15960|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HEALTHNET [1495]|HEALTHNET [149500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45600||||45600|19608|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|45600||||45600|42408|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45600||||45600|27360|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45600||||45600|19137.4|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45600||||45600|39739.81|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45600||||45600|20106.05|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45600||||45600|23486.81|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45600||||45600|17745.59|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MULTIPLAN [1680]|HMA [168003]|45600||||45600|42056.46|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MULTIPLAN [1680]|IHC HS [168011]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|45600||||45600|21636.83|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45600||||45600|19137.4|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|Self-pay|Self-pay|45600||||45600|13680|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45600||||45600|9576|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|45600||||45600|17049.68|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45600||||45600|41360.55|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|TRUSTMARK [2030]|STARMARK [203000]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45600||||45600|21865.2|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|UMR [2035]|UMR OPTIONS [203501]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45600||||45600|19148.1|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45600||||45600|41040|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|45600||||45600|0|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|45600||||45600|22476.49|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|45600||||45600|17397.64|42408|9576
27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|45600||||45600|22800|42408|9576
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|3100||||3100|1085|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3100||||3100|0|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3100||||3100|0|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3100||||3100|1553.1|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3100||||3100|1088.1|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3100||||3100|1333|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3100||||3100|1320.6|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3100||||3100|1550|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3100||||3100|2015|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|CORESOURCE [1315]|CORESOURCE [131500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3100||||3100|1519|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|GEHA [1415]|GEHA [141500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3100||||3100|1085|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HEALTHNET [1495]|HEALTHNET [149500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3100||||3100|1333|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3100||||3100|2883|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3100||||3100|1860|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3100||||3100|1550|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3100||||3100|0|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MULTIPLAN [1680]|HMA [168003]|3100||||3100|1085|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MULTIPLAN [1680]|IHC HS [168011]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3100||||3100|0|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|Self-pay|Self-pay|3100||||3100|930|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3100||||3100|651|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|TRUSTMARK [2030]|STARMARK [203000]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3100||||3100|1486.45|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|UMR [2035]|UMR OPTIONS [203501]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3100||||3100|0|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3100||||3100|2790|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3100||||3100|0|2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3100||||3100||2883|651
27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3100||||3100|1550|2883|651
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|10||||10|3|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|10||||10|3|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|10||||10|3|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.07||||20.07|10.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.07||||20.07|7.04|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.07||||20.07|8.63|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.07||||20.07|8.55|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.07||||20.07|10.04|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.07||||20.07|13.05|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.07||||20.07|7.43|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.07||||20.07|8.63|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|20.07||||20.07|18.67|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.07||||20.07|12.04|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|20.07||||20.07|6.02|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.07||||20.07|4.21|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.07||||20.07|9.62|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.07||||20.07|18.06|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.07||||20.07|0|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.07||||20.07|7.43|18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.07||||20.07||18.67|4.21
27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.07||||20.07|10.04|18.67|4.21
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43.04||||43.04|21.56|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.04||||43.04|15.11|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.04||||43.04|18.51|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43.04||||43.04|18.34|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43.04||||43.04|21.52|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.04||||43.04|27.98|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43.04||||43.04|15.92|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.04||||43.04|18.51|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|43.04||||43.04|40.03|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.04||||43.04|25.82|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|43.04||||43.04|12.91|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.04||||43.04|9.04|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.04||||43.04|20.64|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.04||||43.04|38.74|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43.04||||43.04|0|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43.04||||43.04|15.92|40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43.04||||43.04||40.03|9.04
27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43.04||||43.04|21.52|40.03|9.04
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.33||||54.33|27.22|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.33||||54.33|19.07|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.33||||54.33|23.36|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.33||||54.33|23.14|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.33||||54.33|27.17|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.33||||54.33|35.31|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.33||||54.33|20.1|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.33||||54.33|23.36|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|54.33||||54.33|50.53|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.33||||54.33|32.6|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|54.33||||54.33|16.3|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.33||||54.33|11.41|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.33||||54.33|26.05|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.33||||54.33|48.9|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.33||||54.33|0|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.33||||54.33|20.1|50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.33||||54.33||50.53|11.41
27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.33||||54.33|27.17|50.53|11.41
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64.83||||64.83|32.48|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.83||||64.83|22.76|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.83||||64.83|27.88|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64.83||||64.83|27.62|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64.83||||64.83|32.42|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.83||||64.83|42.14|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64.83||||64.83|23.99|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.83||||64.83|27.88|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|64.83||||64.83|60.29|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.83||||64.83|38.9|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|64.83||||64.83|19.45|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.83||||64.83|13.61|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.83||||64.83|31.09|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.83||||64.83|58.35|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64.83||||64.83|0|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64.83||||64.83|23.99|60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64.83||||64.83||60.29|13.61
27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64.83||||64.83|32.42|60.29|13.61
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|816.03||||816.03|408.83|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|816.03||||816.03|286.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|816.03||||816.03|350.89|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|816.03||||816.03|347.63|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|816.03||||816.03|408.02|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|816.03||||816.03|530.42|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|816.03||||816.03|301.93|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|GEHA [1415]|GEHA [141500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|816.03||||816.03|350.89|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|816.03||||816.03|758.91|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|816.03||||816.03|489.62|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MULTIPLAN [1680]|HMA [168003]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MULTIPLAN [1680]|IHC HS [168011]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|Self-pay|Self-pay|816.03||||816.03|244.81|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|816.03||||816.03|171.37|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|TRUSTMARK [2030]|STARMARK [203000]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|816.03||||816.03|391.29|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|UMR [2035]|UMR OPTIONS [203501]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|816.03||||816.03|734.43|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|816.03||||816.03|0|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|816.03||||816.03|301.93|758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|816.03||||816.03||758.91|171.37
27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|2,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|816.03||||816.03|408.02|758.91|171.37
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34.65||||34.65|17.36|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.65||||34.65|12.16|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.65||||34.65|14.9|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34.65||||34.65|14.76|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34.65||||34.65|17.33|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.65||||34.65|22.52|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34.65||||34.65|12.82|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|GEHA [1415]|GEHA [141500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.65||||34.65|14.9|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|34.65||||34.65|32.22|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.65||||34.65|20.79|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MULTIPLAN [1680]|HMA [168003]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MULTIPLAN [1680]|IHC HS [168011]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|Self-pay|Self-pay|34.65||||34.65|10.39|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.65||||34.65|7.28|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|TRUSTMARK [2030]|STARMARK [203000]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.65||||34.65|16.61|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|UMR [2035]|UMR OPTIONS [203501]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.65||||34.65|31.19|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34.65||||34.65|0|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34.65||||34.65|12.82|32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34.65||||34.65||32.22|7.28
27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34.65||||34.65|17.33|32.22|7.28
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|AETNA [1015]|AETNA ACO WILCO [101532]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15.55||||15.55|7.79|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.55||||15.55|5.46|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.55||||15.55|6.69|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15.55||||15.55|6.62|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15.55||||15.55|7.78|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.55||||15.55|10.11|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|CORESOURCE [1315]|CORESOURCE [131500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15.55||||15.55|5.75|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|GEHA [1415]|GEHA [141500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HEALTHNET [1495]|HEALTHNET [149500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.55||||15.55|6.69|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|15.55||||15.55|14.46|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.55||||15.55|9.33|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MULTIPLAN [1680]|HMA [168003]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MULTIPLAN [1680]|IHC HS [168011]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|Self-pay|Self-pay|15.55||||15.55|4.66|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.55||||15.55|3.27|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|TRUSTMARK [2030]|STARMARK [203000]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.55||||15.55|7.46|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|UMR [2035]|UMR OPTIONS [203501]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.55||||15.55|14|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15.55||||15.55|0|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15.55||||15.55|5.75|14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15.55||||15.55||14.46|3.27
28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|177 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15.55||||15.55|7.78|14.46|3.27
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.16||||13.16|6.59|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.16||||13.16|4.62|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.16||||13.16|5.66|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.16||||13.16|5.61|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.16||||13.16|6.58|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.16||||13.16|8.55|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.16||||13.16|4.87|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.16||||13.16|5.66|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|13.16||||13.16|12.24|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.16||||13.16|7.9|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|Self-pay|Self-pay|13.16||||13.16|3.95|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.16||||13.16|2.76|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.16||||13.16|6.31|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.16||||13.16|11.84|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.16||||13.16|0|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.16||||13.16|4.87|12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.16||||13.16||12.24|2.76
28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.16||||13.16|6.58|12.24|2.76
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|AETNA [1015]|AETNA ACO WILCO [101532]|465.14||||465.14|0|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|465.14||||465.14|29.76|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|465.14||||465.14|29.76|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|465.14||||465.14|233.04|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|465.14||||465.14|163.26|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|465.14||||465.14|200.01|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|465.14||||465.14|198.15|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|465.14||||465.14|232.57|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|465.14||||465.14|302.34|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|CORESOURCE [1315]|CORESOURCE [131500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|465.14||||465.14|25.02|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|465.14||||465.14|172.1|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|GEHA [1415]|GEHA [141500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HEALTHNET [1495]|HEALTHNET [149500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|465.14||||465.14|200.01|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|465.14||||465.14|432.58|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|465.14||||465.14|279.08|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|465.14||||465.14|0|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|465.14||||465.14|27.01|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MULTIPLAN [1680]|HMA [168003]|465.14||||465.14|162.8|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MULTIPLAN [1680]|IHC HS [168011]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|465.14||||465.14|30.93|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|Self-pay|Self-pay|465.14||||465.14|139.54|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|465.14||||465.14|97.68|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|465.14||||465.14|23.88|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|TRUSTMARK [2030]|STARMARK [203000]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|465.14||||465.14|223.03|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|UMR [2035]|UMR OPTIONS [203501]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|465.14||||465.14|25.73|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|465.14||||465.14|418.63|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|465.14||||465.14|0|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|465.14||||465.14|172.1|432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|465.14||||465.14||432.58|23.88
28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|300 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|465.14||||465.14|232.57|432.58|23.88
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|237.67||||237.67|119.07|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237.67||||237.67|83.42|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237.67||||237.67|102.2|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|237.67||||237.67|101.25|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|237.67||||237.67|118.84|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237.67||||237.67|154.49|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|237.67||||237.67|174.44|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|237.67||||237.67|87.94|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237.67||||237.67|102.2|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|237.67||||237.67|221.03|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237.67||||237.67|142.6|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|237.67||||237.67|83.18|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|Self-pay|Self-pay|237.67||||237.67|71.3|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237.67||||237.67|49.91|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237.67||||237.67|184.44|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237.67||||237.67|113.96|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237.67||||237.67|213.9|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|237.67||||237.67|0|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|237.67||||237.67|87.94|221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|237.67||||237.67||221.03|49.91
28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|237.67||||237.67|118.84|221.03|49.91
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|33.08||||33.08|16.57|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33.08||||33.08|11.61|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33.08||||33.08|14.22|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|33.08||||33.08|14.09|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|33.08||||33.08|16.54|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.08||||33.08|21.5|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|33.08||||33.08|12.24|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|GEHA [1415]|GEHA [141500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.08||||33.08|14.22|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|33.08||||33.08|30.76|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33.08||||33.08|19.85|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MULTIPLAN [1680]|HMA [168003]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|Self-pay|Self-pay|33.08||||33.08|9.92|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33.08||||33.08|6.95|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.08||||33.08|15.86|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UMR [2035]|UMR OPTIONS [203501]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33.08||||33.08|29.77|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|33.08||||33.08|0|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|33.08||||33.08|12.24|30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|33.08||||33.08||30.76|6.95
28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|33.08||||33.08|16.54|30.76|6.95
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38.93||||38.93|19.5|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.93||||38.93|13.66|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.93||||38.93|16.74|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38.93||||38.93|16.58|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38.93||||38.93|19.47|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.93||||38.93|25.3|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38.93||||38.93|14.4|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|GEHA [1415]|GEHA [141500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.93||||38.93|16.74|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|38.93||||38.93|36.2|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.93||||38.93|23.36|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MULTIPLAN [1680]|HMA [168003]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|Self-pay|Self-pay|38.93||||38.93|11.68|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.93||||38.93|8.18|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.93||||38.93|18.67|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UMR [2035]|UMR OPTIONS [203501]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.93||||38.93|35.04|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38.93||||38.93|0|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38.93||||38.93|14.4|36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38.93||||38.93||36.2|8.18
28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38.93||||38.93|19.47|36.2|8.18
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|AETNA [1015]|AETNA ACO WILCO [101532]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|99.72||||99.72|49.96|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99.72||||99.72|35|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99.72||||99.72|42.88|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|99.72||||99.72|42.48|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|99.72||||99.72|49.86|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99.72||||99.72|64.82|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|CORESOURCE [1315]|CORESOURCE [131500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|CORVEL CORP [2235]|CORVEL CORP [223500]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|99.72||||99.72|36.9|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|GEHA [1415]|GEHA [141500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HEALTHNET [1495]|HEALTHNET [149500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99.72||||99.72|42.88|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HEALTHSMART [1505]|HEALTHSMART [150501]|99.72||||99.72|92.74|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99.72||||99.72|59.83|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MULTIPLAN [1680]|HMA [168003]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MULTIPLAN [1680]|IHC HS [168011]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|Self-pay|Self-pay|99.72||||99.72|29.92|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99.72||||99.72|20.94|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|TRUSTMARK [2030]|STARMARK [203000]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99.72||||99.72|47.82|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|UMR [2035]|UMR OPTIONS [203501]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99.72||||99.72|89.75|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|99.72||||99.72|0|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|99.72||||99.72|36.9|92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|99.72||||99.72||92.74|20.94
2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|4 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|99.72||||99.72|49.86|92.74|20.94
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.19||||54.19|27.15|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.19||||54.19|19.02|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.19||||54.19|23.3|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.19||||54.19|23.08|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.19||||54.19|27.1|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.19||||54.19|35.22|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.19||||54.19|20.05|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.19||||54.19|23.3|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|54.19||||54.19|50.4|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.19||||54.19|32.51|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|Self-pay|Self-pay|54.19||||54.19|16.26|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.19||||54.19|11.38|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.19||||54.19|25.98|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.19||||54.19|48.77|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.19||||54.19|0|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.19||||54.19|20.05|50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.19||||54.19||50.4|11.38
2899|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.19||||54.19|27.1|50.4|11.38
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|228.25||||228.25|114.35|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|228.25||||228.25|80.12|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|228.25||||228.25|98.15|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|228.25||||228.25|97.23|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|228.25||||228.25|114.13|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|228.25||||228.25|148.36|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|228.25||||228.25|23.03|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|228.25||||228.25|84.45|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.25||||228.25|98.15|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|228.25||||228.25|212.27|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|228.25||||228.25|136.95|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|228.25||||228.25|79.89|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|Self-pay|Self-pay|228.25||||228.25|68.47|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|228.25||||228.25|47.93|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|228.25||||228.25|23.32|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228.25||||228.25|109.45|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|228.25||||228.25|205.43|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|228.25||||228.25|0|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|228.25||||228.25|84.45|212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|228.25||||228.25||212.27|23.03
29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|228.25||||228.25|114.13|212.27|23.03
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|AETNA [1015]|AETNA ACO WILCO [101532]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|314.9||||314.9|157.76|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|314.9||||314.9|110.53|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|314.9||||314.9|135.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|314.9||||314.9|134.15|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|314.9||||314.9|157.45|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|314.9||||314.9|204.69|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|CORESOURCE [1315]|CORESOURCE [131500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|314.9||||314.9|116.51|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|GEHA [1415]|GEHA [141500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HEALTHNET [1495]|HEALTHNET [149500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|314.9||||314.9|135.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|314.9||||314.9|292.86|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|314.9||||314.9|188.94|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MULTIPLAN [1680]|HMA [168003]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MULTIPLAN [1680]|IHC HS [168011]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|Self-pay|Self-pay|314.9||||314.9|94.47|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|314.9||||314.9|66.13|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|TRUSTMARK [2030]|STARMARK [203000]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|314.9||||314.9|150.99|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|UMR [2035]|UMR OPTIONS [203501]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|314.9||||314.9|283.41|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|314.9||||314.9|0|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|314.9||||314.9|116.51|292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|314.9||||314.9||292.86|66.13
29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|470 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|314.9||||314.9|157.45|292.86|66.13
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|AETNA [1015]|AETNA ACO WILCO [101532]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|121.35||||121.35|60.8|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|121.35||||121.35|42.59|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|121.35||||121.35|52.18|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|121.35||||121.35|51.7|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|121.35||||121.35|60.68|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|121.35||||121.35|78.88|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|CORESOURCE [1315]|CORESOURCE [131500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|CORVEL CORP [2235]|CORVEL CORP [223500]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|121.35||||121.35|44.9|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|GEHA [1415]|GEHA [141500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HEALTHNET [1495]|HEALTHNET [149500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|121.35||||121.35|52.18|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HEALTHSMART [1505]|HEALTHSMART [150501]|121.35||||121.35|112.86|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|121.35||||121.35|72.81|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MULTIPLAN [1680]|HMA [168003]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MULTIPLAN [1680]|IHC HS [168011]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|Self-pay|Self-pay|121.35||||121.35|36.4|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|121.35||||121.35|25.48|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|TRUSTMARK [2030]|STARMARK [203000]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|121.35||||121.35|58.19|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|UMR [2035]|UMR OPTIONS [203501]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|121.35||||121.35|109.22|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|121.35||||121.35|0|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|121.35||||121.35|44.9|112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|121.35||||121.35||112.86|25.48
29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|45 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|121.35||||121.35|60.68|112.86|25.48
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|1477.78||||1477.78|0|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1477.78||||1477.78|744.5|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1477.78||||1477.78|744.5|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1477.78||||1477.78|740.37|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1477.78||||1477.78|518.7|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1477.78||||1477.78|635.45|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1477.78||||1477.78|629.53|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1477.78||||1477.78|738.89|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1477.78||||1477.78|960.56|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|1477.78||||1477.78|588.1|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1477.78||||1477.78|546.78|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1477.78||||1477.78|635.45|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|1477.78||||1477.78|1374.34|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1477.78||||1477.78|886.67|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1477.78||||1477.78|868|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1477.78||||1477.78|719.23|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|1477.78||||1477.78|773.81|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|Self-pay|Self-pay|1477.78||||1477.78|443.33|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1477.78||||1477.78|310.33|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1477.78||||1477.78|708.6|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1477.78||||1477.78|684.96|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1477.78||||1477.78|1330|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1477.78||||1477.78|0|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1477.78||||1477.78|546.78|1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1477.78||||1477.78||1374.34|310.33
29449|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1477.78||||1477.78|738.89|1374.34|310.33
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|44 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|529||||529|50.99|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|529||||529|141.6|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|529||||529|144.16|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|529||||529|144.16|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|529||||529|137.52|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|529||||529|265.03|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|529||||529|185.68|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|529||||529|227.47|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|529||||529|225.35|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|529||||529|264.5|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|529||||529|343.85|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|529||||529|37.39|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|529||||529|25.02|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|GEHA [1415]|GEHA [141500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|529||||529|312.35|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|529||||529|227.47|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|529||||529|491.97|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|529||||529|317.4|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|529||||529|151.27|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|529||||529|345.93|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|529||||529|159.37|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|529||||529|187.41|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|529||||529|141.6|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MULTIPLAN [1680]|HMA [168003]|529||||529|208.23|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|529||||529|149.84|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|529||||529|151.27|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|Self-pay|Self-pay|529||||529|158.7|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|529||||529|111.09|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|529||||529|136.05|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|529||||529|202.68|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|529||||529|253.66|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|UMR [2035]|UMR OPTIONS [203501]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|529||||529|151.77|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|529||||529|476.1|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|529||||529|86.84|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|529||||529|25.02|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|529||||529|138.82|491.97|25.02
30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|529||||529|264.5|491.97|25.02
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|AETNA [1015]|AETNA ACO WILCO [101532]|707||||707|162.77|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|707||||707|116.72|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|707||||707|123.97|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|707||||707|123.97|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|707||||707|354.21|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|707||||707|248.16|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|707||||707|301.18|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|707||||707|353.5|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|707||||707|459.55|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|CORESOURCE [1315]|CORESOURCE [131500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|707||||707|0|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|707||||707|0|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|GEHA [1415]|GEHA [141500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|707||||707|257.47|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HEALTHNET [1495]|HEALTHNET [149500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|707||||707|657.51|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|707||||707|424.2|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|707||||707|125.87|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|707||||707|353.5|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|707||||707|119.74|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|707||||707|154.48|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|707||||707|116.72|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MULTIPLAN [1680]|HMA [168003]|707||||707|171.65|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MULTIPLAN [1680]|IHC HS [168011]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|707||||707|128.85|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|707||||707|125.87|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|Self-pay|Self-pay|707||||707|212.1|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|707||||707|148.47|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|707||||707|112.14|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|707||||707|167.07|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|TRUSTMARK [2030]|STARMARK [203000]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|707||||707|339.01|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|UMR [2035]|UMR OPTIONS [203501]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|707||||707|114.03|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|707||||707|636.3|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|707||||707|68.66|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|707||||707|0|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|707||||707|114.43|657.51|68.66
30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|707||||707|353.5|657.51|68.66
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1822||||1822|351.22|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1822||||1822|267.52|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1822||||1822|267.52|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1822||||1822|912.82|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1822||||1822|639.52|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1822||||1822|246.92|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1822||||1822|776.17|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1822||||1822|911|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1822||||1822|1184.3|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|CORESOURCE [1315]|CORESOURCE [131500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1822||||1822|0|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1822||||1822|0|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|GEHA [1415]|GEHA [141500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HEALTHNET [1495]|HEALTHNET [149500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1822||||1822|246.92|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1822||||1822|1694.46|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1822||||1822|1093.2|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1822||||1822|911|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1822||||1822|258.38|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MULTIPLAN [1680]|HMA [168003]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MULTIPLAN [1680]|IHC HS [168011]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1822||||1822|278.05|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|Self-pay|Self-pay|1822||||1822|546.6|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1822||||1822|382.62|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|TRUSTMARK [2030]|STARMARK [203000]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1822||||1822|873.65|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|UMR [2035]|UMR OPTIONS [203501]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1822||||1822|246.07|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1822||||1822|1639.8|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1822||||1822|148.15|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1822||||1822|0|1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1822||||1822||1694.46|148.15
30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1822||||1822|911|1694.46|148.15
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21.96||||21.96|11|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.96||||21.96|7.71|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.96||||21.96|9.44|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21.96||||21.96|9.35|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21.96||||21.96|10.98|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.96||||21.96|14.27|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21.96||||21.96|8.13|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.96||||21.96|9.44|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|21.96||||21.96|20.42|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.96||||21.96|13.18|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|Self-pay|Self-pay|21.96||||21.96|6.59|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.96||||21.96|4.61|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.96||||21.96|10.53|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.96||||21.96|19.76|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21.96||||21.96|0|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21.96||||21.96|8.13|20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21.96||||21.96||20.42|4.61
30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21.96||||21.96|10.98|20.42|4.61
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|392||||392|13.37|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|392||||392|8.63|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|392||||392|9.16|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|392||||392|9.16|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|392||||392|196.39|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|392||||392|137.59|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|392||||392|10.44|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|392||||392|166.99|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|392||||392|196|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|392||||392|254.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|392||||392|18.32|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|392||||392|11.21|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|GEHA [1415]|GEHA [141500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|392||||392|19.04|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|392||||392|10.44|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|392||||392|364.56|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|392||||392|235.2|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|392||||392|9.31|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|392||||392|196|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|392||||392|8.85|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|392||||392|11.42|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|392||||392|8.63|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MULTIPLAN [1680]|HMA [168003]|392||||392|12.69|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|392||||392|9.52|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|392||||392|9.31|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|Self-pay|Self-pay|392||||392|117.6|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|392||||392|82.32|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|392||||392|8.29|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|392||||392|12.35|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|392||||392|187.96|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|UMR [2035]|UMR OPTIONS [203501]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|392||||392|8.43|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|392||||392|352.8|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|392||||392|5.64|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|392||||392|11.21|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|392||||392|8.46|364.56|5.64
30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|392||||392|196|364.56|5.64
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1121||||1121|291.46|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1121||||1121|61.85|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1121||||1121|291.46|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1121||||1121|0|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1121||||1121|0|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1121||||1121|561.62|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1121||||1121|393.47|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1121||||1121|482.03|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1121||||1121|477.55|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1121||||1121|560.5|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1121||||1121|728.65|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1121||||1121|51.5|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1121||||1121|31.53|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|GEHA [1415]|GEHA [141500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1121||||1121|482.03|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1121||||1121|1042.53|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1121||||1121|672.6|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1121||||1121|560.5|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1121||||1121|0|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MULTIPLAN [1680]|HMA [168003]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1121||||1121|0|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|Self-pay|Self-pay|1121||||1121|336.3|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1121||||1121|235.41|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1121||||1121|696.14|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1121||||1121|537.52|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|UMR [2035]|UMR OPTIONS [203501]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1121||||1121|0|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1121||||1121|1008.9|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1121||||1121|28.33|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1121||||1121|840.75|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1121||||1121|31.53|1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1121||||1121||1042.53|28.33
30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1121||||1121|560.5|1042.53|28.33
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|279||||279|11.08|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279||||279|7.15|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279||||279|7.6|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279||||279|7.6|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279||||279|139.78|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279||||279|97.93|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279||||279|8.66|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279||||279|118.85|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279||||279|139.5|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279||||279|181.35|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|279||||279|13.97|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279||||279|8.55|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|GEHA [1415]|GEHA [141500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279||||279|15.77|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279||||279|8.66|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|279||||279|259.47|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279||||279|167.4|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279||||279|7.71|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279||||279|139.5|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279||||279|7.33|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279||||279|9.46|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279||||279|7.15|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MULTIPLAN [1680]|HMA [168003]|279||||279|10.52|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|279||||279|7.9|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279||||279|7.71|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|Self-pay|Self-pay|279||||279|83.7|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279||||279|58.59|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279||||279|6.87|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279||||279|10.23|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279||||279|133.78|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|UMR [2035]|UMR OPTIONS [203501]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279||||279|6.98|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279||||279|251.1|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|279||||279|4.67|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279||||279|8.55|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279||||279|7.01|259.47|4.67
30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279||||279|139.5|259.47|4.67
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|504||||504|16.7|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|504||||504|10.77|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|504||||504|11.45|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|504||||504|11.45|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|504||||504|252.5|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|504||||504|176.9|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|504||||504|13.04|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|504||||504|214.7|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|504||||504|252|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|504||||504|327.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|504||||504|23.06|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|504||||504|14.12|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|GEHA [1415]|GEHA [141500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|504||||504|23.76|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|504||||504|13.04|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|504||||504|468.72|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|504||||504|302.4|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|504||||504|11.62|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|504||||504|252|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|504||||504|11.06|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|504||||504|14.26|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|504||||504|10.77|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MULTIPLAN [1680]|HMA [168003]|504||||504|15.84|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|504||||504|11.9|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|504||||504|11.62|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|Self-pay|Self-pay|504||||504|151.2|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|504||||504|105.84|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|504||||504|10.35|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|504||||504|15.42|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|504||||504|241.67|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|UMR [2035]|UMR OPTIONS [203501]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|504||||504|10.53|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|504||||504|453.6|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|504||||504|7.04|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|504||||504|14.12|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|504||||504|10.56|468.72|7.04
30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|504||||504|252|468.72|7.04
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|244||||244|75.56|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244||||244|51.8|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244||||244|51.8|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|244||||244|122.24|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244||||244|85.64|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244||||244|59.02|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|244||||244|103.94|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|244||||244|122|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244||||244|158.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|244||||244|72.29|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|244||||244|44.26|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|GEHA [1415]|GEHA [141500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244||||244|59.02|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|244||||244|226.92|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244||||244|146.4|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244||||244|122|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244||||244|50.03|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MULTIPLAN [1680]|HMA [168003]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|244||||244|53.84|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|Self-pay|Self-pay|244||||244|73.2|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244||||244|51.24|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244||||244|117|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|UMR [2035]|UMR OPTIONS [203501]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244||||244|47.65|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244||||244|219.6|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|244||||244|31.87|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|244||||244|44.26|226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|244||||244||226.92|31.87
30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|244||||244|122|226.92|31.87
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|357||||357|21.17|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|357||||357|13.66|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|357||||357|14.51|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|357||||357|14.51|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|357||||357|178.86|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|357||||357|125.31|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|357||||357|16.53|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|357||||357|152.08|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|357||||357|178.5|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|357||||357|232.05|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|CORESOURCE [1315]|CORESOURCE [131500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|357||||357|29.54|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|357||||357|18.09|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|GEHA [1415]|GEHA [141500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|357||||357|30.13|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HEALTHNET [1495]|HEALTHNET [149500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|357||||357|16.53|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|357||||357|332.01|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|357||||357|214.2|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|357||||357|14.73|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|357||||357|178.5|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|357||||357|14.01|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|357||||357|18.08|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|357||||357|13.66|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MULTIPLAN [1680]|HMA [168003]|357||||357|20.09|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MULTIPLAN [1680]|IHC HS [168011]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|357||||357|15.08|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|357||||357|14.73|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|Self-pay|Self-pay|357||||357|107.1|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|357||||357|74.97|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|357||||357|13.12|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|357||||357|19.55|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|TRUSTMARK [2030]|STARMARK [203000]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|357||||357|171.18|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|UMR [2035]|UMR OPTIONS [203501]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|357||||357|13.35|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|357||||357|321.3|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|357||||357|8.93|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|357||||357|18.09|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|357||||357|13.39|332.01|8.93
30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|357||||357|178.5|332.01|8.93
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|391||||391|13.73|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|391||||391|8.85|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|391||||391|9.41|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|391||||391|9.41|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|391||||391|195.89|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|391||||391|137.24|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|391||||391|10.72|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|391||||391|166.57|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|391||||391|195.5|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|391||||391|254.15|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|391||||391|26.32|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|391||||391|16.11|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|GEHA [1415]|GEHA [141500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|391||||391|19.53|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|391||||391|10.72|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|391||||391|363.63|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391||||391|234.6|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|391||||391|9.55|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|391||||391|195.5|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|391||||391|9.08|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|391||||391|11.72|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391||||391|8.85|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MULTIPLAN [1680]|HMA [168003]|391||||391|13.02|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|391||||391|9.78|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|391||||391|9.55|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|Self-pay|Self-pay|391||||391|117.3|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|391||||391|82.11|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|391||||391|8.51|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|391||||391|12.67|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391||||391|187.48|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|UMR [2035]|UMR OPTIONS [203501]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|391||||391|8.65|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|391||||391|351.9|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|391||||391|5.79|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|391||||391|16.11|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|391||||391|8.68|363.63|5.79
30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|391||||391|195.5|363.63|5.79
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|690||||690|75.29|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|690||||690|48.58|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|690||||690|51.6|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|690||||690|51.6|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|690||||690|345.69|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|690||||690|242.19|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|690||||690|58.81|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|690||||690|293.94|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|690||||690|345|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|690||||690|448.5|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|690||||690|84.43|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|690||||690|51.69|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|GEHA [1415]|GEHA [141500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|690||||690|107.17|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|690||||690|58.81|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|690||||690|641.7|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|690||||690|414|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|690||||690|52.39|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|690||||690|345|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|690||||690|49.84|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|690||||690|64.3|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|690||||690|48.58|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MULTIPLAN [1680]|HMA [168003]|690||||690|71.45|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|690||||690|53.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|690||||690|52.39|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|Self-pay|Self-pay|690||||690|207|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|690||||690|144.9|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|690||||690|46.68|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|690||||690|69.54|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|690||||690|330.86|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|UMR [2035]|UMR OPTIONS [203501]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|690||||690|47.47|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|690||||690|621|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|690||||690|31.76|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|690||||690|51.69|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|690||||690|47.63|641.7|31.76
30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|690||||690|345|641.7|31.76
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|435||||435|12.91|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435||||435|8.33|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435||||435|8.85|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435||||435|8.85|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|435||||435|217.94|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435||||435|152.69|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435||||435|10.09|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|435||||435|185.31|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|435||||435|217.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435||||435|282.75|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|CORESOURCE [1315]|CORESOURCE [131500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|435||||435|13.91|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|435||||435|8.51|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|GEHA [1415]|GEHA [141500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|435||||435|18.38|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HEALTHNET [1495]|HEALTHNET [149500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435||||435|10.09|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|435||||435|404.55|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435||||435|261|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435||||435|8.99|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435||||435|217.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435||||435|8.55|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435||||435|11.03|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435||||435|8.33|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MULTIPLAN [1680]|HMA [168003]|435||||435|12.26|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MULTIPLAN [1680]|IHC HS [168011]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|435||||435|9.2|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435||||435|8.99|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|Self-pay|Self-pay|435||||435|130.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435||||435|91.35|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|435||||435|8.01|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435||||435|11.93|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|TRUSTMARK [2030]|STARMARK [203000]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435||||435|208.58|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|UMR [2035]|UMR OPTIONS [203501]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435||||435|8.14|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435||||435|391.5|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|435||||435|5.45|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|435||||435|8.51|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|435||||435|8.17|404.55|5.45
30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|435||||435|217.5|404.55|5.45
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56||||56|19.01|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|56||||56|28.06|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56||||56|19.66|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56||||56|24.08|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|56||||56|23.86|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|56||||56|28|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56||||56|36.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|CORESOURCE [1315]|CORESOURCE [131500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|GEHA [1415]|GEHA [141500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|56||||56|41.94|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HEALTHNET [1495]|HEALTHNET [149500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56||||56|24.08|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|56||||56|52.08|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56||||56|33.6|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56||||56|20.5|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56||||56|25.16|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56||||56|19.01|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MULTIPLAN [1680]|HMA [168003]|56||||56|27.96|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MULTIPLAN [1680]|IHC HS [168011]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56||||56|20.5|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|Self-pay|Self-pay|56||||56|16.8|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56||||56|11.76|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|56||||56|18.27|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56||||56|27.21|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|TRUSTMARK [2030]|STARMARK [203000]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56||||56|26.85|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|UMR [2035]|UMR OPTIONS [203501]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56||||56|50.4|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|56||||56|0|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|56||||56|18.64|52.08|11.76
30180143|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETAMINOPHEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|56||||56|28|52.08|11.76
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|378||||378|23.82|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|378||||378|15.38|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|378||||378|16.34|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|378||||378|16.34|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|378||||378|189.38|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|378||||378|132.68|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|378||||378|18.61|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|378||||378|161.03|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|378||||378|189|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|378||||378|245.7|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|CORESOURCE [1315]|CORESOURCE [131500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|378||||378|34.4|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|378||||378|21.06|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|GEHA [1415]|GEHA [141500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|378||||378|33.93|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HEALTHNET [1495]|HEALTHNET [149500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|378||||378|18.61|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|378||||378|351.54|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|378||||378|226.8|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|378||||378|16.59|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|378||||378|189|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|378||||378|15.78|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|378||||378|20.36|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|378||||378|15.38|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MULTIPLAN [1680]|HMA [168003]|378||||378|22.62|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MULTIPLAN [1680]|IHC HS [168011]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|378||||378|16.98|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|378||||378|16.59|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|Self-pay|Self-pay|378||||378|113.4|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|378||||378|79.38|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|378||||378|14.78|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|378||||378|22.02|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|TRUSTMARK [2030]|STARMARK [203000]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|378||||378|181.25|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|UMR [2035]|UMR OPTIONS [203501]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|378||||378|15.03|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|378||||378|340.2|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|378||||378|10.05|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|378||||378|21.06|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|378||||378|15.08|351.54|10.05
30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|378||||378|189|351.54|10.05
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|440||||440|54.86|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|440||||440|41.79|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|440||||440|41.79|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|440||||440|220.44|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|440||||440|154.44|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|440||||440|38.57|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|440||||440|187.44|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|440||||440|220|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|440||||440|286|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|CORESOURCE [1315]|CORESOURCE [131500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|440||||440|37.6|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|440||||440|25.54|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|GEHA [1415]|GEHA [141500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HEALTHNET [1495]|HEALTHNET [149500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|440||||440|38.57|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|440||||440|409.2|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|440||||440|264|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|440||||440|220|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|440||||440|40.37|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MULTIPLAN [1680]|HMA [168003]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MULTIPLAN [1680]|IHC HS [168011]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|440||||440|43.44|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|Self-pay|Self-pay|440||||440|132|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|440||||440|92.4|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|TRUSTMARK [2030]|STARMARK [203000]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|440||||440|210.98|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|UMR [2035]|UMR OPTIONS [203501]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|440||||440|38.45|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|440||||440|396|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|440||||440|23.14|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|440||||440|25.54|409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|440||||440||409.2|23.14
30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|440||||440|220|409.2|23.14
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|AETNA [1015]|AETNA ACO WILCO [101532]|495||||495|23.02|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|495||||495|14.86|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|495||||495|15.79|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|495||||495|15.79|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|495||||495|248|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|495||||495|173.75|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|495||||495|17.98|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|495||||495|210.87|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|495||||495|247.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|495||||495|321.75|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|CORESOURCE [1315]|CORESOURCE [131500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|495||||495|29.98|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|495||||495|18.35|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|GEHA [1415]|GEHA [141500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|495||||495|32.78|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HEALTHNET [1495]|HEALTHNET [149500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|495||||495|17.98|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|495||||495|460.35|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|495||||495|297|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|495||||495|16.03|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|495||||495|247.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|495||||495|15.25|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|495||||495|19.67|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|495||||495|14.86|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MULTIPLAN [1680]|HMA [168003]|495||||495|21.86|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MULTIPLAN [1680]|IHC HS [168011]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|495||||495|16.41|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|495||||495|16.03|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|Self-pay|Self-pay|495||||495|148.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|495||||495|103.95|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|495||||495|14.28|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|495||||495|21.27|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|TRUSTMARK [2030]|STARMARK [203000]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|495||||495|237.35|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|UMR [2035]|UMR OPTIONS [203501]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|495||||495|14.52|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|495||||495|445.5|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|495||||495|9.71|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|495||||495|18.35|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|495||||495|14.57|460.35|9.71
30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|495||||495|247.5|460.35|9.71
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|229||||229|20.96|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229||||229|13.52|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229||||229|14.36|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229||||229|14.36|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|229||||229|114.73|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229||||229|80.38|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229||||229|16.36|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|229||||229|97.55|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|229||||229|114.5|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229||||229|148.85|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|229||||229|20.09|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|229||||229|12.3|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|GEHA [1415]|GEHA [141500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|229||||229|29.81|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229||||229|16.36|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|229||||229|212.97|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229||||229|137.4|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229||||229|14.58|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229||||229|114.5|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229||||229|13.87|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229||||229|17.89|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229||||229|13.52|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MULTIPLAN [1680]|HMA [168003]|229||||229|19.88|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MULTIPLAN [1680]|IHC HS [168011]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|229||||229|14.93|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229||||229|14.58|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|Self-pay|Self-pay|229||||229|68.7|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229||||229|48.09|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|229||||229|12.99|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229||||229|19.35|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|TRUSTMARK [2030]|STARMARK [203000]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229||||229|109.81|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|UMR [2035]|UMR OPTIONS [203501]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229||||229|13.21|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229||||229|206.1|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|229||||229|8.84|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|229||||229|12.3|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|229||||229|13.25|212.97|8.84
30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|229||||229|114.5|212.97|8.84
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|AETNA [1015]|AETNA ACO WILCO [101532]|589||||589|28.54|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|589||||589|18.41|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|589||||589|19.56|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|589||||589|19.56|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|589||||589|295.09|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|589||||589|206.74|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|589||||589|22.28|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|589||||589|250.91|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|589||||589|294.5|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|589||||589|382.85|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|CORESOURCE [1315]|CORESOURCE [131500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|589||||589|30.58|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|589||||589|18.72|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|GEHA [1415]|GEHA [141500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|589||||589|40.61|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HEALTHNET [1495]|HEALTHNET [149500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|589||||589|22.28|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|589||||589|547.77|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|589||||589|353.4|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|589||||589|19.86|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|589||||589|294.5|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|589||||589|18.89|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|589||||589|24.37|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|589||||589|18.41|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MULTIPLAN [1680]|HMA [168003]|589||||589|27.08|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MULTIPLAN [1680]|IHC HS [168011]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|589||||589|20.33|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|589||||589|19.86|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|Self-pay|Self-pay|589||||589|176.7|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|589||||589|123.69|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|589||||589|17.69|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|589||||589|26.35|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|TRUSTMARK [2030]|STARMARK [203000]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|589||||589|282.43|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|UMR [2035]|UMR OPTIONS [203501]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|589||||589|17.99|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|589||||589|530.1|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|589||||589|12.04|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|589||||589|18.72|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|589||||589|18.05|547.77|12.04
30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|589||||589|294.5|547.77|12.04
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|386||||386|20.98|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|386||||386|13.55|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|386||||386|14.38|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|386||||386|14.38|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|386||||386|193.39|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|386||||386|135.49|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|386||||386|16.39|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|386||||386|164.44|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|386||||386|193|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|386||||386|250.9|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|386||||386|24.53|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|386||||386|15.02|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|GEHA [1415]|GEHA [141500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|386||||386|29.88|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|386||||386|16.39|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|386||||386|358.98|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|386||||386|231.6|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|386||||386|14.61|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|386||||386|193|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|386||||386|13.89|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|386||||386|17.93|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|386||||386|13.55|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MULTIPLAN [1680]|HMA [168003]|386||||386|19.92|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|386||||386|14.95|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|386||||386|14.61|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|Self-pay|Self-pay|386||||386|115.8|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|386||||386|81.06|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|386||||386|13.01|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|386||||386|19.39|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|386||||386|185.09|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|386||||386|13.23|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|386||||386|347.4|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|386||||386|8.85|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|386||||386|15.02|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|386||||386|13.28|358.98|8.85
30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|386||||386|193|358.98|8.85
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|546||||546|21.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|546||||546|13.81|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|546||||546|14.67|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|546||||546|14.67|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|546||||546|273.55|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|546||||546|191.65|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|546||||546|16.72|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|546||||546|232.6|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|546||||546|273|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|546||||546|354.9|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|546||||546|34.65|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|546||||546|21.21|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|GEHA [1415]|GEHA [141500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|546||||546|30.47|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|546||||546|16.72|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|546||||546|507.78|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|546||||546|327.6|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|546||||546|14.89|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|546||||546|273|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|546||||546|14.17|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|546||||546|18.28|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|546||||546|13.81|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MULTIPLAN [1680]|HMA [168003]|546||||546|20.31|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|546||||546|15.25|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|546||||546|14.89|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|Self-pay|Self-pay|546||||546|163.8|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|546||||546|114.66|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|546||||546|13.27|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|546||||546|19.77|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|546||||546|261.81|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|546||||546|13.49|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|546||||546|491.4|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|546||||546|9.03|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|546||||546|21.21|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|546||||546|13.54|507.78|9.03
30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|546||||546|273|507.78|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|183||||183|21.4|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183||||183|13.81|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183||||183|0|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183||||183|0|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|183||||183|91.68|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183||||183|64.23|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183||||183|16.72|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|183||||183|77.96|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|183||||183|91.5|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183||||183|118.95|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|183||||183|18.49|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|183||||183|10.87|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|GEHA [1415]|GEHA [141500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|183||||183|30.47|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183||||183|16.72|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|183||||183|170.19|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183||||183|109.8|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183||||183|14.89|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183||||183|91.5|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183||||183|0|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183||||183|18.28|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183||||183|13.81|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MULTIPLAN [1680]|HMA [168003]|183||||183|20.31|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MULTIPLAN [1680]|IHC HS [168011]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|183||||183|0|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183||||183|14.89|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|Self-pay|Self-pay|183||||183|54.9|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183||||183|38.43|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|183||||183|13.27|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183||||183|19.77|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|TRUSTMARK [2030]|STARMARK [203000]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183||||183|87.75|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|UMR [2035]|UMR OPTIONS [203501]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183||||183|0|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183||||183|164.7|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|183||||183|9.03|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|183||||183|10.87|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|183||||183|13.54|170.19|9.03
30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|183||||183|91.5|170.19|9.03
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|25.82|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374|16.67|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|17.7|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|17.7|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|20.17|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|37.47|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|22.94|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374|36.77|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|20.17|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374|17.97|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|17.1|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374|22.06|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374|16.67|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MULTIPLAN [1680]|HMA [168003]|374||||374|24.51|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|18.4|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374|17.97|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|Self-pay|Self-pay|374||||374|112.2|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374|16.01|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374|23.86|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|16.29|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|10.89|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|22.94|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374|16.34|347.82|10.89
30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|10.89
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|318||||318|21.71|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|318||||318|14.88|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|318||||318|14.88|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|318||||318|159.32|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|318||||318|111.62|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|318||||318|16.96|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|318||||318|135.47|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|318||||318|159|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|318||||318|206.7|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|CORESOURCE [1315]|CORESOURCE [131500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|318||||318|24.63|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|318||||318|15.08|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|GEHA [1415]|GEHA [141500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HEALTHNET [1495]|HEALTHNET [149500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|318||||318|16.96|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|318||||318|295.74|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|318||||318|190.8|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|318||||318|159|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|318||||318|14.37|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MULTIPLAN [1680]|HMA [168003]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MULTIPLAN [1680]|IHC HS [168011]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|318||||318|15.47|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|Self-pay|Self-pay|318||||318|95.4|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|318||||318|66.78|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|TRUSTMARK [2030]|STARMARK [203000]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|318||||318|152.48|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|UMR [2035]|UMR OPTIONS [203501]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|318||||318|13.69|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|318||||318|286.2|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|318||||318|9.16|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|318||||318|15.08|295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|318||||318||295.74|9.16
30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|318||||318|159|295.74|9.16
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|509||||509|25.88|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|509||||509|17.75|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|509||||509|17.75|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|509||||509|255.01|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|509||||509|178.66|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|509||||509|20.22|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|509||||509|216.83|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|509||||509|254.5|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|509||||509|330.85|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|CORESOURCE [1315]|CORESOURCE [131500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|509||||509|36.38|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|509||||509|22.27|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|GEHA [1415]|GEHA [141500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HEALTHNET [1495]|HEALTHNET [149500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|509||||509|20.22|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|509||||509|473.37|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|509||||509|305.4|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|509||||509|254.5|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|509||||509|17.15|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MULTIPLAN [1680]|HMA [168003]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MULTIPLAN [1680]|IHC HS [168011]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|509||||509|18.45|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|Self-pay|Self-pay|509||||509|152.7|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|509||||509|106.89|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|TRUSTMARK [2030]|STARMARK [203000]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|509||||509|244.07|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|UMR [2035]|UMR OPTIONS [203501]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|509||||509|16.33|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|509||||509|458.1|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|509||||509|10.92|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|509||||509|22.27|473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|509||||509||473.37|10.92
30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|509||||509|254.5|473.37|10.92
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|AETNA [1015]|AETNA ACO WILCO [101532]|252||||252|30.82|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|252||||252|22.1|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|252||||252|23.48|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|252||||252|23.48|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|252||||252|126.25|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|252||||252|88.45|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|252||||252|107.35|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|252||||252|126|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|252||||252|163.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|CORESOURCE [1315]|CORESOURCE [131500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|252||||252|25.24|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|252||||252|16.08|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|GEHA [1415]|GEHA [141500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|252||||252|48.76|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HEALTHNET [1495]|HEALTHNET [149500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|252||||252|234.36|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|252||||252|151.2|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|252||||252|23.84|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|252||||252|126|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|252||||252|22.68|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|252||||252|29.25|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|252||||252|22.1|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MULTIPLAN [1680]|HMA [168003]|252||||252|32.51|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MULTIPLAN [1680]|IHC HS [168011]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|252||||252|24.4|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|252||||252|23.84|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|Self-pay|Self-pay|252||||252|75.6|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|252||||252|52.92|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|252||||252|21.24|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|252||||252|31.64|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|TRUSTMARK [2030]|STARMARK [203000]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|252||||252|120.83|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|UMR [2035]|UMR OPTIONS [203501]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|252||||252|21.6|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|252||||252|226.8|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|252||||252|13|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|252||||252|16.08|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|252||||252|21.67|234.36|13
30180171|EAP|0301 - LABORATORY-CHEMISTRY|HC GABAPENTIN (NEURONTIN)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|252||||252|126|234.36|13
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|AETNA [1015]|AETNA ACO WILCO [101532]|287||||287|23.02|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|287||||287|16.1|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|287||||287|17.09|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|287||||287|17.09|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|287||||287|143.79|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|287||||287|100.74|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|287||||287|17.98|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|287||||287|122.26|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|287||||287|143.5|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|287||||287|186.55|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|CORESOURCE [1315]|CORESOURCE [131500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|287||||287|24.82|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|287||||287|15.2|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|GEHA [1415]|GEHA [141500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|287||||287|35.51|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HEALTHNET [1495]|HEALTHNET [149500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|287||||287|17.98|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|287||||287|266.91|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|287||||287|172.2|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|287||||287|17.36|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|287||||287|143.5|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|287||||287|16.51|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|287||||287|21.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|287||||287|16.1|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MULTIPLAN [1680]|HMA [168003]|287||||287|23.67|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MULTIPLAN [1680]|IHC HS [168011]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|287||||287|17.76|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|287||||287|17.36|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|Self-pay|Self-pay|287||||287|86.1|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|287||||287|60.27|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|287||||287|15.46|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|287||||287|23.04|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|TRUSTMARK [2030]|STARMARK [203000]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|287||||287|137.62|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|UMR [2035]|UMR OPTIONS [203501]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|287||||287|15.73|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|287||||287|258.3|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|287||||287|9.71|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|287||||287|15.2|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|287||||287|15.78|266.91|9.71
30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|287||||287|143.5|266.91|9.71
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|AETNA [1015]|AETNA ACO WILCO [101532]|342||||342|20.96|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|342||||342|13.52|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|342||||342|14.36|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|342||||342|14.36|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|342||||342|171.34|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|342||||342|120.04|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|342||||342|16.36|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|342||||342|145.69|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|342||||342|171|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|342||||342|222.3|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|CORESOURCE [1315]|CORESOURCE [131500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|342||||342|24.31|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|342||||342|14.88|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|GEHA [1415]|GEHA [141500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|342||||342|29.81|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HEALTHNET [1495]|HEALTHNET [149500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|342||||342|16.36|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|342||||342|318.06|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|342||||342|205.2|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|342||||342|14.58|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|342||||342|171|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|342||||342|13.87|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|342||||342|17.89|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|342||||342|13.52|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MULTIPLAN [1680]|HMA [168003]|342||||342|19.88|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MULTIPLAN [1680]|IHC HS [168011]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|342||||342|14.93|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|342||||342|14.58|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|Self-pay|Self-pay|342||||342|102.6|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|342||||342|71.82|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|342||||342|12.99|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|342||||342|19.35|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|TRUSTMARK [2030]|STARMARK [203000]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|342||||342|163.99|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|UMR [2035]|UMR OPTIONS [203501]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|342||||342|13.21|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|342||||342|307.8|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|342||||342|8.84|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|342||||342|14.88|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|342||||342|13.25|318.06|8.84
30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|342||||342|171|318.06|8.84
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|260||||260|23.22|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260||||260|15.92|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260||||260|15.92|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|260||||260|130.26|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260||||260|91.26|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260||||260|18.14|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|260||||260|110.76|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|260||||260|130|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260||||260|169|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|CORESOURCE [1315]|CORESOURCE [131500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|260||||260|29.65|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|260||||260|18.15|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|GEHA [1415]|GEHA [141500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HEALTHNET [1495]|HEALTHNET [149500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260||||260|18.14|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|260||||260|241.8|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260||||260|156|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260||||260|130|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260||||260|15.38|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MULTIPLAN [1680]|HMA [168003]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MULTIPLAN [1680]|IHC HS [168011]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|260||||260|16.55|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|Self-pay|Self-pay|260||||260|78|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260||||260|54.6|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|TRUSTMARK [2030]|STARMARK [203000]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260||||260|124.67|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|UMR [2035]|UMR OPTIONS [203501]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260||||260|14.65|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260||||260|234|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|260||||260|9.79|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|260||||260|18.15|241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|260||||260||241.8|9.79
30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|260||||260|130|241.8|9.79
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|67||||67|20.96|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67||||67|13.52|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67||||67|14.36|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67||||67|14.36|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67||||67|33.57|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67||||67|23.52|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67||||67|16.36|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67||||67|28.54|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67||||67|33.5|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67||||67|43.55|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|CORESOURCE [1315]|CORESOURCE [131500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67||||67|24.31|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67||||67|14.88|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|GEHA [1415]|GEHA [141500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67||||67|29.81|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HEALTHNET [1495]|HEALTHNET [149500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67||||67|16.36|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67||||67|62.31|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67||||67|40.2|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67||||67|14.58|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67||||67|33.5|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67||||67|13.87|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67||||67|17.89|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67||||67|13.52|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MULTIPLAN [1680]|HMA [168003]|67||||67|19.88|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MULTIPLAN [1680]|IHC HS [168011]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67||||67|14.93|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67||||67|14.58|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|Self-pay|Self-pay|67||||67|20.1|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67||||67|14.07|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67||||67|12.99|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67||||67|19.35|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|TRUSTMARK [2030]|STARMARK [203000]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67||||67|32.13|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|UMR [2035]|UMR OPTIONS [203501]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67||||67|13.21|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67||||67|60.3|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67||||67|8.84|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67||||67|14.88|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67||||67|13.25|62.31|8.84
30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67||||67|33.5|62.31|8.84
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|371||||371|10.45|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371||||371|6.74|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371||||371|7.16|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371||||371|7.16|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|371||||371|185.87|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371||||371|130.22|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371||||371|8.16|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|371||||371|158.05|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|371||||371|185.5|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371||||371|241.15|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|371||||371|16.4|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|371||||371|10.04|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|GEHA [1415]|GEHA [141500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|371||||371|14.87|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371||||371|8.16|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|371||||371|345.03|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371||||371|222.6|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371||||371|7.27|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371||||371|185.5|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371||||371|6.91|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371||||371|8.92|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371||||371|6.74|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MULTIPLAN [1680]|HMA [168003]|371||||371|9.92|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MULTIPLAN [1680]|IHC HS [168011]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|371||||371|7.44|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371||||371|7.27|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|Self-pay|Self-pay|371||||371|111.3|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371||||371|77.91|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|371||||371|6.48|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371||||371|9.65|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|TRUSTMARK [2030]|STARMARK [203000]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371||||371|177.89|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|UMR [2035]|UMR OPTIONS [203501]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371||||371|6.58|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371||||371|333.9|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|371||||371|4.41|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|371||||371|10.04|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|371||||371|6.61|345.03|4.41
30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|371||||371|185.5|345.03|4.41
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|252||||252|28.54|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|252||||252|19.56|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|252||||252|19.56|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|252||||252|126.25|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|252||||252|88.45|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|252||||252|22.28|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|252||||252|107.35|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|252||||252|126|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|252||||252|163.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|CORESOURCE [1315]|CORESOURCE [131500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|252||||252|30.09|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|252||||252|18.42|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|GEHA [1415]|GEHA [141500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HEALTHNET [1495]|HEALTHNET [149500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|252||||252|22.28|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|252||||252|234.36|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|252||||252|151.2|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|252||||252|126|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|252||||252|18.89|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MULTIPLAN [1680]|HMA [168003]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MULTIPLAN [1680]|IHC HS [168011]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|252||||252|20.33|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|Self-pay|Self-pay|252||||252|75.6|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|252||||252|52.92|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|TRUSTMARK [2030]|STARMARK [203000]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|252||||252|120.83|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|UMR [2035]|UMR OPTIONS [203501]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|252||||252|17.99|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|252||||252|226.8|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|252||||252|12.04|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|252||||252|18.42|234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|252||||252||234.36|12.04
30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|252||||252|126|234.36|12.04
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|299||||299|20.96|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|299||||299|13.52|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|299||||299|14.36|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|299||||299|14.36|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|299||||299|149.8|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|299||||299|104.95|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|299||||299|16.36|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|299||||299|127.37|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|299||||299|149.5|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|299||||299|194.35|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|CORESOURCE [1315]|CORESOURCE [131500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|299||||299|24.31|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|299||||299|14.88|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|GEHA [1415]|GEHA [141500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|299||||299|29.81|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HEALTHNET [1495]|HEALTHNET [149500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|299||||299|16.36|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|299||||299|278.07|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|299||||299|179.4|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|299||||299|14.58|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|299||||299|149.5|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|299||||299|13.87|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|299||||299|17.89|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|299||||299|13.52|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MULTIPLAN [1680]|HMA [168003]|299||||299|19.88|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MULTIPLAN [1680]|IHC HS [168011]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|299||||299|14.93|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|299||||299|14.58|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|Self-pay|Self-pay|299||||299|89.7|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|299||||299|62.79|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|299||||299|12.99|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|299||||299|19.35|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|TRUSTMARK [2030]|STARMARK [203000]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|299||||299|143.37|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|UMR [2035]|UMR OPTIONS [203501]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|299||||299|13.21|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|299||||299|269.1|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|299||||299|8.84|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|299||||299|14.88|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|299||||299|13.25|278.07|8.84
30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILEPTAL) QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|299||||299|149.5|278.07|8.84
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|306||||306|21.76|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|306||||306|15.61|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|306||||306|16.57|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|306||||306|16.57|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|306||||306|153.31|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|306||||306|107.41|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|306||||306|130.36|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|306||||306|153|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|306||||306|198.9|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|CORESOURCE [1315]|CORESOURCE [131500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|306||||306|29.66|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|306||||306|18.16|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|GEHA [1415]|GEHA [141500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|306||||306|34.43|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HEALTHNET [1495]|HEALTHNET [149500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|306||||306|284.58|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|306||||306|183.6|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|306||||306|16.83|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|306||||306|153|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|306||||306|16.01|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|306||||306|20.66|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|306||||306|15.61|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MULTIPLAN [1680]|HMA [168003]|306||||306|22.95|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MULTIPLAN [1680]|IHC HS [168011]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|306||||306|17.22|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|306||||306|16.83|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|Self-pay|Self-pay|306||||306|91.8|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|306||||306|64.26|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|306||||306|14.99|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|306||||306|22.34|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|TRUSTMARK [2030]|STARMARK [203000]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|306||||306|146.73|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|UMR [2035]|UMR OPTIONS [203501]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|306||||306|15.25|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|306||||306|275.4|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|306||||306|9.18|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|306||||306|18.16|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|306||||306|15.3|284.58|9.18
30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|306||||306|153|284.58|9.18
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|526||||526|20.96|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|526||||526|13.52|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|526||||526|14.36|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|526||||526|14.36|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|526||||526|263.53|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|526||||526|184.63|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|526||||526|16.36|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|526||||526|224.08|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|526||||526|263|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|526||||526|341.9|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|CORESOURCE [1315]|CORESOURCE [131500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|526||||526|28.54|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|526||||526|17.47|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|GEHA [1415]|GEHA [141500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|526||||526|29.81|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HEALTHNET [1495]|HEALTHNET [149500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|526||||526|16.36|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|526||||526|489.18|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|526||||526|315.6|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|526||||526|14.58|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|526||||526|263|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|526||||526|13.87|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|526||||526|17.89|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|526||||526|13.52|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MULTIPLAN [1680]|HMA [168003]|526||||526|19.88|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MULTIPLAN [1680]|IHC HS [168011]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|526||||526|14.93|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|526||||526|14.58|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|Self-pay|Self-pay|526||||526|157.8|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|526||||526|110.46|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|526||||526|12.99|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|526||||526|19.35|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|TRUSTMARK [2030]|STARMARK [203000]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|526||||526|252.22|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|UMR [2035]|UMR OPTIONS [203501]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|526||||526|13.21|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|526||||526|473.4|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|526||||526|8.84|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|526||||526|17.47|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|526||||526|13.25|489.18|8.84
30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|526||||526|263|489.18|8.84
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|21.75|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254|14.04|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|14.9|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|14.9|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|16.99|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|32.7|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|20.02|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254|30.96|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|16.99|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254|15.14|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|127|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|14.4|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254|18.58|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254|14.04|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MULTIPLAN [1680]|HMA [168003]|254||||254|20.64|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|15.49|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254|15.14|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|Self-pay|Self-pay|254||||254|76.2|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254|13.48|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254|20.09|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|13.71|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|9.17|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|20.02|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254|13.76|236.22|9.17
30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|9.17
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|302||||302|26.23|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|302||||302|17.97|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|302||||302|17.97|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|302||||302|151.3|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|302||||302|106|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|302||||302|20.48|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|302||||302|128.65|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|302||||302|151|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|302||||302|196.3|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|CORESOURCE [1315]|CORESOURCE [131500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|302||||302|32.09|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|302||||302|19.65|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|GEHA [1415]|GEHA [141500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HEALTHNET [1495]|HEALTHNET [149500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|302||||302|20.48|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|302||||302|280.86|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|302||||302|181.2|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|302||||302|151|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|302||||302|17.35|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MULTIPLAN [1680]|HMA [168003]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MULTIPLAN [1680]|IHC HS [168011]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|302||||302|18.68|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|Self-pay|Self-pay|302||||302|90.6|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|302||||302|63.42|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|TRUSTMARK [2030]|STARMARK [203000]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|302||||302|144.81|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|UMR [2035]|UMR OPTIONS [203501]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|302||||302|16.53|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|302||||302|271.8|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|302||||302|11.06|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|302||||302|19.65|280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|302||||302||280.86|11.06
30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|302||||302|151|280.86|11.06
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|288||||288|26.47|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|288||||288|18.15|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|288||||288|18.15|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|288||||288|144.29|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|288||||288|101.09|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|288||||288|20.68|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|288||||288|122.69|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|288||||288|144|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|288||||288|187.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|288||||288|33.69|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|288||||288|20.62|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|GEHA [1415]|GEHA [141500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|288||||288|20.68|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|288||||288|267.84|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288||||288|172.8|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|288||||288|144|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|288||||288|17.54|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MULTIPLAN [1680]|HMA [168003]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MULTIPLAN [1680]|IHC HS [168011]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|288||||288|18.86|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|Self-pay|Self-pay|288||||288|86.4|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|288||||288|60.48|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|TRUSTMARK [2030]|STARMARK [203000]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288||||288|138.1|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|UMR [2035]|UMR OPTIONS [203501]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|288||||288|16.7|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|288||||288|259.2|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|288||||288|11.17|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|288||||288|20.62|267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|288||||288||267.84|11.17
30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|288||||288|144|267.84|11.17
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|216||||216|23.07|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216||||216|15.81|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216||||216|15.81|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|216||||216|108.22|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216||||216|75.82|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216||||216|18.03|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|216||||216|92.02|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|216||||216|108|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216||||216|140.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|CORESOURCE [1315]|CORESOURCE [131500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|216||||216|30.05|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|216||||216|18.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|GEHA [1415]|GEHA [141500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HEALTHNET [1495]|HEALTHNET [149500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216||||216|18.03|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|216||||216|200.88|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216||||216|129.6|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216||||216|108|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216||||216|15.27|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MULTIPLAN [1680]|HMA [168003]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MULTIPLAN [1680]|IHC HS [168011]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|216||||216|16.43|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|Self-pay|Self-pay|216||||216|64.8|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216||||216|45.36|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|TRUSTMARK [2030]|STARMARK [203000]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216||||216|103.57|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|UMR [2035]|UMR OPTIONS [203501]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216||||216|14.54|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216||||216|194.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|216||||216|9.73|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|216||||216|18.4|200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|216||||216||200.88|9.73
30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|216||||216|108|200.88|9.73
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|312||||312|21.71|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|312||||312|14|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|312||||312|14.88|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|312||||312|14.88|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|312||||312|156.31|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|312||||312|109.51|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|312||||312|16.96|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|312||||312|132.91|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|312||||312|156|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|312||||312|202.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|CORESOURCE [1315]|CORESOURCE [131500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|312||||312|34.4|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|312||||312|21.06|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|GEHA [1415]|GEHA [141500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|312||||312|30.89|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HEALTHNET [1495]|HEALTHNET [149500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|312||||312|16.96|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|312||||312|290.16|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|312||||312|187.2|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|312||||312|15.1|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|312||||312|156|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|312||||312|14.37|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|312||||312|18.54|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|312||||312|14|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MULTIPLAN [1680]|HMA [168003]|312||||312|20.6|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MULTIPLAN [1680]|IHC HS [168011]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|312||||312|15.47|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|312||||312|15.1|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|Self-pay|Self-pay|312||||312|93.6|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|312||||312|65.52|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|312||||312|13.46|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|312||||312|20.05|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|TRUSTMARK [2030]|STARMARK [203000]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|312||||312|149.6|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|UMR [2035]|UMR OPTIONS [203501]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|312||||312|13.69|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|312||||312|280.8|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|312||||312|9.16|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|312||||312|21.06|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|312||||312|13.73|290.16|9.16
30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|312||||312|156|290.16|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|726||||726|21.71|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|726||||726|14|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|726||||726|14.88|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|726||||726|14.88|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|726||||726|363.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|726||||726|254.83|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|726||||726|16.96|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|726||||726|309.28|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|726||||726|363|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|726||||726|471.9|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|CORESOURCE [1315]|CORESOURCE [131500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|726||||726|25.77|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|726||||726|15.78|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|GEHA [1415]|GEHA [141500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|726||||726|30.89|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HEALTHNET [1495]|HEALTHNET [149500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|726||||726|16.96|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|726||||726|675.18|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|726||||726|435.6|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|726||||726|15.1|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|726||||726|363|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|726||||726|14.37|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|726||||726|18.54|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|726||||726|14|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MULTIPLAN [1680]|HMA [168003]|726||||726|20.6|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MULTIPLAN [1680]|IHC HS [168011]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|726||||726|15.47|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|726||||726|15.1|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|Self-pay|Self-pay|726||||726|217.8|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|726||||726|152.46|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|726||||726|13.46|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|726||||726|20.05|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|TRUSTMARK [2030]|STARMARK [203000]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|726||||726|348.12|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|UMR [2035]|UMR OPTIONS [203501]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|726||||726|13.69|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|726||||726|653.4|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|726||||726|9.16|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|726||||726|15.78|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|726||||726|13.73|675.18|9.16
30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|726||||726|363|675.18|9.16
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|637||||637|22.34|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|637||||637|14.42|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|637||||637|15.32|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|637||||637|15.32|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|637||||637|319.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|637||||637|223.59|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|637||||637|17.46|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|637||||637|271.36|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|637||||637|318.5|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|637||||637|414.05|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|637||||637|25.38|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|637||||637|15.54|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|GEHA [1415]|GEHA [141500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|637||||637|31.82|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|637||||637|17.46|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|637||||637|592.41|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|637||||637|382.2|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|637||||637|15.55|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|637||||637|318.5|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|637||||637|14.8|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|637||||637|19.09|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|637||||637|14.42|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MULTIPLAN [1680]|HMA [168003]|637||||637|21.21|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MULTIPLAN [1680]|IHC HS [168011]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|637||||637|15.92|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|637||||637|15.55|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|Self-pay|Self-pay|637||||637|191.1|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|637||||637|133.77|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|637||||637|13.86|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|637||||637|20.64|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|TRUSTMARK [2030]|STARMARK [203000]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|637||||637|305.44|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|UMR [2035]|UMR OPTIONS [203501]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|637||||637|14.09|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|637||||637|573.3|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|637||||637|9.43|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|637||||637|15.54|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|637||||637|14.14|592.41|9.43
30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|637||||637|318.5|592.41|9.43
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|612||||612|25.49|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|612||||612|17.47|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|612||||612|17.47|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|612||||612|306.61|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|612||||612|214.81|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|612||||612|19.91|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|612||||612|260.71|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|612||||612|306|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|612||||612|397.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|CORESOURCE [1315]|CORESOURCE [131500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|612||||612|30.44|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|612||||612|18.64|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|GEHA [1415]|GEHA [141500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HEALTHNET [1495]|HEALTHNET [149500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|612||||612|19.91|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|612||||612|569.16|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|612||||612|367.2|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|612||||612|306|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|612||||612|16.87|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MULTIPLAN [1680]|HMA [168003]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MULTIPLAN [1680]|IHC HS [168011]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|612||||612|18.16|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|Self-pay|Self-pay|612||||612|183.6|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|612||||612|128.52|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|TRUSTMARK [2030]|STARMARK [203000]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|612||||612|293.45|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|UMR [2035]|UMR OPTIONS [203501]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|612||||612|16.07|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|612||||612|550.8|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|612||||612|10.75|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|612||||612|18.64|569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|612||||612||569.16|10.75
30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|612||||612|306|569.16|10.75
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|195||||195|18.83|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195||||195|12.16|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195||||195|12.91|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195||||195|12.91|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|195||||195|97.7|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195||||195|68.45|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195||||195|14.72|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|195||||195|83.07|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|195||||195|97.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195||||195|126.75|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|CORESOURCE [1315]|CORESOURCE [131500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|195||||195|24.75|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|195||||195|15.16|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|GEHA [1415]|GEHA [141500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|195||||195|26.82|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HEALTHNET [1495]|HEALTHNET [149500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195||||195|14.72|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|195||||195|181.35|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195||||195|117|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195||||195|13.11|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195||||195|97.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195||||195|12.46|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195||||195|16.09|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195||||195|12.16|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MULTIPLAN [1680]|HMA [168003]|195||||195|17.88|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MULTIPLAN [1680]|IHC HS [168011]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|195||||195|13.42|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195||||195|13.11|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|Self-pay|Self-pay|195||||195|58.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195||||195|40.95|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|195||||195|11.68|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195||||195|17.4|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|TRUSTMARK [2030]|STARMARK [203000]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195||||195|93.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|UMR [2035]|UMR OPTIONS [203501]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195||||195|11.87|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195||||195|175.5|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|195||||195|7.94|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|195||||195|15.16|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|195||||195|11.92|181.35|7.94
30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|195||||195|97.5|181.35|7.94
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|AETNA [1015]|AETNA ACO WILCO [101532]|261||||261|21.4|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|261||||261|13.81|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|261||||261|14.67|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|261||||261|14.67|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|261||||261|130.76|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|261||||261|91.61|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|261||||261|16.72|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|261||||261|111.19|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|261||||261|130.5|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|261||||261|169.65|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|CORESOURCE [1315]|CORESOURCE [131500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|261||||261|36.44|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|261||||261|22.31|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|GEHA [1415]|GEHA [141500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|261||||261|30.47|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HEALTHNET [1495]|HEALTHNET [149500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|261||||261|16.72|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|261||||261|242.73|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|261||||261|156.6|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|261||||261|14.89|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|261||||261|130.5|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|261||||261|14.17|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|261||||261|18.28|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|261||||261|13.81|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MULTIPLAN [1680]|HMA [168003]|261||||261|20.31|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MULTIPLAN [1680]|IHC HS [168011]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|261||||261|15.25|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|261||||261|14.89|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|Self-pay|Self-pay|261||||261|78.3|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|261||||261|54.81|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|261||||261|13.27|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|261||||261|19.77|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|TRUSTMARK [2030]|STARMARK [203000]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|261||||261|125.15|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|UMR [2035]|UMR OPTIONS [203501]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|261||||261|13.49|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|261||||261|234.9|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|261||||261|9.03|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|261||||261|22.31|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|261||||261|13.54|242.73|9.03
30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|261||||261|130.5|242.73|9.03
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|473||||473|20.96|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|473||||473|13.52|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|473||||473|14.36|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|473||||473|14.36|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|473||||473|236.97|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|473||||473|166.02|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|473||||473|16.36|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|473||||473|201.5|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|473||||473|236.5|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|473||||473|307.45|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|473||||473|24.31|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|473||||473|14.88|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|GEHA [1415]|GEHA [141500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|473||||473|29.81|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|473||||473|16.36|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|473||||473|439.89|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|473||||473|283.8|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|473||||473|14.58|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|473||||473|236.5|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|473||||473|13.87|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|473||||473|17.89|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|473||||473|13.52|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MULTIPLAN [1680]|HMA [168003]|473||||473|19.88|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MULTIPLAN [1680]|IHC HS [168011]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|473||||473|14.93|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|473||||473|14.58|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|Self-pay|Self-pay|473||||473|141.9|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|473||||473|99.33|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|473||||473|12.99|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|473||||473|19.35|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|TRUSTMARK [2030]|STARMARK [203000]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|473||||473|226.8|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|UMR [2035]|UMR OPTIONS [203501]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|473||||473|13.21|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|473||||473|425.7|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|473||||473|8.84|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|473||||473|14.88|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|473||||473|13.25|439.89|8.84
30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|473||||473|236.5|439.89|8.84
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|AETNA [1015]|AETNA ACO WILCO [101532]|295||||295|26.51|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295||||295|19.01|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295||||295|20.19|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295||||295|20.19|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|295||||295|147.8|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295||||295|103.55|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|295||||295|125.67|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|295||||295|147.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295||||295|191.75|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|CORESOURCE [1315]|CORESOURCE [131500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|295||||295|36.13|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|295||||295|22.12|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|GEHA [1415]|GEHA [141500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|295||||295|41.94|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HEALTHNET [1495]|HEALTHNET [149500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|295||||295|274.35|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295||||295|177|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295||||295|20.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295||||295|147.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295||||295|19.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295||||295|25.16|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295||||295|19.01|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MULTIPLAN [1680]|HMA [168003]|295||||295|27.96|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MULTIPLAN [1680]|IHC HS [168011]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|295||||295|20.98|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295||||295|20.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|Self-pay|Self-pay|295||||295|88.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295||||295|61.95|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|295||||295|18.27|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295||||295|27.21|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|TRUSTMARK [2030]|STARMARK [203000]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295||||295|141.45|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|UMR [2035]|UMR OPTIONS [203501]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295||||295|18.57|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295||||295|265.5|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|295||||295|11.18|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|295||||295|22.12|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|295||||295|18.64|274.35|11.18
30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|295||||295|147.5|274.35|11.18
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|39||||39|17.92|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39||||39|12.85|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39||||39|13.65|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39||||39|13.65|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39||||39|19.54|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39||||39|13.69|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39||||39|13.46|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39||||39|16.61|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39||||39|19.5|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39||||39|25.35|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39||||39|0|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39||||39|8.7|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|GEHA [1415]|GEHA [141500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39||||39|28.35|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39||||39|13.46|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39||||39|36.27|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39||||39|23.4|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39||||39|13.86|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39||||39|19.5|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39||||39|13.18|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39||||39|17.01|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39||||39|12.85|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MULTIPLAN [1680]|HMA [168003]|39||||39|18.9|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MULTIPLAN [1680]|IHC HS [168011]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39||||39|14.19|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39||||39|13.86|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|Self-pay|Self-pay|39||||39|11.7|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39||||39|8.19|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39||||39|12.35|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39||||39|18.4|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|TRUSTMARK [2030]|STARMARK [203000]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39||||39|18.7|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|UMR [2035]|UMR OPTIONS [203501]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39||||39|12.56|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39||||39|35.1|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39||||39|7.56|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39||||39|8.7|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39||||39|12.6|36.27|7.56
30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39||||39|19.5|36.27|7.56
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1851||||1851|91.96|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1851||||1851|63.38|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1851||||1851|67.32|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1851||||1851|67.32|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1851||||1851|927.35|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1851||||1851|649.7|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1851||||1851|71.83|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1851||||1851|788.53|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1851||||1851|925.5|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1851||||1851|1203.15|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1851||||1851|0|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1851||||1851|46.4|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|GEHA [1415]|GEHA [141500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1851||||1851|139.82|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1851||||1851|71.83|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1851||||1851|1721.43|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1851||||1851|1110.6|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1851||||1851|68.35|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1851||||1851|925.5|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1851||||1851|65.03|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1851||||1851|83.89|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1851||||1851|63.38|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MULTIPLAN [1680]|HMA [168003]|1851||||1851|93.21|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MULTIPLAN [1680]|IHC HS [168011]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1851||||1851|69.97|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1851||||1851|68.35|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|Self-pay|Self-pay|1851||||1851|555.3|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1851||||1851|388.71|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1851||||1851|60.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1851||||1851|90.72|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|TRUSTMARK [2030]|STARMARK [203000]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1851||||1851|887.55|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|UMR [2035]|UMR OPTIONS [203501]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1851||||1851|61.93|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1851||||1851|1665.9|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1851||||1851|38.79|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1851||||1851|46.4|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1851||||1851|62.14|1721.43|38.79
30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1851||||1851|925.5|1721.43|38.79
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|375||||375|51.54|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|375||||375|35.34|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|375||||375|35.34|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|375||||375|187.88|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|375||||375|131.63|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|375||||375|40.27|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|375||||375|159.75|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|375||||375|187.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|375||||375|243.75|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|CORESOURCE [1315]|CORESOURCE [131500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|375||||375|74.76|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|375||||375|38.61|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|GEHA [1415]|GEHA [141500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HEALTHNET [1495]|HEALTHNET [149500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|375||||375|40.27|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|375||||375|348.75|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|375||||375|225|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|375||||375|187.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|375||||375|34.13|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MULTIPLAN [1680]|HMA [168003]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MULTIPLAN [1680]|IHC HS [168011]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|375||||375|36.73|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|Self-pay|Self-pay|375||||375|112.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|375||||375|78.75|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|TRUSTMARK [2030]|STARMARK [203000]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|375||||375|179.81|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|UMR [2035]|UMR OPTIONS [203501]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|375||||375|32.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|375||||375|337.5|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|375||||375|21.74|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|375||||375|38.61|348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|375||||375||348.75|21.74
30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|375||||375|187.5|348.75|21.74
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|674||||674|228.91|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|674||||674|156.93|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|674||||674|156.93|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|674||||674|337.67|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|674||||674|236.57|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|674||||674|178.81|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|674||||674|287.12|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|674||||674|337|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|674||||674|438.1|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|CORESOURCE [1315]|CORESOURCE [131500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|674||||674|215.16|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|674||||674|131.73|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|GEHA [1415]|GEHA [141500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HEALTHNET [1495]|HEALTHNET [149500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|674||||674|178.81|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|674||||674|626.82|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|674||||674|404.4|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|674||||674|337|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|674||||674|151.56|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MULTIPLAN [1680]|HMA [168003]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MULTIPLAN [1680]|IHC HS [168011]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|674||||674|163.11|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|Self-pay|Self-pay|674||||674|202.2|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|674||||674|141.54|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|TRUSTMARK [2030]|STARMARK [203000]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|674||||674|323.18|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|UMR [2035]|UMR OPTIONS [203501]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|674||||674|144.34|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|674||||674|606.6|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|674||||674|96.56|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|674||||674|131.73|626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|674||||674||626.82|96.56
30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|674||||674|337|626.82|96.56
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|7470||||7470|791.71|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7470||||7470|0|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7470||||7470|0|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7470||||7470|3742.47|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7470||||7470|2621.97|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7470||||7470|556.6|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7470||||7470|3182.22|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7470||||7470|3735|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7470||||7470|4855.5|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7470||||7470|621.79|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7470||||7470|380.69|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|GEHA [1415]|GEHA [141500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7470||||7470|556.6|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7470||||7470|6947.1|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7470||||7470|4482|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7470||||7470|3735|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7470||||7470|0|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7470||||7470|0|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|Self-pay|Self-pay|7470||||7470|2241|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7470||||7470|1568.7|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7470||||7470|3581.87|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7470||||7470|0|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7470||||7470|6723|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7470||||7470|333.96|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7470||||7470|380.69|6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7470||||7470||6947.1|333.96
30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7470||||7470|3735|6947.1|333.96
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|AETNA [1015]|AETNA ACO WILCO [101532]|921||||921|312.92|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|921||||921|214.51|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|921||||921|214.51|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|921||||921|461.42|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|921||||921|323.27|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|921||||921|244.43|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|921||||921|392.35|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|921||||921|460.5|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|921||||921|598.65|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|CORESOURCE [1315]|CORESOURCE [131500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|921||||921|294.01|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|921||||921|180.01|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|GEHA [1415]|GEHA [141500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HEALTHNET [1495]|HEALTHNET [149500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|921||||921|244.43|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|921||||921|856.53|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|921||||921|552.6|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|921||||921|460.5|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|921||||921|207.18|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MULTIPLAN [1680]|HMA [168003]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MULTIPLAN [1680]|IHC HS [168011]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|921||||921|222.96|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|Self-pay|Self-pay|921||||921|276.3|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|921||||921|193.41|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|TRUSTMARK [2030]|STARMARK [203000]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|921||||921|441.62|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|UMR [2035]|UMR OPTIONS [203501]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|921||||921|197.31|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|921||||921|828.9|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|921||||921|131.99|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|921||||921|180.01|856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|921||||921||856.53|131.99
30181261|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|921||||921|460.5|856.53|131.99
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1102||||1102|92.94|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1102||||1102|70.79|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1102||||1102|70.79|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1102||||1102|552.1|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1102||||1102|386.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1102||||1102|65.34|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1102||||1102|469.45|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1102||||1102|551|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1102||||1102|716.3|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1102||||1102|65.11|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1102||||1102|43.39|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|GEHA [1415]|GEHA [141500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1102||||1102|65.34|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1102||||1102|1024.86|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1102||||1102|661.2|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1102||||1102|551|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1102||||1102|68.38|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1102||||1102|73.58|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|Self-pay|Self-pay|1102||||1102|330.6|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1102||||1102|231.42|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1102||||1102|528.41|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1102||||1102|65.12|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1102||||1102|991.8|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1102||||1102|39.2|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1102||||1102|43.39|1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1102||||1102||1024.86|39.2
30181291|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MTHFR GENE ANALYSIS COMMON VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1102||||1102|551|1024.86|39.2
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|881||||881|480.39|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|881||||881|365.92|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|881||||881|365.92|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|881||||881|441.38|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|881||||881|309.23|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|881||||881|337.73|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|881||||881|375.31|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|881||||881|440.5|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|881||||881|572.65|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|881||||881|329.62|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|881||||881|223.87|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|GEHA [1415]|GEHA [141500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|881||||881|337.73|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|881||||881|819.33|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|881||||881|528.6|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|881||||881|440.5|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|881||||881|353.42|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|881||||881|380.33|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|Self-pay|Self-pay|881||||881|264.3|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|881||||881|185.01|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|881||||881|422.44|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|881||||881|336.58|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|881||||881|792.9|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|881||||881|202.64|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|881||||881|223.87|819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|881||||881||819.33|185.01
30181296|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|881||||881|440.5|819.33|185.01
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|1755||||1755|330.19|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1755||||1755|226.35|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1755||||1755|226.35|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1755||||1755|879.26|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1755||||1755|616.01|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1755||||1755|257.92|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1755||||1755|747.63|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1755||||1755|877.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1755||||1755|1140.75|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|CORESOURCE [1315]|CORESOURCE [131500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1755||||1755|310.36|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1755||||1755|190.02|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|GEHA [1415]|GEHA [141500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HEALTHNET [1495]|HEALTHNET [149500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1755||||1755|257.92|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1755||||1755|1632.15|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1755||||1755|1053|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1755||||1755|877.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1755||||1755|218.62|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MULTIPLAN [1680]|HMA [168003]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MULTIPLAN [1680]|IHC HS [168011]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1755||||1755|235.26|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|Self-pay|Self-pay|1755||||1755|526.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1755||||1755|368.55|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|TRUSTMARK [2030]|STARMARK [203000]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1755||||1755|841.52|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|UMR [2035]|UMR OPTIONS [203501]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1755||||1755|208.2|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1755||||1755|1579.5|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1755||||1755|139.28|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1755||||1755|190.02|1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1755||||1755||1632.15|139.28
30181340|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1755||||1755|877.5|1632.15|139.28
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|114.97|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|80.53|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|80.53|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|89.81|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|108.05|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|66.15|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|89.81|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|77.78|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MULTIPLAN [1680]|HMA [168003]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|83.7|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|Self-pay|Self-pay|374||||374|112.2|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|74.08|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|48.5|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|66.15|347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374||347.82|48.5
30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|48.5
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5085||||5085|850.47|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5085||||5085|0|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5085||||5085|0|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5085||||5085|2547.59|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5085||||5085|1784.84|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5085||||5085|597.91|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5085||||5085|2166.21|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5085||||5085|2542.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5085||||5085|3305.25|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|CORESOURCE [1315]|CORESOURCE [131500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5085||||5085|627.34|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5085||||5085|387.39|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|GEHA [1415]|GEHA [141500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HEALTHNET [1495]|HEALTHNET [149500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5085||||5085|597.91|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5085||||5085|4729.05|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5085||||5085|3051|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5085||||5085|2542.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5085||||5085|0|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MULTIPLAN [1680]|HMA [168003]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MULTIPLAN [1680]|IHC HS [168011]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5085||||5085|0|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|Self-pay|Self-pay|5085||||5085|1525.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5085||||5085|1067.85|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|TRUSTMARK [2030]|STARMARK [203000]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5085||||5085|2438.26|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|UMR [2035]|UMR OPTIONS [203501]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5085||||5085|0|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5085||||5085|4576.5|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5085||||5085|358.75|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5085||||5085|387.39|4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5085||||5085||4729.05|358.75
30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5085||||5085|2542.5|4729.05|358.75
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|AETNA [1015]|AETNA ACO WILCO [101532]|12465||||12465|5508.96|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12465||||12465|4196.18|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12465||||12465|4196.18|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12465||||12465|6244.97|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12465||||12465|4375.22|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12465||||12465|3873|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12465||||12465|5310.09|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12465||||12465|6232.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12465||||12465|8102.25|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|CORESOURCE [1315]|CORESOURCE [131500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|12465||||12465|3634.69|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12465||||12465|2509.17|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|GEHA [1415]|GEHA [141500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HEALTHNET [1495]|HEALTHNET [149500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12465||||12465|3873|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|12465||||12465|11592.45|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12465||||12465|7479|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12465||||12465|6232.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12465||||12465|4052.84|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MULTIPLAN [1680]|HMA [168003]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MULTIPLAN [1680]|IHC HS [168011]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|12465||||12465|4361.4|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|Self-pay|Self-pay|12465||||12465|3739.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12465||||12465|2617.65|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|TRUSTMARK [2030]|STARMARK [203000]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12465||||12465|5976.97|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|UMR [2035]|UMR OPTIONS [203501]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12465||||12465|3859.74|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12465||||12465|11218.5|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12465||||12465|2323.8|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12465||||12465|2509.17|11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12465||||12465||11592.45|2323.8
30181519|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12465||||12465|6232.5|11592.45|2323.8
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|18||||18|7.15|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18||||18|4.61|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18||||18|4.9|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18||||18|4.9|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18||||18|9.02|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18||||18|6.32|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18||||18|5.58|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18||||18|7.67|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18||||18|9|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18||||18|11.7|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|CORESOURCE [1315]|CORESOURCE [131500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18||||18|8.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18||||18|5.22|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|GEHA [1415]|GEHA [141500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18||||18|10.17|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HEALTHNET [1495]|HEALTHNET [149500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18||||18|5.58|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18||||18|16.74|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18||||18|10.8|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18||||18|4.97|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18||||18|9|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18||||18|4.74|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18||||18|6.1|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18||||18|4.61|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MULTIPLAN [1680]|HMA [168003]|18||||18|6.78|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MULTIPLAN [1680]|IHC HS [168011]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18||||18|5.09|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18||||18|4.97|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|Self-pay|Self-pay|18||||18|5.4|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18||||18|3.78|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18||||18|4.43|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18||||18|6.6|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|TRUSTMARK [2030]|STARMARK [203000]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18||||18|8.63|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|UMR [2035]|UMR OPTIONS [203501]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18||||18|4.51|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18||||18|16.2|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18||||18|3.01|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18||||18|5.22|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18||||18|4.52|16.74|3.01
30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18||||18|9|16.74|3.01
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|219||||219|12.91|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219||||219|8.33|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219||||219|8.85|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219||||219|8.85|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|219||||219|109.72|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219||||219|76.87|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219||||219|10.09|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|219||||219|93.29|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|219||||219|109.5|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219||||219|142.35|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|CORESOURCE [1315]|CORESOURCE [131500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|219||||219|19.76|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|219||||219|12.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|GEHA [1415]|GEHA [141500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|219||||219|18.38|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HEALTHNET [1495]|HEALTHNET [149500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219||||219|10.09|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|219||||219|203.67|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219||||219|131.4|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219||||219|8.99|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219||||219|109.5|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219||||219|8.55|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219||||219|11.03|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219||||219|8.33|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MULTIPLAN [1680]|HMA [168003]|219||||219|12.26|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MULTIPLAN [1680]|IHC HS [168011]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|219||||219|9.2|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219||||219|8.99|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|Self-pay|Self-pay|219||||219|65.7|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219||||219|45.99|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|219||||219|8.01|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219||||219|11.93|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|TRUSTMARK [2030]|STARMARK [203000]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219||||219|105.01|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|UMR [2035]|UMR OPTIONS [203501]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219||||219|8.14|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219||||219|197.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|219||||219|5.45|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|219||||219|12.1|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|219||||219|8.17|203.67|5.45
30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|219||||219|109.5|203.67|5.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|214||||214|17.65|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|214||||214|13.31|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|214||||214|13.31|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|214||||214|107.21|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|214||||214|75.11|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|214||||214|13.79|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|214||||214|91.16|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|214||||214|107|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|214||||214|139.1|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|CORESOURCE [1315]|CORESOURCE [131500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|214||||214|19.5|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|214||||214|11.94|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|GEHA [1415]|GEHA [141500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HEALTHNET [1495]|HEALTHNET [149500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|214||||214|13.79|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|214||||214|199.02|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|214||||214|128.4|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|214||||214|107|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|214||||214|12.86|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MULTIPLAN [1680]|HMA [168003]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MULTIPLAN [1680]|IHC HS [168011]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|214||||214|13.83|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|Self-pay|Self-pay|214||||214|64.2|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|214||||214|44.94|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|TRUSTMARK [2030]|STARMARK [203000]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|214||||214|102.61|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|UMR [2035]|UMR OPTIONS [203501]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|214||||214|12.24|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|214||||214|192.6|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|214||||214|7.45|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|214||||214|11.94|199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|214||||214||199.02|7.45
30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|214||||214|107|199.02|7.45
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|AETNA [1015]|AETNA ACO WILCO [101532]|672||||672|61.04|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|672||||672|39.39|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|672||||672|41.84|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|672||||672|41.84|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|672||||672|336.67|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|672||||672|235.87|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|672||||672|47.68|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|672||||672|286.27|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|672||||672|336|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|672||||672|436.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|CORESOURCE [1315]|CORESOURCE [131500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|672||||672|61.92|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|672||||672|37.91|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|GEHA [1415]|GEHA [141500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|672||||672|86.9|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HEALTHNET [1495]|HEALTHNET [149500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|672||||672|47.68|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|672||||672|624.96|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|672||||672|403.2|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|672||||672|42.48|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|672||||672|336|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|672||||672|40.41|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|672||||672|52.14|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|672||||672|39.39|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MULTIPLAN [1680]|HMA [168003]|672||||672|57.93|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MULTIPLAN [1680]|IHC HS [168011]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|672||||672|43.49|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|672||||672|42.48|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|Self-pay|Self-pay|672||||672|201.6|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|672||||672|141.12|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|672||||672|37.85|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|672||||672|56.39|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|TRUSTMARK [2030]|STARMARK [203000]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|672||||672|322.22|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|UMR [2035]|UMR OPTIONS [203501]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|672||||672|38.49|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|672||||672|604.8|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|672||||672|25.75|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|672||||672|37.91|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|672||||672|38.62|624.96|25.75
30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|672||||672|336|624.96|25.75
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|AETNA [1015]|AETNA ACO WILCO [101532]|475||||475|40.78|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|475||||475|27.95|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|475||||475|27.95|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|475||||475|237.98|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|475||||475|166.73|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|475||||475|31.85|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|475||||475|202.35|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|475||||475|237.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|475||||475|308.75|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|CORESOURCE [1315]|CORESOURCE [131500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|475||||475|40.11|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|475||||475|24.56|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|GEHA [1415]|GEHA [141500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HEALTHNET [1495]|HEALTHNET [149500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|475||||475|31.85|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|475||||475|441.75|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|475||||475|285|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|475||||475|237.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|475||||475|27|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MULTIPLAN [1680]|HMA [168003]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MULTIPLAN [1680]|IHC HS [168011]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|475||||475|29.05|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|Self-pay|Self-pay|475||||475|142.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|475||||475|99.75|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|TRUSTMARK [2030]|STARMARK [203000]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|475||||475|227.76|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|UMR [2035]|UMR OPTIONS [203501]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|475||||475|25.71|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|475||||475|427.5|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|475||||475|17.2|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|475||||475|24.56|441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|475||||475||441.75|17.2
30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|475||||475|237.5|441.75|17.2
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|213||||213|7.83|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213||||213|5.05|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213||||213|5.36|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213||||213|5.36|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213||||213|106.71|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213||||213|74.76|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213||||213|6.11|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213||||213|90.74|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213||||213|106.5|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213||||213|138.45|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|CORESOURCE [1315]|CORESOURCE [131500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|213||||213|10.25|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213||||213|6.27|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|GEHA [1415]|GEHA [141500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213||||213|11.14|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HEALTHNET [1495]|HEALTHNET [149500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213||||213|6.11|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|213||||213|198.09|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213||||213|127.8|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213||||213|5.45|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213||||213|106.5|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213||||213|5.17|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213||||213|6.68|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213||||213|5.05|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MULTIPLAN [1680]|HMA [168003]|213||||213|7.43|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MULTIPLAN [1680]|IHC HS [168011]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|213||||213|5.57|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213||||213|5.45|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|Self-pay|Self-pay|213||||213|63.9|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213||||213|44.73|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213||||213|4.85|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213||||213|7.23|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|TRUSTMARK [2030]|STARMARK [203000]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213||||213|102.13|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|UMR [2035]|UMR OPTIONS [203501]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213||||213|4.93|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213||||213|191.7|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213||||213|3.3|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213||||213|6.27|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213||||213|4.95|198.09|3.3
30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213||||213|106.5|198.09|3.3
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|198||||198|11.07|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198||||198|7.94|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198||||198|8.43|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198||||198|8.43|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198||||198|99.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198||||198|69.5|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198||||198|84.35|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198||||198|99|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198||||198|128.7|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|CORESOURCE [1315]|CORESOURCE [131500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198||||198|8.97|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198||||198|5.49|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|GEHA [1415]|GEHA [141500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198||||198|17.51|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HEALTHNET [1495]|HEALTHNET [149500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198||||198|184.14|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198||||198|118.8|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198||||198|8.56|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198||||198|99|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198||||198|8.14|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198||||198|10.5|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198||||198|7.94|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MULTIPLAN [1680]|HMA [168003]|198||||198|11.67|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MULTIPLAN [1680]|IHC HS [168011]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198||||198|8.76|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198||||198|8.56|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|Self-pay|Self-pay|198||||198|59.4|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198||||198|41.58|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198||||198|7.62|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198||||198|11.36|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|TRUSTMARK [2030]|STARMARK [203000]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198||||198|94.94|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|UMR [2035]|UMR OPTIONS [203501]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198||||198|7.75|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198||||198|178.2|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198||||198|4.67|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198||||198|5.49|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198||||198|7.78|184.14|4.67
30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198||||198|99|184.14|4.67
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|230||||230|9.13|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230||||230|5.9|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230||||230|6.26|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230||||230|6.26|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|230||||230|115.23|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230||||230|80.73|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230||||230|7.14|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|230||||230|97.98|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|230||||230|115|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230||||230|149.5|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|CORESOURCE [1315]|CORESOURCE [131500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|230||||230|12.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|230||||230|7.82|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|GEHA [1415]|GEHA [141500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|230||||230|13.01|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HEALTHNET [1495]|HEALTHNET [149500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230||||230|7.14|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|230||||230|213.9|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230||||230|138|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230||||230|6.36|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230||||230|115|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230||||230|6.05|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230||||230|7.8|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230||||230|5.9|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MULTIPLAN [1680]|HMA [168003]|230||||230|8.67|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MULTIPLAN [1680]|IHC HS [168011]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|230||||230|6.51|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230||||230|6.36|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|Self-pay|Self-pay|230||||230|69|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230||||230|48.3|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|230||||230|5.66|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230||||230|8.44|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|TRUSTMARK [2030]|STARMARK [203000]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230||||230|110.29|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|UMR [2035]|UMR OPTIONS [203501]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230||||230|5.76|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230||||230|207|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|230||||230|3.85|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|230||||230|7.82|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|230||||230|5.78|213.9|3.85
30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|230||||230|115|213.9|3.85
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|295||||295|15.34|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295||||295|9.9|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295||||295|10.52|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295||||295|10.52|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|295||||295|147.8|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295||||295|103.55|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295||||295|11.99|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|295||||295|125.67|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|295||||295|147.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295||||295|191.75|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|CORESOURCE [1315]|CORESOURCE [131500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|295||||295|20.04|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|295||||295|12.27|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|GEHA [1415]|GEHA [141500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|295||||295|21.85|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HEALTHNET [1495]|HEALTHNET [149500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295||||295|11.99|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|295||||295|274.35|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295||||295|177|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295||||295|10.68|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295||||295|147.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295||||295|10.16|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295||||295|13.11|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295||||295|9.9|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MULTIPLAN [1680]|HMA [168003]|295||||295|14.57|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MULTIPLAN [1680]|IHC HS [168011]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|295||||295|10.93|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295||||295|10.68|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|Self-pay|Self-pay|295||||295|88.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295||||295|61.95|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|295||||295|9.52|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295||||295|14.18|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|TRUSTMARK [2030]|STARMARK [203000]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295||||295|141.45|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|UMR [2035]|UMR OPTIONS [203501]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295||||295|9.68|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295||||295|265.5|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|295||||295|6.47|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|295||||295|12.27|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|295||||295|9.71|274.35|6.47
30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|295||||295|147.5|274.35|6.47
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|634||||634|64.41|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|634||||634|41.57|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|634||||634|44.16|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|634||||634|44.16|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|634||||634|317.63|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|634||||634|222.53|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|634||||634|50.31|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|634||||634|270.08|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|634||||634|317|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|634||||634|412.1|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|CORESOURCE [1315]|CORESOURCE [131500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|634||||634|77.32|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|634||||634|47.34|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|GEHA [1415]|GEHA [141500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|634||||634|91.69|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HEALTHNET [1495]|HEALTHNET [149500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|634||||634|50.31|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|634||||634|589.62|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|634||||634|380.4|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|634||||634|44.83|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|634||||634|317|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|634||||634|42.65|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|634||||634|55.01|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|634||||634|41.57|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MULTIPLAN [1680]|HMA [168003]|634||||634|61.13|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MULTIPLAN [1680]|IHC HS [168011]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|634||||634|45.9|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|634||||634|44.83|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|Self-pay|Self-pay|634||||634|190.2|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|634||||634|133.14|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|634||||634|39.94|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|634||||634|59.5|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|TRUSTMARK [2030]|STARMARK [203000]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|634||||634|304|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|UMR [2035]|UMR OPTIONS [203501]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|634||||634|40.62|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|634||||634|570.6|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|634||||634|27.17|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|634||||634|47.34|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|634||||634|40.75|589.62|27.17
30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|634||||634|317|589.62|27.17
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|264||||264|21.24|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|264||||264|13.71|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|264||||264|14.56|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|264||||264|14.56|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|264||||264|132.26|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|264||||264|92.66|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|264||||264|16.59|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|264||||264|112.46|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|264||||264|132|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|264||||264|171.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|264||||264|20.35|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|264||||264|12.46|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|GEHA [1415]|GEHA [141500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|264||||264|30.24|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|264||||264|16.59|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|264||||264|245.52|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|264||||264|158.4|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|264||||264|14.78|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|264||||264|132|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|264||||264|14.06|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|264||||264|18.14|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|264||||264|13.71|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MULTIPLAN [1680]|HMA [168003]|264||||264|20.16|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|264||||264|15.13|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|264||||264|14.78|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|Self-pay|Self-pay|264||||264|79.2|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|264||||264|55.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|264||||264|13.17|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|264||||264|19.62|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|264||||264|126.59|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|264||||264|13.39|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|264||||264|237.6|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|264||||264|8.96|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|264||||264|12.46|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|264||||264|13.44|245.52|8.96
30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|264||||264|132|245.52|8.96
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|554||||554|22.86|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|554||||554|14.75|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|554||||554|15.66|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|554||||554|15.66|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|554||||554|277.55|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|554||||554|194.45|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|554||||554|17.86|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|554||||554|236|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|554||||554|277|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|554||||554|360.1|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|CORESOURCE [1315]|CORESOURCE [131500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|554||||554|22.96|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|554||||554|14.06|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|GEHA [1415]|GEHA [141500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|554||||554|32.54|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HEALTHNET [1495]|HEALTHNET [149500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|554||||554|17.86|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|554||||554|515.22|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|554||||554|332.4|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|554||||554|15.91|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|554||||554|277|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|554||||554|15.13|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|554||||554|19.52|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|554||||554|14.75|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MULTIPLAN [1680]|HMA [168003]|554||||554|21.69|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MULTIPLAN [1680]|IHC HS [168011]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|554||||554|16.28|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|554||||554|15.91|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|Self-pay|Self-pay|554||||554|166.2|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|554||||554|116.34|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|554||||554|14.17|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|554||||554|21.11|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|TRUSTMARK [2030]|STARMARK [203000]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|554||||554|265.64|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|UMR [2035]|UMR OPTIONS [203501]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|554||||554|14.41|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|554||||554|498.6|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|554||||554|9.64|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|554||||554|14.06|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|554||||554|14.46|515.22|9.64
30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|554||||554|277|515.22|9.64
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|791||||791|26.51|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|791||||791|17.11|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|791||||791|18.16|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|791||||791|18.16|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|791||||791|396.29|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|791||||791|277.64|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|791||||791|20.71|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|791||||791|336.97|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|791||||791|395.5|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|791||||791|514.15|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|791||||791|25.6|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|791||||791|15.67|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|GEHA [1415]|GEHA [141500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|791||||791|37.73|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|791||||791|20.71|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|791||||791|735.63|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|791||||791|474.6|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|791||||791|18.45|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|791||||791|395.5|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|791||||791|17.55|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|791||||791|22.64|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|791||||791|17.11|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MULTIPLAN [1680]|HMA [168003]|791||||791|25.16|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|791||||791|18.88|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|791||||791|18.45|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|Self-pay|Self-pay|791||||791|237.3|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|791||||791|166.11|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|791||||791|16.43|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|791||||791|24.48|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|791||||791|379.28|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|UMR [2035]|UMR OPTIONS [203501]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|791||||791|16.71|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|791||||791|711.9|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|791||||791|11.18|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|791||||791|15.67|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|791||||791|16.77|735.63|11.18
30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|791||||791|395.5|735.63|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|229||||229|26.51|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229||||229|18.42|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229||||229|18.42|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|229||||229|114.73|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229||||229|80.38|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229||||229|20.71|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|229||||229|97.55|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|229||||229|114.5|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229||||229|148.85|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|229||||229|25.6|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|229||||229|15.67|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|GEHA [1415]|GEHA [141500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229||||229|20.71|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|229||||229|212.97|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229||||229|137.4|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229||||229|114.5|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229||||229|17.79|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MULTIPLAN [1680]|HMA [168003]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MULTIPLAN [1680]|IHC HS [168011]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|229||||229|19.15|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|Self-pay|Self-pay|229||||229|68.7|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229||||229|48.09|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|TRUSTMARK [2030]|STARMARK [203000]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229||||229|109.81|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|UMR [2035]|UMR OPTIONS [203501]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229||||229|16.94|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229||||229|206.1|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|229||||229|11.18|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|229||||229|15.67|212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|229||||229||212.97|11.18
30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|229||||229|114.5|212.97|11.18
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|AETNA [1015]|AETNA ACO WILCO [101532]|1104||||1104|101.8|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1104||||1104|69.79|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1104||||1104|69.79|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1104||||1104|553.1|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1104||||1104|387.5|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1104||||1104|79.52|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1104||||1104|470.3|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1104||||1104|552|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1104||||1104|717.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|CORESOURCE [1315]|CORESOURCE [131500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1104||||1104|81.74|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1104||||1104|50.04|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|GEHA [1415]|GEHA [141500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HEALTHNET [1495]|HEALTHNET [149500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1104||||1104|79.52|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1104||||1104|1026.72|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1104||||1104|662.4|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1104||||1104|552|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1104||||1104|67.4|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MULTIPLAN [1680]|HMA [168003]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MULTIPLAN [1680]|IHC HS [168011]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1104||||1104|72.54|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|Self-pay|Self-pay|1104||||1104|331.2|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1104||||1104|231.84|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|TRUSTMARK [2030]|STARMARK [203000]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1104||||1104|529.37|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|UMR [2035]|UMR OPTIONS [203501]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1104||||1104|64.19|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1104||||1104|993.6|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1104||||1104|42.94|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1104||||1104|50.04|1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1104||||1104||1026.72|42.94
30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1104||||1104|552|1026.72|42.94
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|273||||273|40.26|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273||||273|27.6|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273||||273|27.6|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|273||||273|136.77|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273||||273|95.82|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273||||273|31.46|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|273||||273|116.3|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|273||||273|136.5|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273||||273|177.45|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|CORESOURCE [1315]|CORESOURCE [131500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|273||||273|41.02|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|273||||273|25.11|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|GEHA [1415]|GEHA [141500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HEALTHNET [1495]|HEALTHNET [149500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273||||273|31.46|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|273||||273|253.89|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273||||273|163.8|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273||||273|136.5|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273||||273|26.66|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MULTIPLAN [1680]|HMA [168003]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MULTIPLAN [1680]|IHC HS [168011]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|273||||273|28.69|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|Self-pay|Self-pay|273||||273|81.9|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273||||273|57.33|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|TRUSTMARK [2030]|STARMARK [203000]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273||||273|130.9|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|UMR [2035]|UMR OPTIONS [203501]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273||||273|25.39|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273||||273|245.7|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|273||||273|16.99|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|273||||273|25.11|253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|273||||273||253.89|16.99
30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|273||||273|136.5|253.89|16.99
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|203||||203|21.92|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203||||203|15.03|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203||||203|15.03|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|203||||203|101.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203||||203|71.25|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203||||203|17.13|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|203||||203|86.48|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|203||||203|101.5|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203||||203|131.95|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|CORESOURCE [1315]|CORESOURCE [131500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|203||||203|27.93|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|203||||203|17.1|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|GEHA [1415]|GEHA [141500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HEALTHNET [1495]|HEALTHNET [149500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203||||203|17.13|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|203||||203|188.79|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203||||203|121.8|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203||||203|101.5|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203||||203|14.52|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MULTIPLAN [1680]|HMA [168003]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MULTIPLAN [1680]|IHC HS [168011]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|203||||203|15.62|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|Self-pay|Self-pay|203||||203|60.9|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203||||203|42.63|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|TRUSTMARK [2030]|STARMARK [203000]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203||||203|97.34|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|UMR [2035]|UMR OPTIONS [203501]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203||||203|13.82|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203||||203|182.7|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|203||||203|9.25|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|203||||203|17.1|188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|203||||203||188.79|9.25
30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|203||||203|101.5|188.79|9.25
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|289||||289|32.68|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|289||||289|24.9|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|289||||289|24.9|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|289||||289|144.79|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|289||||289|101.44|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|289||||289|22.98|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|289||||289|123.11|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|289||||289|144.5|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|289||||289|187.85|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|CORESOURCE [1315]|CORESOURCE [131500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|289||||289|51.64|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|289||||289|31.62|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|GEHA [1415]|GEHA [141500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HEALTHNET [1495]|HEALTHNET [149500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289||||289|22.98|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|289||||289|268.77|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|289||||289|173.4|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|289||||289|144.5|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|289||||289|24.04|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MULTIPLAN [1680]|HMA [168003]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MULTIPLAN [1680]|IHC HS [168011]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|289||||289|25.88|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|Self-pay|Self-pay|289||||289|86.7|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|289||||289|60.69|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|TRUSTMARK [2030]|STARMARK [203000]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289||||289|138.58|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|UMR [2035]|UMR OPTIONS [203501]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|289||||289|22.9|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|289||||289|260.1|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|289||||289|13.79|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|289||||289|31.62|268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|289||||289||268.77|13.79
30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|289||||289|144.5|268.77|13.79
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|357||||357|26.01|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|357||||357|17.82|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|357||||357|17.82|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|357||||357|178.86|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|357||||357|125.31|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|357||||357|20.31|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|357||||357|152.08|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|357||||357|178.5|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|357||||357|232.05|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|CORESOURCE [1315]|CORESOURCE [131500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|357||||357|30.28|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|357||||357|18.54|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|GEHA [1415]|GEHA [141500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HEALTHNET [1495]|HEALTHNET [149500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|357||||357|20.31|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|357||||357|332.01|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|357||||357|214.2|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|357||||357|178.5|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|357||||357|17.21|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MULTIPLAN [1680]|HMA [168003]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MULTIPLAN [1680]|IHC HS [168011]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|357||||357|18.52|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|Self-pay|Self-pay|357||||357|107.1|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|357||||357|74.97|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|TRUSTMARK [2030]|STARMARK [203000]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|357||||357|171.18|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|UMR [2035]|UMR OPTIONS [203501]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|357||||357|16.39|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|357||||357|321.3|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|357||||357|10.97|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|357||||357|18.54|332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|357||||357||332.01|10.97
30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|357||||357|178.5|332.01|10.97
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|360||||360|26.66|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|360||||360|17.21|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|360||||360|18.28|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|360||||360|18.28|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|360||||360|180.36|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|360||||360|126.36|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|360||||360|20.83|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|360||||360|153.36|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|360||||360|180|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|360||||360|234|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|CORESOURCE [1315]|CORESOURCE [131500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|360||||360|36.16|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|360||||360|22.14|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|GEHA [1415]|GEHA [141500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|360||||360|37.96|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HEALTHNET [1495]|HEALTHNET [149500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|360||||360|20.83|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|360||||360|334.8|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|360||||360|216|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|360||||360|18.56|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|360||||360|180|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|360||||360|17.66|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|360||||360|22.77|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|360||||360|17.21|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MULTIPLAN [1680]|HMA [168003]|360||||360|25.31|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MULTIPLAN [1680]|IHC HS [168011]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|360||||360|19|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|360||||360|18.56|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|Self-pay|Self-pay|360||||360|108|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|360||||360|75.6|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|360||||360|16.53|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|360||||360|24.63|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|TRUSTMARK [2030]|STARMARK [203000]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|360||||360|172.62|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|UMR [2035]|UMR OPTIONS [203501]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|360||||360|16.82|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|360||||360|324|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|360||||360|11.24|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|360||||360|22.14|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|360||||360|16.87|334.8|11.24
30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|360||||360|180|334.8|11.24
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|411||||411|23.03|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|411||||411|14.86|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|411||||411|15.79|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|411||||411|15.79|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|411||||411|205.91|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|411||||411|144.26|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|411||||411|17.99|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|411||||411|175.09|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|411||||411|205.5|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|411||||411|267.15|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|CORESOURCE [1315]|CORESOURCE [131500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|411||||411|32.99|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|411||||411|20.2|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|GEHA [1415]|GEHA [141500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|411||||411|32.78|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HEALTHNET [1495]|HEALTHNET [149500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|411||||411|17.99|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|411||||411|382.23|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|411||||411|246.6|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|411||||411|16.03|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|411||||411|205.5|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|411||||411|15.25|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|411||||411|19.67|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|411||||411|14.86|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MULTIPLAN [1680]|HMA [168003]|411||||411|21.86|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MULTIPLAN [1680]|IHC HS [168011]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|411||||411|16.41|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|411||||411|16.03|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|Self-pay|Self-pay|411||||411|123.3|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|411||||411|86.31|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|411||||411|14.28|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|411||||411|21.27|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|TRUSTMARK [2030]|STARMARK [203000]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|411||||411|197.07|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|UMR [2035]|UMR OPTIONS [203501]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|411||||411|14.52|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|411||||411|369.9|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|411||||411|9.71|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|411||||411|20.2|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|411||||411|14.57|382.23|9.71
30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|411||||411|205.5|382.23|9.71
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|152||||152|13.29|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152||||152|10.13|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152||||152|10.13|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|152||||152|76.15|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152||||152|53.35|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152||||152|9.35|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|152||||152|64.75|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|152||||152|76|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152||||152|98.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|CORESOURCE [1315]|CORESOURCE [131500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|152||||152|20.45|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|152||||152|12.52|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|GEHA [1415]|GEHA [141500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HEALTHNET [1495]|HEALTHNET [149500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152||||152|9.35|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|152||||152|141.36|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152||||152|91.2|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152||||152|76|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152||||152|9.79|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MULTIPLAN [1680]|HMA [168003]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MULTIPLAN [1680]|IHC HS [168011]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|152||||152|10.53|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|Self-pay|Self-pay|152||||152|45.6|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152||||152|31.92|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|TRUSTMARK [2030]|STARMARK [203000]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152||||152|72.88|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|UMR [2035]|UMR OPTIONS [203501]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152||||152|9.32|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152||||152|136.8|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|152||||152|5.61|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|152||||152|12.52|141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|152||||152||141.36|5.61
30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|152||||152|76|141.36|5.61
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|356||||356|10.24|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356||||356|6.61|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356||||356|7.02|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356||||356|7.02|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|356||||356|178.36|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356||||356|124.96|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356||||356|8|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|356||||356|151.66|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|356||||356|178|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356||||356|231.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|CORESOURCE [1315]|CORESOURCE [131500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|356||||356|14.32|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|356||||356|8.77|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|GEHA [1415]|GEHA [141500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|356||||356|14.58|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HEALTHNET [1495]|HEALTHNET [149500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356||||356|8|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|356||||356|331.08|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356||||356|213.6|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356||||356|7.13|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356||||356|178|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356||||356|6.78|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356||||356|8.75|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356||||356|6.61|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MULTIPLAN [1680]|HMA [168003]|356||||356|9.72|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MULTIPLAN [1680]|IHC HS [168011]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|356||||356|7.3|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356||||356|7.13|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|Self-pay|Self-pay|356||||356|106.8|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356||||356|74.76|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|356||||356|6.35|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356||||356|9.46|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|TRUSTMARK [2030]|STARMARK [203000]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356||||356|170.7|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|UMR [2035]|UMR OPTIONS [203501]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356||||356|6.45|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356||||356|320.4|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|356||||356|4.32|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|356||||356|8.77|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|356||||356|6.48|331.08|4.32
30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|356||||356|178|331.08|4.32
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|532||||532|45.57|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|532||||532|31.24|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|532||||532|31.24|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|532||||532|266.53|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|532||||532|186.73|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|532||||532|35.6|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|532||||532|226.63|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|532||||532|266|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|532||||532|345.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|532||||532|46.03|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|532||||532|28.18|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|GEHA [1415]|GEHA [141500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|532||||532|35.6|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|532||||532|494.76|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|532||||532|319.2|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|532||||532|266|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|532||||532|30.17|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MULTIPLAN [1680]|HMA [168003]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MULTIPLAN [1680]|IHC HS [168011]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|532||||532|32.47|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|Self-pay|Self-pay|532||||532|159.6|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|532||||532|111.72|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|TRUSTMARK [2030]|STARMARK [203000]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|532||||532|255.09|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|UMR [2035]|UMR OPTIONS [203501]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|532||||532|28.73|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|532||||532|478.8|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|532||||532|19.22|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|532||||532|28.18|494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|532||||532||494.76|19.22
30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|532||||532|266|494.76|19.22
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|511||||511|46.27|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|511||||511|29.87|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|511||||511|31.72|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|511||||511|31.72|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|511||||511|256.01|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|511||||511|179.36|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|511||||511|36.14|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|511||||511|217.69|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|511||||511|255.5|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|511||||511|332.15|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|CORESOURCE [1315]|CORESOURCE [131500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|511||||511|49.94|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|511||||511|30.58|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|GEHA [1415]|GEHA [141500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|511||||511|65.88|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HEALTHNET [1495]|HEALTHNET [149500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|511||||511|36.14|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|511||||511|475.23|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|511||||511|306.6|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|511||||511|32.21|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|511||||511|255.5|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|511||||511|30.64|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|511||||511|39.53|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|511||||511|29.87|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MULTIPLAN [1680]|HMA [168003]|511||||511|43.92|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MULTIPLAN [1680]|IHC HS [168011]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|511||||511|32.97|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|511||||511|32.21|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|Self-pay|Self-pay|511||||511|153.3|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|511||||511|107.31|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|511||||511|28.69|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|511||||511|42.75|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|TRUSTMARK [2030]|STARMARK [203000]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|511||||511|245.02|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|UMR [2035]|UMR OPTIONS [203501]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|511||||511|29.18|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|511||||511|459.9|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|511||||511|19.52|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|511||||511|30.58|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|511||||511|29.28|475.23|19.52
30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|511||||511|255.5|475.23|19.52
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|AETNA [1015]|AETNA ACO WILCO [101532]|273||||273|23.07|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273||||273|14.89|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273||||273|15.81|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273||||273|15.81|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|273||||273|136.77|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273||||273|95.82|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273||||273|18.03|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|273||||273|116.3|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|273||||273|136.5|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273||||273|177.45|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|CORESOURCE [1315]|CORESOURCE [131500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|273||||273|26.9|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|273||||273|16.47|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|GEHA [1415]|GEHA [141500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|273||||273|32.85|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HEALTHNET [1495]|HEALTHNET [149500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273||||273|18.03|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|273||||273|253.89|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273||||273|163.8|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273||||273|16.06|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273||||273|136.5|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273||||273|15.27|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273||||273|19.71|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273||||273|14.89|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MULTIPLAN [1680]|HMA [168003]|273||||273|21.9|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MULTIPLAN [1680]|IHC HS [168011]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|273||||273|16.43|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273||||273|16.06|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|Self-pay|Self-pay|273||||273|81.9|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273||||273|57.33|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|273||||273|14.31|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273||||273|21.32|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|TRUSTMARK [2030]|STARMARK [203000]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273||||273|130.9|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|UMR [2035]|UMR OPTIONS [203501]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273||||273|14.54|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273||||273|245.7|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|273||||273|9.73|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|273||||273|16.47|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|273||||273|14.6|253.89|9.73
30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|273||||273|136.5|253.89|9.73
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|188||||188|29.99|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|188||||188|21.51|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|188||||188|22.84|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|188||||188|22.84|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|188||||188|94.19|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|188||||188|65.99|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|188||||188|80.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|188||||188|94|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|188||||188|122.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|188||||188|27.51|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|188||||188|16.84|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|GEHA [1415]|GEHA [141500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|188||||188|47.45|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|188||||188|174.84|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|188||||188|112.8|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|188||||188|23.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|188||||188|94|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|188||||188|22.07|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|188||||188|28.47|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|188||||188|21.51|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MULTIPLAN [1680]|HMA [168003]|188||||188|31.64|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MULTIPLAN [1680]|IHC HS [168011]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|188||||188|23.74|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|188||||188|23.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|Self-pay|Self-pay|188||||188|56.4|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|188||||188|39.48|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|188||||188|20.67|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|188||||188|30.79|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|TRUSTMARK [2030]|STARMARK [203000]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|188||||188|90.15|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|UMR [2035]|UMR OPTIONS [203501]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|188||||188|21.02|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|188||||188|169.2|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|188||||188|12.65|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|188||||188|16.84|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|188||||188|21.09|174.84|12.65
30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|188||||188|94|174.84|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|224||||224|29.98|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|224||||224|19.35|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|224||||224|20.55|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|224||||224|20.55|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|224||||224|112.22|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|224||||224|78.62|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|224||||224|23.42|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|224||||224|95.42|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|224||||224|112|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|224||||224|145.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|CORESOURCE [1315]|CORESOURCE [131500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|224||||224|41.22|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|224||||224|25.24|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|GEHA [1415]|GEHA [141500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|224||||224|42.68|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HEALTHNET [1495]|HEALTHNET [149500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|224||||224|23.42|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|224||||224|208.32|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|224||||224|134.4|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|224||||224|20.87|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|224||||224|112|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|224||||224|19.85|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|224||||224|25.61|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|224||||224|19.35|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MULTIPLAN [1680]|HMA [168003]|224||||224|28.46|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MULTIPLAN [1680]|IHC HS [168011]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|224||||224|21.36|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|224||||224|20.87|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|Self-pay|Self-pay|224||||224|67.2|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|224||||224|47.04|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|224||||224|18.59|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|224||||224|27.7|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|TRUSTMARK [2030]|STARMARK [203000]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|224||||224|107.41|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|UMR [2035]|UMR OPTIONS [203501]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|224||||224|18.91|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|224||||224|201.6|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|224||||224|12.65|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|224||||224|25.24|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|224||||224|18.97|208.32|12.65
30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|224||||224|112|208.32|12.65
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|AETNA [1015]|AETNA ACO WILCO [101532]|379||||379|15.61|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|379||||379|10.09|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|379||||379|10.72|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|379||||379|10.72|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|379||||379|189.88|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|379||||379|133.03|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|379||||379|12.2|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|379||||379|161.45|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|379||||379|189.5|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|379||||379|246.35|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|CORESOURCE [1315]|CORESOURCE [131500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|379||||379|22.49|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|379||||379|13.77|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|GEHA [1415]|GEHA [141500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|379||||379|22.25|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HEALTHNET [1495]|HEALTHNET [149500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|379||||379|12.2|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|379||||379|352.47|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|379||||379|227.4|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|379||||379|10.88|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|379||||379|189.5|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|379||||379|10.36|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|379||||379|13.35|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|379||||379|10.09|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MULTIPLAN [1680]|HMA [168003]|379||||379|14.84|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MULTIPLAN [1680]|IHC HS [168011]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|379||||379|11.14|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|379||||379|10.88|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|Self-pay|Self-pay|379||||379|113.7|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|379||||379|79.59|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|379||||379|9.69|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|379||||379|14.44|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|TRUSTMARK [2030]|STARMARK [203000]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|379||||379|181.73|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|UMR [2035]|UMR OPTIONS [203501]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|379||||379|9.86|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|379||||379|341.1|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|379||||379|6.59|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|379||||379|13.77|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|379||||379|9.89|352.47|6.59
30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|379||||379|189.5|352.47|6.59
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|275||||275|25.56|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|275||||275|16.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|275||||275|17.53|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|275||||275|17.53|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|275||||275|137.78|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|275||||275|96.53|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|275||||275|19.97|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|275||||275|117.15|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|275||||275|137.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|275||||275|178.75|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|275||||275|32.03|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|275||||275|19.61|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|GEHA [1415]|GEHA [141500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|275||||275|36.41|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|275||||275|19.97|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|275||||275|255.75|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|275||||275|165|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|275||||275|17.8|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|275||||275|137.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|275||||275|16.93|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|275||||275|21.84|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|275||||275|16.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MULTIPLAN [1680]|HMA [168003]|275||||275|24.27|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MULTIPLAN [1680]|IHC HS [168011]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|275||||275|18.22|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|275||||275|17.8|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|Self-pay|Self-pay|275||||275|82.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|275||||275|57.75|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|275||||275|15.86|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|275||||275|23.62|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|TRUSTMARK [2030]|STARMARK [203000]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|275||||275|131.86|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|UMR [2035]|UMR OPTIONS [203501]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|275||||275|16.12|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|275||||275|247.5|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|275||||275|10.78|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|275||||275|19.61|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|275||||275|16.18|255.75|10.78
30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|275||||275|137.5|255.75|10.78
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|662||||662|7.92|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|662||||662|5.12|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|662||||662|5.44|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|662||||662|5.44|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|662||||662|331.66|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|662||||662|232.36|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|662||||662|6.19|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|662||||662|282.01|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|662||||662|331|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|662||||662|430.3|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|662||||662|8.54|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|662||||662|5.23|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|GEHA [1415]|GEHA [141500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|662||||662|11.3|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|662||||662|6.19|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|662||||662|615.66|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|662||||662|397.2|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|662||||662|5.52|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|662||||662|331|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|662||||662|5.25|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|662||||662|6.78|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|662||||662|5.12|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MULTIPLAN [1680]|HMA [168003]|662||||662|7.53|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|662||||662|5.65|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|662||||662|5.52|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|Self-pay|Self-pay|662||||662|198.6|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|662||||662|139.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|662||||662|4.92|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|662||||662|7.33|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|662||||662|317.43|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|662||||662|5|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|662||||662|595.8|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|662||||662|3.34|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|662||||662|5.23|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|662||||662|5.02|615.66|3.34
30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|662||||662|331|615.66|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|AETNA [1015]|AETNA ACO WILCO [101532]|129||||129|7.92|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|129||||129|5.12|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|129||||129|5.44|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|129||||129|5.44|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|129||||129|64.63|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|129||||129|45.28|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|129||||129|6.19|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|129||||129|54.95|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|129||||129|64.5|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|129||||129|83.85|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|CORESOURCE [1315]|CORESOURCE [131500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|129||||129|8.54|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|129||||129|5.23|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|GEHA [1415]|GEHA [141500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|129||||129|11.3|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HEALTHNET [1495]|HEALTHNET [149500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|129||||129|6.19|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|129||||129|119.97|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|129||||129|77.4|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|129||||129|5.52|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|129||||129|64.5|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|129||||129|5.25|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|129||||129|6.78|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|129||||129|5.12|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MULTIPLAN [1680]|HMA [168003]|129||||129|7.53|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MULTIPLAN [1680]|IHC HS [168011]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|129||||129|5.65|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|129||||129|5.52|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|Self-pay|Self-pay|129||||129|38.7|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|129||||129|27.09|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|129||||129|4.92|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|129||||129|7.33|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|TRUSTMARK [2030]|STARMARK [203000]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|129||||129|61.86|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|UMR [2035]|UMR OPTIONS [203501]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|129||||129|5|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|129||||129|116.1|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|129||||129|3.34|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|129||||129|5.23|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|129||||129|5.02|119.97|3.34
30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|129||||129|64.5|119.97|3.34
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|139||||139|26.66|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139||||139|18.28|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139||||139|18.28|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139||||139|69.64|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139||||139|48.79|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139||||139|20.83|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139||||139|59.21|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139||||139|69.5|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139||||139|90.35|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|CORESOURCE [1315]|CORESOURCE [131500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139||||139|31.12|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139||||139|19.05|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|GEHA [1415]|GEHA [141500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HEALTHNET [1495]|HEALTHNET [149500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139||||139|20.83|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139||||139|129.27|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139||||139|83.4|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139||||139|69.5|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139||||139|17.66|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MULTIPLAN [1680]|HMA [168003]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MULTIPLAN [1680]|IHC HS [168011]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139||||139|19|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|Self-pay|Self-pay|139||||139|41.7|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139||||139|29.19|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|TRUSTMARK [2030]|STARMARK [203000]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139||||139|66.65|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|UMR [2035]|UMR OPTIONS [203501]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139||||139|16.82|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139||||139|125.1|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139||||139|11.24|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139||||139|19.05|129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139||||139||129.27|11.24
30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139||||139|69.5|129.27|11.24
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|AETNA [1015]|AETNA ACO WILCO [101532]|93||||93|6.23|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93||||93|4.75|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93||||93|4.75|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|93||||93|46.59|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93||||93|32.64|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93||||93|4.38|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|93||||93|39.62|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|93||||93|46.5|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93||||93|60.45|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|CORESOURCE [1315]|CORESOURCE [131500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|CORVEL CORP [2235]|CORVEL CORP [223500]|93||||93|5.46|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|93||||93|3.34|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|GEHA [1415]|GEHA [141500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HEALTHNET [1495]|HEALTHNET [149500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93||||93|4.38|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HEALTHSMART [1505]|HEALTHSMART [150501]|93||||93|86.49|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93||||93|55.8|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93||||93|46.5|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93||||93|4.58|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MULTIPLAN [1680]|HMA [168003]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MULTIPLAN [1680]|IHC HS [168011]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|93||||93|4.94|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|Self-pay|Self-pay|93||||93|27.9|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93||||93|19.53|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|TRUSTMARK [2030]|STARMARK [203000]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93||||93|44.59|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|UMR [2035]|UMR OPTIONS [203501]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93||||93|4.37|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93||||93|83.7|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|93||||93|2.63|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|93||||93|3.34|86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|93||||93||86.49|2.63
30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|93||||93|46.5|86.49|2.63
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|7.57|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|5.76|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|5.76|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|5.32|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|5.1|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|3.49|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|5.32|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|60|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|5.57|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MULTIPLAN [1680]|HMA [168003]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|5.99|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|Self-pay|Self-pay|120||||120|36|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|5.3|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|3.19|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|3.49|111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120||111.6|3.19
30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|3.19
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|AETNA [1015]|AETNA ACO WILCO [101532]|107||||107|6.01|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107||||107|4.31|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107||||107|4.59|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107||||107|4.59|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107||||107|53.61|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107||||107|37.56|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107||||107|45.58|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107||||107|53.5|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107||||107|69.55|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|CORESOURCE [1315]|CORESOURCE [131500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107||||107|7.5|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107||||107|4.59|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|GEHA [1415]|GEHA [141500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107||||107|9.52|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HEALTHNET [1495]|HEALTHNET [149500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107||||107|99.51|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107||||107|64.2|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107||||107|4.65|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107||||107|53.5|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107||||107|4.43|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107||||107|5.71|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107||||107|4.31|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MULTIPLAN [1680]|HMA [168003]|107||||107|6.35|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MULTIPLAN [1680]|IHC HS [168011]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107||||107|4.77|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107||||107|4.65|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|Self-pay|Self-pay|107||||107|32.1|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107||||107|22.47|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107||||107|4.15|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107||||107|6.18|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|TRUSTMARK [2030]|STARMARK [203000]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107||||107|51.31|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|UMR [2035]|UMR OPTIONS [203501]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107||||107|4.22|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107||||107|96.3|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107||||107|2.54|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107||||107|4.59|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107||||107|4.23|99.51|2.54
30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107||||107|53.5|99.51|2.54
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|AETNA [1015]|AETNA ACO WILCO [101532]|292||||292|25.13|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|292||||292|16.24|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|292||||292|17.24|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|292||||292|17.24|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|292||||292|146.29|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|292||||292|102.49|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|292||||292|19.64|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|292||||292|124.39|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|292||||292|146|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|292||||292|189.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|CORESOURCE [1315]|CORESOURCE [131500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|CORVEL CORP [2235]|CORVEL CORP [223500]|292||||292|20.27|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|292||||292|12.6|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|GEHA [1415]|GEHA [141500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|292||||292|35.82|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HEALTHNET [1495]|HEALTHNET [149500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|292||||292|19.64|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HEALTHSMART [1505]|HEALTHSMART [150501]|292||||292|271.56|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|292||||292|175.2|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|292||||292|17.51|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|292||||292|146|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|292||||292|16.65|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|292||||292|21.49|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|292||||292|16.24|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MULTIPLAN [1680]|HMA [168003]|292||||292|23.88|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MULTIPLAN [1680]|IHC HS [168011]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|292||||292|17.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|292||||292|17.51|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|Self-pay|Self-pay|292||||292|87.6|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|292||||292|61.32|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|292||||292|15.6|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|292||||292|23.24|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|TRUSTMARK [2030]|STARMARK [203000]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|292||||292|140.01|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|UMR [2035]|UMR OPTIONS [203501]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|292||||292|15.86|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|292||||292|262.8|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|292||||292|10.6|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|292||||292|12.6|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|292||||292|15.92|271.56|10.6
30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|292||||292|146|271.56|10.6
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|369||||369|36.58|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|369||||369|25.61|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|369||||369|25.61|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|369||||369|184.87|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|369||||369|129.52|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|369||||369|28.58|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|369||||369|157.19|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|369||||369|184.5|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|369||||369|239.85|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|369||||369|45.46|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|369||||369|27.83|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|GEHA [1415]|GEHA [141500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|369||||369|28.58|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|369||||369|343.17|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|369||||369|221.4|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|369||||369|184.5|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|369||||369|24.73|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MULTIPLAN [1680]|HMA [168003]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MULTIPLAN [1680]|IHC HS [168011]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|369||||369|26.62|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|Self-pay|Self-pay|369||||369|110.7|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|369||||369|77.49|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|TRUSTMARK [2030]|STARMARK [203000]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|369||||369|176.94|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|UMR [2035]|UMR OPTIONS [203501]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|369||||369|23.55|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|369||||369|332.1|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|369||||369|15.43|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|369||||369|27.83|343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|369||||369||343.17|15.43
30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|369||||369|184.5|343.17|15.43
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|AETNA [1015]|AETNA ACO WILCO [101532]|448||||448|46.78|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|448||||448|30.19|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|448||||448|32.07|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|448||||448|32.07|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|448||||448|224.45|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|448||||448|157.25|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|448||||448|36.55|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|448||||448|190.85|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|448||||448|224|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|448||||448|291.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|CORESOURCE [1315]|CORESOURCE [131500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|448||||448|67.45|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|448||||448|41.3|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|GEHA [1415]|GEHA [141500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|448||||448|66.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HEALTHNET [1495]|HEALTHNET [149500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|448||||448|36.55|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|448||||448|416.64|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|448||||448|268.8|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|448||||448|32.56|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|448||||448|224|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|448||||448|30.97|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|448||||448|39.96|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|448||||448|30.19|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MULTIPLAN [1680]|HMA [168003]|448||||448|44.4|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MULTIPLAN [1680]|IHC HS [168011]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|448||||448|33.33|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|448||||448|32.56|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|Self-pay|Self-pay|448||||448|134.4|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|448||||448|94.08|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|448||||448|29.01|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|448||||448|43.22|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|TRUSTMARK [2030]|STARMARK [203000]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|448||||448|214.82|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|UMR [2035]|UMR OPTIONS [203501]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|448||||448|29.5|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|448||||448|403.2|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|448||||448|19.73|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|448||||448|41.3|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|448||||448|29.6|416.64|19.73
30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|448||||448|224|416.64|19.73
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|390||||390|42.35|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390||||390|27.33|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390||||390|29.02|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390||||390|29.02|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|390||||390|195.39|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390||||390|136.89|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390||||390|33.08|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|390||||390|166.14|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|390||||390|195|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390||||390|253.5|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|CORESOURCE [1315]|CORESOURCE [131500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|390||||390|53.48|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|390||||390|32.75|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|GEHA [1415]|GEHA [141500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|390||||390|60.28|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HEALTHNET [1495]|HEALTHNET [149500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390||||390|33.08|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|390||||390|362.7|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390||||390|234|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390||||390|29.47|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390||||390|195|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390||||390|28.03|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390||||390|36.17|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390||||390|27.33|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MULTIPLAN [1680]|HMA [168003]|390||||390|40.19|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MULTIPLAN [1680]|IHC HS [168011]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|390||||390|30.16|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390||||390|29.47|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|Self-pay|Self-pay|390||||390|117|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390||||390|81.9|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|390||||390|26.25|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390||||390|39.11|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|TRUSTMARK [2030]|STARMARK [203000]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390||||390|187.01|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|UMR [2035]|UMR OPTIONS [203501]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390||||390|26.69|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390||||390|351|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|390||||390|17.86|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|390||||390|32.75|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|390||||390|26.79|362.7|17.86
30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|390||||390|195|362.7|17.86
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|184||||184|8.15|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|184||||184|5.26|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|184||||184|5.59|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|184||||184|5.59|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|184||||184|92.18|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|184||||184|64.58|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|184||||184|6.37|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|184||||184|78.38|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|184||||184|92|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|184||||184|119.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|184||||184|9.54|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|184||||184|5.84|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|GEHA [1415]|GEHA [141500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|184||||184|11.61|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|184||||184|6.37|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|184||||184|171.12|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|184||||184|110.4|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|184||||184|5.68|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|184||||184|92|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|184||||184|5.4|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|184||||184|6.97|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|184||||184|5.26|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MULTIPLAN [1680]|HMA [168003]|184||||184|7.74|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|184||||184|5.81|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|184||||184|5.68|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|Self-pay|Self-pay|184||||184|55.2|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|184||||184|38.64|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|184||||184|5.06|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|184||||184|7.53|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|184||||184|88.23|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|184||||184|5.15|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|184||||184|165.6|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|184||||184|3.44|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|184||||184|5.84|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|184||||184|5.16|171.12|3.44
30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|184||||184|92|171.12|3.44
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|AETNA [1015]|AETNA ACO WILCO [101532]|273||||273|21.62|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273||||273|13.95|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273||||273|14.82|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273||||273|14.82|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|273||||273|136.77|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273||||273|95.82|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273||||273|16.88|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|273||||273|116.3|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|273||||273|136.5|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273||||273|177.45|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|CORESOURCE [1315]|CORESOURCE [131500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|273||||273|30.58|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|273||||273|18.72|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|GEHA [1415]|GEHA [141500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|273||||273|30.78|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HEALTHNET [1495]|HEALTHNET [149500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273||||273|16.88|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|273||||273|253.89|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273||||273|163.8|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273||||273|15.05|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273||||273|136.5|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273||||273|14.32|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273||||273|18.47|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273||||273|13.95|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MULTIPLAN [1680]|HMA [168003]|273||||273|20.52|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MULTIPLAN [1680]|IHC HS [168011]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|273||||273|15.4|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273||||273|15.05|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|Self-pay|Self-pay|273||||273|81.9|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273||||273|57.33|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|273||||273|13.41|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273||||273|19.97|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|TRUSTMARK [2030]|STARMARK [203000]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273||||273|130.9|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|UMR [2035]|UMR OPTIONS [203501]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273||||273|13.64|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273||||273|245.7|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|273||||273|9.12|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|273||||273|18.72|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|273||||273|13.68|253.89|9.12
30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|273||||273|136.5|253.89|9.12
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|135||||135|9.53|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135||||135|6.15|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135||||135|6.54|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135||||135|6.54|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|135||||135|67.64|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135||||135|47.39|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135||||135|7.44|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|135||||135|57.51|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|135||||135|67.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135||||135|87.75|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|CORESOURCE [1315]|CORESOURCE [131500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|135||||135|11.6|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|135||||135|7.1|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|GEHA [1415]|GEHA [141500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|135||||135|13.57|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HEALTHNET [1495]|HEALTHNET [149500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135||||135|7.44|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|135||||135|125.55|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135||||135|81|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135||||135|6.63|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135||||135|67.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135||||135|6.31|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135||||135|8.14|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135||||135|6.15|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MULTIPLAN [1680]|HMA [168003]|135||||135|9.05|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MULTIPLAN [1680]|IHC HS [168011]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|135||||135|6.8|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135||||135|6.63|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|Self-pay|Self-pay|135||||135|40.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135||||135|28.35|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|135||||135|5.91|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135||||135|8.8|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|TRUSTMARK [2030]|STARMARK [203000]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135||||135|64.73|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|UMR [2035]|UMR OPTIONS [203501]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135||||135|6.01|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135||||135|121.5|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|135||||135|4.02|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|135||||135|7.1|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|135||||135|6.03|125.55|4.02
30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|135||||135|67.5|125.55|4.02
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|192||||192|18.29|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192||||192|12.55|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192||||192|12.55|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192||||192|96.19|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192||||192|67.39|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192||||192|14.29|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192||||192|81.79|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192||||192|96|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192||||192|124.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|CORESOURCE [1315]|CORESOURCE [131500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192||||192|25.16|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192||||192|15.4|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|GEHA [1415]|GEHA [141500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HEALTHNET [1495]|HEALTHNET [149500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192||||192|14.29|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192||||192|178.56|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192||||192|115.2|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192||||192|96|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192||||192|12.13|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MULTIPLAN [1680]|HMA [168003]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MULTIPLAN [1680]|IHC HS [168011]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192||||192|13.04|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|Self-pay|Self-pay|192||||192|57.6|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192||||192|40.32|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|TRUSTMARK [2030]|STARMARK [203000]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192||||192|92.06|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|UMR [2035]|UMR OPTIONS [203501]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192||||192|11.55|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192||||192|172.8|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192||||192|7.72|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192||||192|15.4|178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192||||192||178.56|7.72
30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192||||192|96|178.56|7.72
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|AETNA [1015]|AETNA ACO WILCO [101532]|192||||192|20.38|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192||||192|13.16|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192||||192|13.98|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192||||192|13.98|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192||||192|96.19|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192||||192|67.39|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192||||192|15.92|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192||||192|81.79|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192||||192|96|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192||||192|124.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|CORESOURCE [1315]|CORESOURCE [131500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192||||192|26.23|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192||||192|16.06|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|GEHA [1415]|GEHA [141500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192||||192|29.03|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HEALTHNET [1495]|HEALTHNET [149500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192||||192|15.92|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192||||192|178.56|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192||||192|115.2|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192||||192|14.19|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192||||192|96|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192||||192|13.5|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192||||192|17.42|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192||||192|13.16|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MULTIPLAN [1680]|HMA [168003]|192||||192|19.35|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MULTIPLAN [1680]|IHC HS [168011]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192||||192|14.53|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192||||192|14.19|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|Self-pay|Self-pay|192||||192|57.6|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192||||192|40.32|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192||||192|12.64|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192||||192|18.83|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|TRUSTMARK [2030]|STARMARK [203000]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192||||192|92.06|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|UMR [2035]|UMR OPTIONS [203501]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192||||192|12.86|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192||||192|172.8|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192||||192|8.6|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192||||192|16.06|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192||||192|12.9|178.56|8.6
30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192||||192|96|178.56|8.6
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|334||||334|28.54|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334||||334|19.57|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334||||334|19.57|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|334||||334|167.33|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334||||334|117.23|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334||||334|22.29|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|334||||334|142.28|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|334||||334|167|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334||||334|217.1|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|CORESOURCE [1315]|CORESOURCE [131500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|334||||334|24.47|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|334||||334|14.5|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|GEHA [1415]|GEHA [141500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HEALTHNET [1495]|HEALTHNET [149500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334||||334|22.29|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|334||||334|310.62|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334||||334|200.4|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334||||334|167|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334||||334|18.9|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MULTIPLAN [1680]|HMA [168003]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MULTIPLAN [1680]|IHC HS [168011]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|334||||334|20.34|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|Self-pay|Self-pay|334||||334|100.2|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334||||334|70.14|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|TRUSTMARK [2030]|STARMARK [203000]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334||||334|160.15|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|UMR [2035]|UMR OPTIONS [203501]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334||||334|18|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334||||334|300.6|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|334||||334|12.04|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|334||||334|14.5|310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|334||||334||310.62|12.04
30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|334||||334|167|310.62|12.04
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|AETNA [1015]|AETNA ACO WILCO [101532]|116||||116|7.73|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116||||116|5.29|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116||||116|5.29|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116||||116|58.12|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116||||116|40.72|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116||||116|6.03|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116||||116|49.42|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116||||116|58|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116||||116|75.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|CORESOURCE [1315]|CORESOURCE [131500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|116||||116|8.61|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116||||116|5.27|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|GEHA [1415]|GEHA [141500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HEALTHNET [1495]|HEALTHNET [149500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116||||116|6.03|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|116||||116|107.88|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116||||116|69.6|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116||||116|58|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116||||116|5.11|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MULTIPLAN [1680]|HMA [168003]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MULTIPLAN [1680]|IHC HS [168011]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|116||||116|5.5|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|Self-pay|Self-pay|116||||116|34.8|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116||||116|24.36|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|TRUSTMARK [2030]|STARMARK [203000]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116||||116|55.62|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|UMR [2035]|UMR OPTIONS [203501]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116||||116|4.86|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116||||116|104.4|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116||||116|3.26|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116||||116|5.27|107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116||||116||107.88|3.26
30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116||||116|58|107.88|3.26
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|176||||176|19.48|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176||||176|12.57|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176||||176|13.35|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176||||176|13.35|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|176||||176|88.18|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176||||176|61.78|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176||||176|15.21|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|176||||176|74.98|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|176||||176|88|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176||||176|114.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|CORESOURCE [1315]|CORESOURCE [131500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|176||||176|28.57|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|176||||176|17.49|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|GEHA [1415]|GEHA [141500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|176||||176|27.72|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HEALTHNET [1495]|HEALTHNET [149500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176||||176|15.21|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|176||||176|163.68|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176||||176|105.6|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176||||176|13.55|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176||||176|88|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176||||176|12.89|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176||||176|16.63|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176||||176|12.57|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MULTIPLAN [1680]|HMA [168003]|176||||176|18.48|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MULTIPLAN [1680]|IHC HS [168011]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|176||||176|13.88|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176||||176|13.55|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|Self-pay|Self-pay|176||||176|52.8|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176||||176|36.96|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|176||||176|12.07|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176||||176|17.99|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|TRUSTMARK [2030]|STARMARK [203000]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176||||176|84.39|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|UMR [2035]|UMR OPTIONS [203501]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176||||176|12.28|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176||||176|158.4|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|176||||176|8.21|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|176||||176|17.49|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|176||||176|12.32|163.68|8.21
30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|176||||176|88|163.68|8.21
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|360||||360|29.97|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|360||||360|19.34|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|360||||360|20.54|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|360||||360|20.54|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|360||||360|180.36|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|360||||360|126.36|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|360||||360|23.41|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|360||||360|153.36|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|360||||360|180|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|360||||360|234|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|CORESOURCE [1315]|CORESOURCE [131500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|360||||360|28.69|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|360||||360|17.57|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|GEHA [1415]|GEHA [141500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|360||||360|42.66|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HEALTHNET [1495]|HEALTHNET [149500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|360||||360|23.41|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|360||||360|334.8|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|360||||360|216|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|360||||360|20.86|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|360||||360|180|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|360||||360|19.84|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|360||||360|25.6|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|360||||360|19.34|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MULTIPLAN [1680]|HMA [168003]|360||||360|28.44|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MULTIPLAN [1680]|IHC HS [168011]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|360||||360|21.35|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|360||||360|20.86|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|Self-pay|Self-pay|360||||360|108|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|360||||360|75.6|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|360||||360|18.58|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|360||||360|27.68|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|TRUSTMARK [2030]|STARMARK [203000]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|360||||360|172.62|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|UMR [2035]|UMR OPTIONS [203501]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|360||||360|18.9|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|360||||360|324|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|360||||360|12.64|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|360||||360|17.57|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|360||||360|18.96|334.8|12.64
30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|360||||360|180|334.8|12.64
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|219||||219|26.66|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219||||219|18.28|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219||||219|18.28|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|219||||219|109.72|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219||||219|76.87|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219||||219|20.83|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|219||||219|93.29|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|219||||219|109.5|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219||||219|142.35|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|CORESOURCE [1315]|CORESOURCE [131500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|219||||219|29.42|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|219||||219|18.01|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|GEHA [1415]|GEHA [141500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HEALTHNET [1495]|HEALTHNET [149500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219||||219|20.83|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|219||||219|203.67|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219||||219|131.4|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219||||219|109.5|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219||||219|17.66|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MULTIPLAN [1680]|HMA [168003]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MULTIPLAN [1680]|IHC HS [168011]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|219||||219|19|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|Self-pay|Self-pay|219||||219|65.7|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219||||219|45.99|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|TRUSTMARK [2030]|STARMARK [203000]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219||||219|105.01|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|UMR [2035]|UMR OPTIONS [203501]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219||||219|16.82|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219||||219|197.1|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|219||||219|11.24|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|219||||219|18.01|203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|219||||219||203.67|11.24
30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|219||||219|109.5|203.67|11.24
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|AETNA [1015]|AETNA ACO WILCO [101532]|111||||111|14.58|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111||||111|9.99|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111||||111|9.99|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|111||||111|55.61|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111||||111|38.96|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111||||111|11.39|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|111||||111|47.29|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|111||||111|55.5|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111||||111|72.15|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|CORESOURCE [1315]|CORESOURCE [131500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111||||111|18.73|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111||||111|11.47|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|GEHA [1415]|GEHA [141500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HEALTHNET [1495]|HEALTHNET [149500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111||||111|11.39|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|111||||111|103.23|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111||||111|66.6|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111||||111|55.5|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111||||111|9.65|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MULTIPLAN [1680]|HMA [168003]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MULTIPLAN [1680]|IHC HS [168011]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111||||111|10.38|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|Self-pay|Self-pay|111||||111|33.3|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111||||111|23.31|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|TRUSTMARK [2030]|STARMARK [203000]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111||||111|53.22|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|UMR [2035]|UMR OPTIONS [203501]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111||||111|9.19|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111||||111|99.9|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111||||111|6.15|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|111||||111|11.47|103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|111||||111||103.23|6.15
30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|111||||111|55.5|103.23|6.15
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|223||||223|38.83|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223||||223|29.58|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223||||223|29.58|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|223||||223|111.72|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223||||223|78.27|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223||||223|27.3|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|223||||223|95|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|223||||223|111.5|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223||||223|144.95|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|223||||223|32.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|223||||223|20.02|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|GEHA [1415]|GEHA [141500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223||||223|27.3|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|223||||223|207.39|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223||||223|133.8|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223||||223|111.5|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223||||223|28.56|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MULTIPLAN [1680]|HMA [168003]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MULTIPLAN [1680]|IHC HS [168011]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|223||||223|30.74|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|Self-pay|Self-pay|223||||223|66.9|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223||||223|46.83|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|TRUSTMARK [2030]|STARMARK [203000]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223||||223|106.93|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|UMR [2035]|UMR OPTIONS [203501]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223||||223|27.2|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223||||223|200.7|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|223||||223|16.38|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|223||||223|20.02|207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|223||||223||207.39|16.38
30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES TOTAL URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|223||||223|111.5|207.39|16.38
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|634||||634|39.92|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|634||||634|25.76|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|634||||634|27.36|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|634||||634|27.36|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|634||||634|317.63|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|634||||634|222.53|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|634||||634|31.18|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|634||||634|270.08|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|634||||634|317|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|634||||634|412.1|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|CORESOURCE [1315]|CORESOURCE [131500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|634||||634|53.13|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|634||||634|32.53|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|GEHA [1415]|GEHA [141500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|634||||634|56.81|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HEALTHNET [1495]|HEALTHNET [149500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|634||||634|31.18|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|634||||634|589.62|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|634||||634|380.4|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|634||||634|27.78|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|634||||634|317|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|634||||634|26.42|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|634||||634|34.09|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|634||||634|25.76|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MULTIPLAN [1680]|HMA [168003]|634||||634|37.88|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MULTIPLAN [1680]|IHC HS [168011]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|634||||634|28.44|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|634||||634|27.78|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|Self-pay|Self-pay|634||||634|190.2|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|634||||634|133.14|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|634||||634|24.75|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|634||||634|36.87|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|TRUSTMARK [2030]|STARMARK [203000]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|634||||634|304|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|UMR [2035]|UMR OPTIONS [203501]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|634||||634|25.16|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|634||||634|570.6|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|634||||634|16.84|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|634||||634|32.53|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|634||||634|25.25|589.62|16.84
30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|634||||634|317|589.62|16.84
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|228||||228|16.97|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|228||||228|10.95|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|228||||228|11.64|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|228||||228|11.64|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|228||||228|114.23|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|228||||228|80.03|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|228||||228|13.26|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|228||||228|97.13|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|228||||228|114|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|228||||228|148.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|CORESOURCE [1315]|CORESOURCE [131500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|228||||228|20.52|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|228||||228|12.56|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|GEHA [1415]|GEHA [141500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|228||||228|24.17|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HEALTHNET [1495]|HEALTHNET [149500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228||||228|13.26|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|228||||228|212.04|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|228||||228|136.8|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|228||||228|11.81|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228||||228|114|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|228||||228|11.24|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|228||||228|14.5|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|228||||228|10.95|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MULTIPLAN [1680]|HMA [168003]|228||||228|16.11|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MULTIPLAN [1680]|IHC HS [168011]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|228||||228|12.1|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|228||||228|11.81|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|Self-pay|Self-pay|228||||228|68.4|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|228||||228|47.88|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|228||||228|10.53|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|228||||228|15.68|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|TRUSTMARK [2030]|STARMARK [203000]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228||||228|109.33|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|UMR [2035]|UMR OPTIONS [203501]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|228||||228|10.71|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|228||||228|205.2|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|228||||228|7.16|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|228||||228|12.56|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|228||||228|10.74|212.04|7.16
30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|228||||228|114|212.04|7.16
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|226||||226|22.32|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226||||226|14.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226||||226|15.3|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226||||226|15.3|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|226||||226|113.23|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226||||226|79.33|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226||||226|17.43|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|226||||226|96.28|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|226||||226|113|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226||||226|146.9|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|226||||226|22.13|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|226||||226|13.55|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|GEHA [1415]|GEHA [141500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|226||||226|31.77|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226||||226|17.43|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|226||||226|210.18|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226||||226|135.6|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226||||226|15.53|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226||||226|113|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226||||226|14.78|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226||||226|19.06|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226||||226|14.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MULTIPLAN [1680]|HMA [168003]|226||||226|21.18|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|226||||226|15.9|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226||||226|15.53|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|Self-pay|Self-pay|226||||226|67.8|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226||||226|47.46|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|226||||226|13.84|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226||||226|20.62|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226||||226|108.37|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226||||226|14.07|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226||||226|203.4|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|226||||226|9.41|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|226||||226|13.55|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|226||||226|14.12|210.18|9.41
30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|226||||226|113|210.18|9.41
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|106||||106|7.27|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106||||106|4.69|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106||||106|4.98|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106||||106|4.98|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106||||106|53.11|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106||||106|37.21|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106||||106|5.68|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106||||106|45.16|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106||||106|53|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106||||106|68.9|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|CORESOURCE [1315]|CORESOURCE [131500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106||||106|8.53|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106||||106|5.22|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|GEHA [1415]|GEHA [141500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106||||106|10.35|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HEALTHNET [1495]|HEALTHNET [149500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106||||106|5.68|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106||||106|98.58|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106||||106|63.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106||||106|5.06|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106||||106|53|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106||||106|4.81|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106||||106|6.21|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106||||106|4.69|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MULTIPLAN [1680]|HMA [168003]|106||||106|6.9|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MULTIPLAN [1680]|IHC HS [168011]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106||||106|5.18|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106||||106|5.06|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|Self-pay|Self-pay|106||||106|31.8|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106||||106|22.26|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106||||106|4.51|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106||||106|6.72|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|TRUSTMARK [2030]|STARMARK [203000]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106||||106|50.83|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|UMR [2035]|UMR OPTIONS [203501]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106||||106|4.58|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106||||106|95.4|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106||||106|3.07|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106||||106|5.22|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106||||106|4.6|98.58|3.07
30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106||||106|53|98.58|3.07
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|218||||218|8.18|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218||||218|5.87|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218||||218|6.24|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218||||218|6.24|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|218||||218|109.22|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218||||218|76.52|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218||||218|6.21|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|218||||218|92.87|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|218||||218|109|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218||||218|141.7|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|218||||218|12.25|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|218||||218|7.5|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|GEHA [1415]|GEHA [141500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|218||||218|12.94|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218||||218|6.21|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|218||||218|202.74|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218||||218|130.8|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218||||218|6.33|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218||||218|109|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218||||218|6.02|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218||||218|7.76|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218||||218|5.87|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MULTIPLAN [1680]|HMA [168003]|218||||218|8.63|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MULTIPLAN [1680]|IHC HS [168011]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|218||||218|6.49|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218||||218|6.33|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|Self-pay|Self-pay|218||||218|65.4|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218||||218|45.78|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|218||||218|5.64|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218||||218|8.4|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|TRUSTMARK [2030]|STARMARK [203000]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218||||218|104.53|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|UMR [2035]|UMR OPTIONS [203501]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218||||218|5.74|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218||||218|196.2|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|218||||218|3.45|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|218||||218|7.5|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|218||||218|5.75|202.74|3.45
30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|218||||218|109|202.74|3.45
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|51||||51|7.73|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51||||51|5.42|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51||||51|5.42|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51||||51|25.55|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51||||51|17.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51||||51|6.03|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51||||51|21.73|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51||||51|25.5|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51||||51|33.15|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51||||51|10.8|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51||||51|6.61|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|GEHA [1415]|GEHA [141500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51||||51|6.03|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51||||51|47.43|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51||||51|30.6|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51||||51|25.5|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51||||51|5.23|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MULTIPLAN [1680]|HMA [168003]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51||||51|5.63|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|Self-pay|Self-pay|51||||51|15.3|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51||||51|10.71|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51||||51|24.45|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51||||51|4.98|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51||||51|45.9|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51||||51|3.26|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51||||51|6.61|47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51||||51||47.43|3.26
30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51||||51|25.5|47.43|3.26
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|AETNA [1015]|AETNA ACO WILCO [101532]|82||||82|9.49|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82||||82|6.51|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82||||82|6.51|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82||||82|41.08|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82||||82|28.78|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82||||82|7.42|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82||||82|34.93|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82||||82|41|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82||||82|53.3|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|CORESOURCE [1315]|CORESOURCE [131500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82||||82|11.95|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82||||82|7.32|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|GEHA [1415]|GEHA [141500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HEALTHNET [1495]|HEALTHNET [149500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82||||82|7.42|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82||||82|76.26|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82||||82|49.2|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82||||82|41|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82||||82|6.29|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MULTIPLAN [1680]|HMA [168003]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MULTIPLAN [1680]|IHC HS [168011]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82||||82|6.77|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|Self-pay|Self-pay|82||||82|24.6|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82||||82|17.22|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|TRUSTMARK [2030]|STARMARK [203000]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82||||82|39.32|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|UMR [2035]|UMR OPTIONS [203501]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82||||82|5.99|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82||||82|73.8|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82||||82|4|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82||||82|7.32|76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82||||82||76.26|4
30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82||||82|41|76.26|4
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|251||||251|6.89|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|251||||251|4.44|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|251||||251|4.71|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|251||||251|4.71|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|251||||251|125.75|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|251||||251|88.1|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|251||||251|5.37|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|251||||251|106.93|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|251||||251|125.5|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|251||||251|163.15|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|251||||251|7.61|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|251||||251|4.66|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|GEHA [1415]|GEHA [141500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|251||||251|9.79|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|251||||251|5.37|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|251||||251|233.43|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|251||||251|150.6|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|251||||251|4.79|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|251||||251|125.5|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|251||||251|4.55|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|251||||251|5.87|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|251||||251|4.44|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MULTIPLAN [1680]|HMA [168003]|251||||251|6.53|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|251||||251|4.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|251||||251|4.79|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|Self-pay|Self-pay|251||||251|75.3|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|251||||251|52.71|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|251||||251|4.26|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|251||||251|6.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|251||||251|120.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|251||||251|4.33|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|251||||251|225.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|251||||251|2.9|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|251||||251|4.66|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|251||||251|4.35|233.43|2.9
30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|251||||251|125.5|233.43|2.9
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|163||||163|12.44|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163||||163|8.53|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163||||163|8.53|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|163||||163|81.66|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163||||163|57.21|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163||||163|9.72|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|163||||163|69.44|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|163||||163|81.5|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163||||163|105.95|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|163||||163|18.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|163||||163|11.45|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|GEHA [1415]|GEHA [141500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163||||163|9.72|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|163||||163|151.59|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163||||163|97.8|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163||||163|81.5|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163||||163|8.24|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MULTIPLAN [1680]|HMA [168003]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|163||||163|8.87|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|Self-pay|Self-pay|163||||163|48.9|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163||||163|34.23|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163||||163|78.16|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|UMR [2035]|UMR OPTIONS [203501]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163||||163|7.85|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163||||163|146.7|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|163||||163|5.25|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|163||||163|11.45|151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|163||||163||151.59|5.25
30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|163||||163|81.5|151.59|5.25
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|AETNA [1015]|AETNA ACO WILCO [101532]|116||||116|13.96|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116||||116|10.63|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116||||116|10.63|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116||||116|58.12|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116||||116|40.72|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116||||116|9.81|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116||||116|49.42|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116||||116|58|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116||||116|75.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|CORESOURCE [1315]|CORESOURCE [131500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|116||||116|22.49|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116||||116|13.77|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|GEHA [1415]|GEHA [141500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HEALTHNET [1495]|HEALTHNET [149500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116||||116|9.81|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|116||||116|107.88|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116||||116|69.6|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116||||116|58|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116||||116|10.26|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MULTIPLAN [1680]|HMA [168003]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MULTIPLAN [1680]|IHC HS [168011]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|116||||116|11.05|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|Self-pay|Self-pay|116||||116|34.8|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116||||116|24.36|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|TRUSTMARK [2030]|STARMARK [203000]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116||||116|55.62|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|UMR [2035]|UMR OPTIONS [203501]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116||||116|9.77|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116||||116|104.4|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116||||116|5.89|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116||||116|13.77|107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116||||116||107.88|5.89
30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116||||116|58|107.88|5.89
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|931||||931|32.04|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|931||||931|20.69|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|931||||931|21.97|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|931||||931|21.97|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|931||||931|466.43|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|931||||931|326.78|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|931||||931|25.04|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|931||||931|396.61|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|931||||931|465.5|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|931||||931|605.15|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|931||||931|41.22|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|931||||931|25.24|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|GEHA [1415]|GEHA [141500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|931||||931|45.63|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|931||||931|25.04|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|931||||931|865.83|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|931||||931|558.6|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|931||||931|22.31|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|931||||931|465.5|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|931||||931|21.22|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|931||||931|27.38|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|931||||931|20.69|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MULTIPLAN [1680]|HMA [168003]|931||||931|30.42|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MULTIPLAN [1680]|IHC HS [168011]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|931||||931|22.84|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|931||||931|22.31|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|Self-pay|Self-pay|931||||931|279.3|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|931||||931|195.51|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|931||||931|19.87|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|931||||931|29.61|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|TRUSTMARK [2030]|STARMARK [203000]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|931||||931|446.41|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|UMR [2035]|UMR OPTIONS [203501]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|931||||931|20.21|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|931||||931|837.9|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|931||||931|13.52|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|931||||931|25.24|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|931||||931|20.28|865.83|13.52
30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|931||||931|465.5|865.83|13.52
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|360||||360|43.94|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|360||||360|28.36|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|360||||360|30.12|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|360||||360|30.12|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|360||||360|180.36|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|360||||360|126.36|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|360||||360|34.33|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|360||||360|153.36|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|360||||360|180|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|360||||360|234|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|CORESOURCE [1315]|CORESOURCE [131500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|360||||360|47.99|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|360||||360|29.38|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|GEHA [1415]|GEHA [141500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|360||||360|62.55|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HEALTHNET [1495]|HEALTHNET [149500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|360||||360|34.33|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|360||||360|334.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|360||||360|216|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|360||||360|30.58|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|360||||360|180|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|360||||360|29.09|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|360||||360|37.53|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|360||||360|28.36|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MULTIPLAN [1680]|HMA [168003]|360||||360|41.7|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MULTIPLAN [1680]|IHC HS [168011]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|360||||360|31.31|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|360||||360|30.58|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|Self-pay|Self-pay|360||||360|108|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|360||||360|75.6|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|360||||360|27.24|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|360||||360|40.59|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|TRUSTMARK [2030]|STARMARK [203000]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|360||||360|172.62|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|UMR [2035]|UMR OPTIONS [203501]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|360||||360|27.7|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|360||||360|324|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|360||||360|18.53|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|360||||360|29.38|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|360||||360|27.8|334.8|18.53
30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|360||||360|180|334.8|18.53
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|AETNA [1015]|AETNA ACO WILCO [101532]|227||||227|29.53|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|227||||227|19.05|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|227||||227|20.24|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|227||||227|20.24|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|227||||227|113.73|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|227||||227|79.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|227||||227|23.07|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|227||||227|96.7|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|227||||227|113.5|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|227||||227|147.55|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|CORESOURCE [1315]|CORESOURCE [131500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|227||||227|34.65|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|227||||227|21.21|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|GEHA [1415]|GEHA [141500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|227||||227|42.03|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HEALTHNET [1495]|HEALTHNET [149500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|227||||227|23.07|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|227||||227|211.11|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|227||||227|136.2|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|227||||227|20.55|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|227||||227|113.5|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|227||||227|19.55|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|227||||227|25.22|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|227||||227|19.05|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MULTIPLAN [1680]|HMA [168003]|227||||227|28.02|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MULTIPLAN [1680]|IHC HS [168011]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|227||||227|21.04|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|227||||227|20.55|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|Self-pay|Self-pay|227||||227|68.1|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|227||||227|47.67|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|227||||227|18.31|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|227||||227|27.27|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|TRUSTMARK [2030]|STARMARK [203000]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|227||||227|108.85|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|UMR [2035]|UMR OPTIONS [203501]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|227||||227|18.62|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|227||||227|204.3|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|227||||227|12.46|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|227||||227|21.21|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|227||||227|18.68|211.11|12.46
30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|227||||227|113.5|211.11|12.46
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|AETNA [1015]|AETNA ACO WILCO [101532]|523||||523|19.61|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|523||||523|12.66|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|523||||523|13.45|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|523||||523|13.45|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|523||||523|262.02|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|523||||523|183.57|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|523||||523|15.32|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|523||||523|222.8|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|523||||523|261.5|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|523||||523|339.95|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|CORESOURCE [1315]|CORESOURCE [131500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|523||||523|28.95|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|523||||523|17.73|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|GEHA [1415]|GEHA [141500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|523||||523|27.92|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HEALTHNET [1495]|HEALTHNET [149500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|523||||523|15.32|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|523||||523|486.39|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|523||||523|313.8|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|523||||523|13.65|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|523||||523|261.5|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|523||||523|12.99|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|523||||523|16.75|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|523||||523|12.66|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MULTIPLAN [1680]|HMA [168003]|523||||523|18.62|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MULTIPLAN [1680]|IHC HS [168011]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|523||||523|13.98|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|523||||523|13.65|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|Self-pay|Self-pay|523||||523|156.9|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|523||||523|109.83|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|523||||523|12.16|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|523||||523|18.12|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|TRUSTMARK [2030]|STARMARK [203000]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|523||||523|250.78|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|UMR [2035]|UMR OPTIONS [203501]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|523||||523|12.37|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|523||||523|470.7|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|523||||523|8.27|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|523||||523|17.73|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|523||||523|12.41|486.39|8.27
30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|523||||523|261.5|486.39|8.27
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|386||||386|35.59|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|386||||386|24.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|386||||386|24.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|386||||386|193.39|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|386||||386|135.49|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|386||||386|27.8|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|386||||386|164.44|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|386||||386|193|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|386||||386|250.9|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|CORESOURCE [1315]|CORESOURCE [131500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|386||||386|36.06|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|386||||386|22.08|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|GEHA [1415]|GEHA [141500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HEALTHNET [1495]|HEALTHNET [149500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|386||||386|27.8|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|386||||386|358.98|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|386||||386|231.6|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|386||||386|193|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|386||||386|23.56|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MULTIPLAN [1680]|HMA [168003]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MULTIPLAN [1680]|IHC HS [168011]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|386||||386|25.36|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|Self-pay|Self-pay|386||||386|115.8|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|386||||386|81.06|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|TRUSTMARK [2030]|STARMARK [203000]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|386||||386|185.09|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|UMR [2035]|UMR OPTIONS [203501]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|386||||386|22.44|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|386||||386|347.4|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|386||||386|15.01|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|386||||386|22.08|358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|386||||386||358.98|15.01
30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|386||||386|193|358.98|15.01
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|301||||301|26.41|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|301||||301|17.04|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|301||||301|18.11|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|301||||301|18.11|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|301||||301|150.8|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|301||||301|105.65|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|301||||301|20.63|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|301||||301|128.23|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|301||||301|150.5|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|301||||301|195.65|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|301||||301|32.7|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|301||||301|20.02|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|GEHA [1415]|GEHA [141500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|301||||301|37.6|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|301||||301|20.63|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|301||||301|279.93|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|301||||301|180.6|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|301||||301|18.38|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|301||||301|150.5|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|301||||301|17.48|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|301||||301|22.56|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|301||||301|17.04|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MULTIPLAN [1680]|HMA [168003]|301||||301|25.07|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MULTIPLAN [1680]|IHC HS [168011]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|301||||301|18.82|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|301||||301|18.38|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|Self-pay|Self-pay|301||||301|90.3|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|301||||301|63.21|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|301||||301|16.38|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|301||||301|24.4|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|TRUSTMARK [2030]|STARMARK [203000]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|301||||301|144.33|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|UMR [2035]|UMR OPTIONS [203501]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|301||||301|16.65|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|301||||301|270.9|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|301||||301|11.14|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|301||||301|20.02|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|301||||301|16.71|279.93|11.14
30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|301||||301|150.5|279.93|11.14
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|282||||282|25.76|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|282||||282|16.63|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|282||||282|17.66|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|282||||282|17.66|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|282||||282|141.28|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|282||||282|98.98|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|282||||282|20.12|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|282||||282|120.13|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|282||||282|141|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|282||||282|183.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|282||||282|29.98|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|282||||282|18.35|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|GEHA [1415]|GEHA [141500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|282||||282|36.68|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|282||||282|20.12|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|282||||282|262.26|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|282||||282|169.2|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|282||||282|17.93|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|282||||282|141|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|282||||282|17.06|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|282||||282|22.01|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|282||||282|16.63|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MULTIPLAN [1680]|HMA [168003]|282||||282|24.45|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|282||||282|18.36|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|282||||282|17.93|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|Self-pay|Self-pay|282||||282|84.6|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|282||||282|59.22|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|282||||282|15.97|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|282||||282|23.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|282||||282|135.22|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|282||||282|16.25|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|282||||282|253.8|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|282||||282|10.87|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|282||||282|18.35|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|282||||282|16.3|262.26|10.87
30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|282||||282|141|262.26|10.87
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|519||||519|7.32|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|519||||519|5.03|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|519||||519|5.03|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|519||||519|260.02|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|519||||519|182.17|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|519||||519|5.72|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|519||||519|221.09|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|519||||519|259.5|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|519||||519|337.35|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|CORESOURCE [1315]|CORESOURCE [131500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|519||||519|8.52|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|519||||519|5.22|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|GEHA [1415]|GEHA [141500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HEALTHNET [1495]|HEALTHNET [149500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|519||||519|5.72|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|519||||519|482.67|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|519||||519|311.4|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|519||||519|259.5|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|519||||519|4.86|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MULTIPLAN [1680]|HMA [168003]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MULTIPLAN [1680]|IHC HS [168011]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|519||||519|5.23|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|Self-pay|Self-pay|519||||519|155.7|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|519||||519|108.99|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|TRUSTMARK [2030]|STARMARK [203000]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|519||||519|248.86|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|UMR [2035]|UMR OPTIONS [203501]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|519||||519|4.63|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|519||||519|467.1|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|519||||519|3.09|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|519||||519|5.22|482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|519||||519||482.67|3.09
30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|519||||519|259.5|482.67|3.09
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|328||||328|34.26|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|328||||328|24.57|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|328||||328|26.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|328||||328|26.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|328||||328|164.33|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|328||||328|115.13|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|328||||328|139.73|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|328||||328|164|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|328||||328|213.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|CORESOURCE [1315]|CORESOURCE [131500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|328||||328|31.44|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|328||||328|19.25|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|GEHA [1415]|GEHA [141500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|328||||328|54.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HEALTHNET [1495]|HEALTHNET [149500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|328||||328|305.04|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|328||||328|196.8|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|328||||328|26.5|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|328||||328|164|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|328||||328|25.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|328||||328|32.52|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|328||||328|24.57|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MULTIPLAN [1680]|HMA [168003]|328||||328|36.14|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MULTIPLAN [1680]|IHC HS [168011]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|328||||328|27.12|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|328||||328|26.5|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|Self-pay|Self-pay|328||||328|98.4|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|328||||328|68.88|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|328||||328|23.61|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|328||||328|35.17|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|TRUSTMARK [2030]|STARMARK [203000]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|328||||328|157.28|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|UMR [2035]|UMR OPTIONS [203501]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|328||||328|24|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|328||||328|295.2|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|328||||328|14.45|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|328||||328|19.25|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|328||||328|24.09|305.04|14.45
30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|328||||328|164|305.04|14.45
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|AETNA [1015]|AETNA ACO WILCO [101532]|207||||207|10.28|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|207||||207|6.64|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|207||||207|7.05|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|207||||207|7.05|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|207||||207|103.71|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|207||||207|72.66|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|207||||207|8.04|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|207||||207|88.18|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|207||||207|103.5|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|207||||207|134.55|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|CORESOURCE [1315]|CORESOURCE [131500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|207||||207|13.97|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|207||||207|8.55|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|GEHA [1415]|GEHA [141500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|207||||207|14.65|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HEALTHNET [1495]|HEALTHNET [149500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|207||||207|8.04|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|207||||207|192.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|207||||207|124.2|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|207||||207|7.16|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|207||||207|103.5|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|207||||207|6.81|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|207||||207|8.79|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|207||||207|6.64|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MULTIPLAN [1680]|HMA [168003]|207||||207|9.77|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MULTIPLAN [1680]|IHC HS [168011]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|207||||207|7.33|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|207||||207|7.16|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|Self-pay|Self-pay|207||||207|62.1|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|207||||207|43.47|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|207||||207|6.38|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|207||||207|9.5|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|TRUSTMARK [2030]|STARMARK [203000]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|207||||207|99.26|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|UMR [2035]|UMR OPTIONS [203501]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|207||||207|6.49|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|207||||207|186.3|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|207||||207|4.34|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|207||||207|8.55|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|207||||207|6.51|192.51|4.34
30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|207||||207|103.5|192.51|4.34
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|AETNA [1015]|AETNA ACO WILCO [101532]|162||||162|21.17|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162||||162|14.51|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162||||162|14.51|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|162||||162|81.16|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162||||162|56.86|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162||||162|16.53|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|162||||162|69.01|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|162||||162|81|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162||||162|105.3|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|CORESOURCE [1315]|CORESOURCE [131500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|CORVEL CORP [2235]|CORVEL CORP [223500]|162||||162|27.93|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|162||||162|17.1|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|GEHA [1415]|GEHA [141500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HEALTHNET [1495]|HEALTHNET [149500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162||||162|16.53|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HEALTHSMART [1505]|HEALTHSMART [150501]|162||||162|150.66|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162||||162|97.2|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162||||162|81|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162||||162|14.01|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MULTIPLAN [1680]|HMA [168003]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MULTIPLAN [1680]|IHC HS [168011]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|162||||162|15.08|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|Self-pay|Self-pay|162||||162|48.6|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162||||162|34.02|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|TRUSTMARK [2030]|STARMARK [203000]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162||||162|77.68|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|UMR [2035]|UMR OPTIONS [203501]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162||||162|13.35|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162||||162|145.8|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|162||||162|8.93|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|162||||162|17.1|150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|162||||162||150.66|8.93
30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|162||||162|81|150.66|8.93
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|251||||251|18.24|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|251||||251|11.78|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|251||||251|12.52|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|251||||251|12.52|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|251||||251|125.75|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|251||||251|88.1|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|251||||251|14.26|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|251||||251|106.93|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|251||||251|125.5|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|251||||251|163.15|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|251||||251|17.4|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|251||||251|10.65|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|GEHA [1415]|GEHA [141500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|251||||251|25.99|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|251||||251|14.26|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|251||||251|233.43|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|251||||251|150.6|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|251||||251|12.71|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|251||||251|125.5|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|251||||251|12.09|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|251||||251|15.59|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|251||||251|11.78|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MULTIPLAN [1680]|HMA [168003]|251||||251|17.33|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|251||||251|13.01|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|251||||251|12.71|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|Self-pay|Self-pay|251||||251|75.3|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|251||||251|52.71|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|251||||251|11.32|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|251||||251|16.86|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|251||||251|120.35|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|UMR [2035]|UMR OPTIONS [203501]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|251||||251|11.52|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|251||||251|225.9|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|251||||251|7.7|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|251||||251|10.65|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|251||||251|11.55|233.43|7.7
30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|251||||251|125.5|233.43|7.7
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|AETNA [1015]|AETNA ACO WILCO [101532]|240||||240|8.1|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240||||240|5.22|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240||||240|5.54|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240||||240|5.54|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|240||||240|120.24|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240||||240|84.24|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240||||240|6.33|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|240||||240|102.24|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|240||||240|120|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240||||240|156|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|CORESOURCE [1315]|CORESOURCE [131500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|240||||240|10.18|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|240||||240|6.24|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|GEHA [1415]|GEHA [141500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|240||||240|11.52|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HEALTHNET [1495]|HEALTHNET [149500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240||||240|6.33|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|240||||240|223.2|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240||||240|144|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240||||240|5.63|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240||||240|120|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240||||240|5.36|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240||||240|6.91|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240||||240|5.22|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MULTIPLAN [1680]|HMA [168003]|240||||240|7.68|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MULTIPLAN [1680]|IHC HS [168011]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|240||||240|5.76|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240||||240|5.63|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|Self-pay|Self-pay|240||||240|72|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240||||240|50.4|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|240||||240|5.02|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240||||240|7.48|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|TRUSTMARK [2030]|STARMARK [203000]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240||||240|115.08|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|UMR [2035]|UMR OPTIONS [203501]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240||||240|5.1|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240||||240|216|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|240||||240|3.41|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|240||||240|6.24|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|240||||240|5.12|223.2|3.41
30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|240||||240|120|223.2|3.41
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|236||||236|8.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236||||236|5.28|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236||||236|5.61|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236||||236|5.61|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|236||||236|118.24|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236||||236|82.84|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236||||236|6.39|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|236||||236|100.54|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|236||||236|118|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236||||236|153.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|236||||236|11.24|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|236||||236|6.88|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|GEHA [1415]|GEHA [141500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|236||||236|11.66|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236||||236|6.39|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|236||||236|219.48|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236||||236|141.6|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236||||236|5.7|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236||||236|118|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236||||236|5.42|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236||||236|6.99|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236||||236|5.28|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MULTIPLAN [1680]|HMA [168003]|236||||236|7.77|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|236||||236|5.83|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236||||236|5.7|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|Self-pay|Self-pay|236||||236|70.8|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236||||236|49.56|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|236||||236|5.08|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236||||236|7.56|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236||||236|113.16|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236||||236|5.17|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236||||236|212.4|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|236||||236|3.45|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|236||||236|6.88|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|236||||236|5.18|219.48|3.45
30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|236||||236|118|219.48|3.45
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|523||||523|14.95|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|523||||523|9.65|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|523||||523|10.25|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|523||||523|10.25|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|523||||523|262.02|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|523||||523|183.57|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|523||||523|11.67|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|523||||523|222.8|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|523||||523|261.5|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|523||||523|339.95|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|CORESOURCE [1315]|CORESOURCE [131500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|523||||523|18.77|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|523||||523|11.49|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|GEHA [1415]|GEHA [141500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|523||||523|21.29|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HEALTHNET [1495]|HEALTHNET [149500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|523||||523|11.67|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|523||||523|486.39|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|523||||523|313.8|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|523||||523|10.41|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|523||||523|261.5|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|523||||523|9.9|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|523||||523|12.77|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|523||||523|9.65|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MULTIPLAN [1680]|HMA [168003]|523||||523|14.19|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MULTIPLAN [1680]|IHC HS [168011]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|523||||523|10.65|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|523||||523|10.41|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|Self-pay|Self-pay|523||||523|156.9|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|523||||523|109.83|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|523||||523|9.27|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|523||||523|13.81|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|TRUSTMARK [2030]|STARMARK [203000]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|523||||523|250.78|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|UMR [2035]|UMR OPTIONS [203501]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|523||||523|9.43|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|523||||523|470.7|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|523||||523|6.31|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|523||||523|11.49|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|523||||523|9.46|486.39|6.31
30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|523||||523|261.5|486.39|6.31
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|105||||105|20.12|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105||||105|15.32|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105||||105|15.32|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|105||||105|52.61|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105||||105|36.86|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105||||105|14.14|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|105||||105|44.73|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|105||||105|52.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105||||105|68.25|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|105||||105|15.55|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|105||||105|9.52|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|GEHA [1415]|GEHA [141500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105||||105|14.14|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|105||||105|97.65|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105||||105|63|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105||||105|52.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105||||105|14.8|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MULTIPLAN [1680]|HMA [168003]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MULTIPLAN [1680]|IHC HS [168011]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|105||||105|15.92|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|Self-pay|Self-pay|105||||105|31.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105||||105|22.05|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|TRUSTMARK [2030]|STARMARK [203000]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105||||105|50.35|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|UMR [2035]|UMR OPTIONS [203501]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105||||105|14.09|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105||||105|94.5|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|105||||105|8.48|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|105||||105|9.52|97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|105||||105||97.65|8.48
30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|105||||105|52.5|97.65|8.48
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|111||||111|10.21|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111||||111|6.6|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111||||111|7.01|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111||||111|7.01|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|111||||111|55.61|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111||||111|38.96|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111||||111|7.98|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|111||||111|47.29|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|111||||111|55.5|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111||||111|72.15|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|CORESOURCE [1315]|CORESOURCE [131500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111||||111|13.61|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111||||111|8.33|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|GEHA [1415]|GEHA [141500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|111||||111|14.56|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HEALTHNET [1495]|HEALTHNET [149500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111||||111|7.98|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|111||||111|103.23|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111||||111|66.6|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111||||111|7.12|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111||||111|55.5|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111||||111|6.77|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111||||111|8.73|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111||||111|6.6|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MULTIPLAN [1680]|HMA [168003]|111||||111|9.71|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MULTIPLAN [1680]|IHC HS [168011]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111||||111|7.29|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111||||111|7.12|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|Self-pay|Self-pay|111||||111|33.3|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111||||111|23.31|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111||||111|6.34|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111||||111|9.45|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|TRUSTMARK [2030]|STARMARK [203000]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111||||111|53.22|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|UMR [2035]|UMR OPTIONS [203501]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111||||111|6.44|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111||||111|99.9|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111||||111|4.31|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|111||||111|8.33|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|111||||111|6.47|103.23|4.31
30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|111||||111|55.5|103.23|4.31
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|349||||349|30.65|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349||||349|21.02|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349||||349|21.02|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349||||349|174.85|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349||||349|122.5|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349||||349|23.95|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349||||349|148.67|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349||||349|174.5|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349||||349|226.85|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349||||349|34.75|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349||||349|21.28|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|GEHA [1415]|GEHA [141500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349||||349|23.95|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349||||349|324.57|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349||||349|209.4|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349||||349|174.5|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349||||349|20.3|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MULTIPLAN [1680]|HMA [168003]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MULTIPLAN [1680]|IHC HS [168011]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349||||349|21.85|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|Self-pay|Self-pay|349||||349|104.7|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349||||349|73.29|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|TRUSTMARK [2030]|STARMARK [203000]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349||||349|167.35|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|UMR [2035]|UMR OPTIONS [203501]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349||||349|19.33|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349||||349|314.1|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349||||349|12.93|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349||||349|21.28|324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349||||349||324.57|12.93
30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349||||349|174.5|324.57|12.93
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|AETNA [1015]|AETNA ACO WILCO [101532]|318||||318|23.82|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|318||||318|15.38|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|318||||318|16.34|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|318||||318|16.34|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|318||||318|159.32|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|318||||318|111.62|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|318||||318|18.61|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|318||||318|135.47|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|318||||318|159|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|318||||318|206.7|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|CORESOURCE [1315]|CORESOURCE [131500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|CORVEL CORP [2235]|CORVEL CORP [223500]|318||||318|33.11|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|318||||318|20.27|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|GEHA [1415]|GEHA [141500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|318||||318|33.93|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HEALTHNET [1495]|HEALTHNET [149500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|318||||318|18.61|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HEALTHSMART [1505]|HEALTHSMART [150501]|318||||318|295.74|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|318||||318|190.8|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|318||||318|16.59|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|318||||318|159|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|318||||318|15.78|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|318||||318|20.36|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|318||||318|15.38|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MULTIPLAN [1680]|HMA [168003]|318||||318|22.62|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MULTIPLAN [1680]|IHC HS [168011]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|318||||318|16.98|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|318||||318|16.59|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|Self-pay|Self-pay|318||||318|95.4|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|318||||318|66.78|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|318||||318|14.78|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|318||||318|22.02|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|TRUSTMARK [2030]|STARMARK [203000]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|318||||318|152.48|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|UMR [2035]|UMR OPTIONS [203501]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|318||||318|15.03|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|318||||318|286.2|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|318||||318|10.05|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|318||||318|20.27|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|318||||318|15.08|295.74|10.05
30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|318||||318|159|295.74|10.05
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|AETNA [1015]|AETNA ACO WILCO [101532]|256||||256|22.64|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|256||||256|15.51|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|256||||256|15.51|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|256||||256|128.26|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|256||||256|89.86|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|256||||256|17.68|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|256||||256|109.06|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|256||||256|128|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|256||||256|166.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|CORESOURCE [1315]|CORESOURCE [131500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|256||||256|34.05|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|256||||256|20.84|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|GEHA [1415]|GEHA [141500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HEALTHNET [1495]|HEALTHNET [149500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|256||||256|17.68|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|256||||256|238.08|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|256||||256|153.6|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|256||||256|128|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|256||||256|14.98|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MULTIPLAN [1680]|HMA [168003]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MULTIPLAN [1680]|IHC HS [168011]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|256||||256|16.12|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|Self-pay|Self-pay|256||||256|76.8|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|256||||256|53.76|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|TRUSTMARK [2030]|STARMARK [203000]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|256||||256|122.75|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|UMR [2035]|UMR OPTIONS [203501]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|256||||256|14.27|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|256||||256|230.4|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|256||||256|9.55|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|256||||256|20.84|238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|256||||256||238.08|9.55
30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|256||||256|128|238.08|9.55
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|AETNA [1015]|AETNA ACO WILCO [101532]|233||||233|26.34|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233||||233|18.89|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|233||||233|20.07|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|233||||233|20.07|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|233||||233|116.73|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|233||||233|81.78|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|233||||233|99.26|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|233||||233|116.5|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233||||233|151.45|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|CORESOURCE [1315]|CORESOURCE [131500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|233||||233|48.73|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|233||||233|29.84|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|GEHA [1415]|GEHA [141500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|233||||233|41.67|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HEALTHNET [1495]|HEALTHNET [149500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|233||||233|216.69|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|233||||233|139.8|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|233||||233|20.37|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|233||||233|116.5|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|233||||233|19.38|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|233||||233|25|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233||||233|18.89|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MULTIPLAN [1680]|HMA [168003]|233||||233|27.78|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MULTIPLAN [1680]|IHC HS [168011]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|233||||233|20.86|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|233||||233|20.37|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|Self-pay|Self-pay|233||||233|69.9|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|233||||233|48.93|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|233||||233|18.15|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|233||||233|27.04|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|TRUSTMARK [2030]|STARMARK [203000]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233||||233|111.72|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|UMR [2035]|UMR OPTIONS [203501]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|233||||233|18.46|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|233||||233|209.7|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|233||||233|11.11|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|233||||233|29.84|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|233||||233|18.52|216.69|11.11
30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|233||||233|116.5|216.69|11.11
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|AETNA [1015]|AETNA ACO WILCO [101532]|608||||608|39.94|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|608||||608|25.78|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|608||||608|27.37|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|608||||608|27.37|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|608||||608|304.61|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|608||||608|213.41|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|608||||608|31.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|608||||608|259.01|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|608||||608|304|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|608||||608|395.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|CORESOURCE [1315]|CORESOURCE [131500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|608||||608|51.44|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|608||||608|31.49|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|GEHA [1415]|GEHA [141500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|608||||608|56.86|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HEALTHNET [1495]|HEALTHNET [149500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|608||||608|31.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|608||||608|565.44|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|608||||608|364.8|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|608||||608|27.8|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|608||||608|304|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|608||||608|26.44|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|608||||608|34.11|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|608||||608|25.78|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MULTIPLAN [1680]|HMA [168003]|608||||608|37.91|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MULTIPLAN [1680]|IHC HS [168011]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|608||||608|28.45|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|608||||608|27.8|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|Self-pay|Self-pay|608||||608|182.4|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|608||||608|127.68|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|608||||608|24.76|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|608||||608|36.89|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|TRUSTMARK [2030]|STARMARK [203000]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|608||||608|291.54|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|UMR [2035]|UMR OPTIONS [203501]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|608||||608|25.18|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|608||||608|547.2|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|608||||608|16.85|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|608||||608|31.49|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|608||||608|25.27|565.44|16.85
30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|608||||608|304|565.44|16.85
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|AETNA [1015]|AETNA ACO WILCO [101532]|460||||460|35.15|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|460||||460|22.67|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|460||||460|24.09|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|460||||460|24.09|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|460||||460|230.46|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|460||||460|161.46|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|460||||460|27.45|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|460||||460|195.96|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|460||||460|230|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|460||||460|299|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|CORESOURCE [1315]|CORESOURCE [131500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|CORVEL CORP [2235]|CORVEL CORP [223500]|460||||460|33.61|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|460||||460|20.58|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|GEHA [1415]|GEHA [141500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|460||||460|50.02|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HEALTHNET [1495]|HEALTHNET [149500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|460||||460|27.45|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HEALTHSMART [1505]|HEALTHSMART [150501]|460||||460|427.8|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|460||||460|276|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|460||||460|24.45|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|460||||460|230|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|460||||460|23.27|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|460||||460|30.01|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|460||||460|22.67|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MULTIPLAN [1680]|HMA [168003]|460||||460|33.35|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MULTIPLAN [1680]|IHC HS [168011]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|460||||460|25.04|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|460||||460|24.45|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|Self-pay|Self-pay|460||||460|138|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|460||||460|96.6|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|460||||460|21.79|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|460||||460|32.46|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|TRUSTMARK [2030]|STARMARK [203000]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|460||||460|220.57|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|UMR [2035]|UMR OPTIONS [203501]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|460||||460|22.16|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|460||||460|414|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|460||||460|14.83|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|460||||460|20.58|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|460||||460|22.23|427.8|14.83
30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|460||||460|230|427.8|14.83
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|533||||533|48.98|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|533||||533|33.56|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|533||||533|33.56|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|533||||533|267.03|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|533||||533|187.08|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|533||||533|38.25|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|533||||533|227.06|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|533||||533|266.5|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|533||||533|346.45|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|CORESOURCE [1315]|CORESOURCE [131500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|533||||533|59.45|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|533||||533|36.4|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|GEHA [1415]|GEHA [141500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HEALTHNET [1495]|HEALTHNET [149500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|533||||533|38.25|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|533||||533|495.69|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|533||||533|319.8|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|533||||533|266.5|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|533||||533|32.41|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MULTIPLAN [1680]|HMA [168003]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MULTIPLAN [1680]|IHC HS [168011]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|533||||533|34.88|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|Self-pay|Self-pay|533||||533|159.9|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|533||||533|111.93|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|TRUSTMARK [2030]|STARMARK [203000]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|533||||533|255.57|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|UMR [2035]|UMR OPTIONS [203501]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|533||||533|30.87|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|533||||533|479.7|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|533||||533|20.66|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|533||||533|36.4|495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|533||||533||495.69|20.66
30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|533||||533|266.5|495.69|20.66
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|519||||519|46.27|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|519||||519|31.72|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|519||||519|31.72|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|519||||519|260.02|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|519||||519|182.17|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|519||||519|36.14|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|519||||519|221.09|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|519||||519|259.5|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|519||||519|337.35|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|CORESOURCE [1315]|CORESOURCE [131500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|519||||519|53.97|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|519||||519|33.04|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|GEHA [1415]|GEHA [141500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HEALTHNET [1495]|HEALTHNET [149500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|519||||519|36.14|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|519||||519|482.67|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|519||||519|311.4|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|519||||519|259.5|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|519||||519|30.64|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MULTIPLAN [1680]|HMA [168003]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MULTIPLAN [1680]|IHC HS [168011]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|519||||519|32.97|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|Self-pay|Self-pay|519||||519|155.7|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|519||||519|108.99|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|TRUSTMARK [2030]|STARMARK [203000]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|519||||519|248.86|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|UMR [2035]|UMR OPTIONS [203501]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|519||||519|29.18|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|519||||519|467.1|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|519||||519|19.52|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|519||||519|33.04|482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|519||||519||482.67|19.52
30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|519||||519|259.5|482.67|19.52
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|AETNA [1015]|AETNA ACO WILCO [101532]|160||||160|19.35|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|160||||160|13.28|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|160||||160|13.28|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|160||||160|80.16|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|160||||160|56.16|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|160||||160|15.12|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|160||||160|68.16|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|160||||160|80|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|160||||160|104|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|CORESOURCE [1315]|CORESOURCE [131500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|160||||160|20.67|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|160||||160|12.65|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|GEHA [1415]|GEHA [141500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HEALTHNET [1495]|HEALTHNET [149500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|160||||160|15.12|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|160||||160|148.8|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|160||||160|96|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|160||||160|80|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|160||||160|12.82|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MULTIPLAN [1680]|HMA [168003]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MULTIPLAN [1680]|IHC HS [168011]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|160||||160|13.8|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|Self-pay|Self-pay|160||||160|48|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|160||||160|33.6|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|TRUSTMARK [2030]|STARMARK [203000]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|160||||160|76.72|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|UMR [2035]|UMR OPTIONS [203501]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|160||||160|12.21|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|160||||160|144|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|160||||160|8.17|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|160||||160|12.65|148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|160||||160||148.8|8.17
30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|160||||160|80|148.8|8.17
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|AETNA [1015]|AETNA ACO WILCO [101532]|699||||699|60.85|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|699||||699|39.27|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|699||||699|41.71|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|699||||699|41.71|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|699||||699|350.2|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|699||||699|245.35|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|699||||699|47.53|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|699||||699|297.77|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|699||||699|349.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|699||||699|454.35|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|CORESOURCE [1315]|CORESOURCE [131500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|699||||699|75.62|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|699||||699|46.3|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|GEHA [1415]|GEHA [141500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|699||||699|86.63|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HEALTHNET [1495]|HEALTHNET [149500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|699||||699|47.53|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|699||||699|650.07|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|699||||699|419.4|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|699||||699|42.35|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|699||||699|349.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|699||||699|40.28|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|699||||699|51.98|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|699||||699|39.27|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MULTIPLAN [1680]|HMA [168003]|699||||699|57.75|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MULTIPLAN [1680]|IHC HS [168011]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|699||||699|43.35|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|699||||699|42.35|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|Self-pay|Self-pay|699||||699|209.7|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|699||||699|146.79|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|699||||699|37.73|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|699||||699|56.21|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|TRUSTMARK [2030]|STARMARK [203000]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|699||||699|335.17|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|UMR [2035]|UMR OPTIONS [203501]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|699||||699|38.36|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|699||||699|629.1|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|699||||699|25.67|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|699||||699|46.3|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|699||||699|38.5|650.07|25.67
30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|699||||699|349.5|650.07|25.67
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|AETNA [1015]|AETNA ACO WILCO [101532]|206||||206|18.22|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206||||206|11.76|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206||||206|12.49|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206||||206|12.49|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|206||||206|103.21|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206||||206|72.31|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206||||206|14.24|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|206||||206|87.76|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|206||||206|103|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206||||206|133.9|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|CORESOURCE [1315]|CORESOURCE [131500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|206||||206|17.42|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|206||||206|10.66|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|GEHA [1415]|GEHA [141500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|206||||206|25.94|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HEALTHNET [1495]|HEALTHNET [149500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206||||206|14.24|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|206||||206|191.58|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206||||206|123.6|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206||||206|12.68|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206||||206|103|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206||||206|12.07|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206||||206|15.57|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206||||206|11.76|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MULTIPLAN [1680]|HMA [168003]|206||||206|17.3|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MULTIPLAN [1680]|IHC HS [168011]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|206||||206|12.98|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206||||206|12.68|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|Self-pay|Self-pay|206||||206|61.8|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206||||206|43.26|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|206||||206|11.3|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206||||206|16.83|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|TRUSTMARK [2030]|STARMARK [203000]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206||||206|98.78|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|UMR [2035]|UMR OPTIONS [203501]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206||||206|11.5|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206||||206|185.4|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|206||||206|7.69|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|206||||206|10.66|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|206||||206|11.53|191.58|7.69
30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|206||||206|103|191.58|7.69
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|308||||308|31.54|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|308||||308|24.02|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|308||||308|24.02|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|308||||308|154.31|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|308||||308|108.11|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|308||||308|22.29|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|308||||308|131.21|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|308||||308|154|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|308||||308|200.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|CORESOURCE [1315]|CORESOURCE [131500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|308||||308|32.07|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|308||||308|19.63|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|GEHA [1415]|GEHA [141500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HEALTHNET [1495]|HEALTHNET [149500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|308||||308|22.29|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|308||||308|286.44|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|308||||308|184.8|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|308||||308|154|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|308||||308|23.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MULTIPLAN [1680]|HMA [168003]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MULTIPLAN [1680]|IHC HS [168011]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|308||||308|24.97|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|Self-pay|Self-pay|308||||308|92.4|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|308||||308|64.68|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|TRUSTMARK [2030]|STARMARK [203000]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|308||||308|147.69|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|UMR [2035]|UMR OPTIONS [203501]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|308||||308|22.1|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|308||||308|277.2|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|308||||308|13.3|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|308||||308|19.63|286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|308||||308||286.44|13.3
30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|308||||308|154|286.44|13.3
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|AETNA [1015]|AETNA ACO WILCO [101532]|444||||444|87.48|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|444||||444|62.73|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|444||||444|66.63|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|444||||444|66.63|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|444||||444|222.44|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|444||||444|155.84|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|444||||444|189.14|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|444||||444|222|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|444||||444|288.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|CORESOURCE [1315]|CORESOURCE [131500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|444||||444|56.21|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|444||||444|39|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|GEHA [1415]|GEHA [141500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|444||||444|138.38|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HEALTHNET [1495]|HEALTHNET [149500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|444||||444|412.92|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|444||||444|266.4|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|444||||444|67.65|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|444||||444|222|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|444||||444|64.36|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|444||||444|83.03|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|444||||444|62.73|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MULTIPLAN [1680]|HMA [168003]|444||||444|92.25|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MULTIPLAN [1680]|IHC HS [168011]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|444||||444|69.25|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|444||||444|67.65|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|Self-pay|Self-pay|444||||444|133.2|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|444||||444|93.24|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|444||||444|60.27|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|444||||444|89.79|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|TRUSTMARK [2030]|STARMARK [203000]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|444||||444|212.9|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|UMR [2035]|UMR OPTIONS [203501]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|444||||444|61.29|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|444||||444|399.6|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|444||||444|36.9|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|444||||444|39|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|444||||444|61.5|412.92|36.9
30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|444||||444|222|412.92|36.9
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|349||||349|29.7|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349||||349|19.17|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349||||349|20.35|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349||||349|20.35|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349||||349|174.85|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349||||349|122.5|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349||||349|23.2|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349||||349|148.67|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349||||349|174.5|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349||||349|226.85|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|CORESOURCE [1315]|CORESOURCE [131500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349||||349|37.32|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349||||349|22.85|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|GEHA [1415]|GEHA [141500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349||||349|42.28|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HEALTHNET [1495]|HEALTHNET [149500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349||||349|23.2|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349||||349|324.57|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349||||349|209.4|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349||||349|20.67|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349||||349|174.5|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349||||349|19.66|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349||||349|25.37|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349||||349|19.17|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MULTIPLAN [1680]|HMA [168003]|349||||349|28.19|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MULTIPLAN [1680]|IHC HS [168011]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349||||349|21.15|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349||||349|20.67|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|Self-pay|Self-pay|349||||349|104.7|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349||||349|73.29|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349||||349|18.41|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349||||349|27.43|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|TRUSTMARK [2030]|STARMARK [203000]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349||||349|167.35|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|UMR [2035]|UMR OPTIONS [203501]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349||||349|18.72|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349||||349|314.1|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349||||349|12.53|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349||||349|22.85|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349||||349|18.79|324.57|12.53
30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349||||349|174.5|324.57|12.53
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|456||||456|44.15|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|456||||456|28.5|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|456||||456|30.27|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|456||||456|30.27|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|456||||456|228.46|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|456||||456|160.06|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|456||||456|34.49|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|456||||456|194.26|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|456||||456|228|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|456||||456|296.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|CORESOURCE [1315]|CORESOURCE [131500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|456||||456|51.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|456||||456|31.47|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|GEHA [1415]|GEHA [141500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|456||||456|62.87|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HEALTHNET [1495]|HEALTHNET [149500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|456||||456|34.49|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|456||||456|424.08|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|456||||456|273.6|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|456||||456|30.73|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|456||||456|228|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|456||||456|29.24|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|456||||456|37.72|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|456||||456|28.5|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MULTIPLAN [1680]|HMA [168003]|456||||456|41.91|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MULTIPLAN [1680]|IHC HS [168011]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|456||||456|31.46|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|456||||456|30.73|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|Self-pay|Self-pay|456||||456|136.8|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|456||||456|95.76|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|456||||456|27.38|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|456||||456|40.79|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|TRUSTMARK [2030]|STARMARK [203000]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|456||||456|218.65|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|UMR [2035]|UMR OPTIONS [203501]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|456||||456|27.85|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|456||||456|410.4|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|456||||456|18.62|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|456||||456|31.47|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|456||||456|27.94|424.08|18.62
30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL ESTRADIOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|456||||456|228|424.08|18.62
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|477||||477|34.29|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|477||||477|22.13|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|477||||477|23.51|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|477||||477|23.51|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|477||||477|238.98|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|477||||477|167.43|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|477||||477|26.78|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|477||||477|203.2|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|477||||477|238.5|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|477||||477|310.05|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|477||||477|42.24|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|477||||477|25.86|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|GEHA [1415]|GEHA [141500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|477||||477|48.83|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|477||||477|26.78|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|477||||477|443.61|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|477||||477|286.2|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|477||||477|23.87|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|477||||477|238.5|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|477||||477|22.71|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|477||||477|29.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|477||||477|22.13|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MULTIPLAN [1680]|HMA [168003]|477||||477|32.55|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|477||||477|24.44|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|477||||477|23.87|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|Self-pay|Self-pay|477||||477|143.1|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|477||||477|100.17|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|477||||477|21.27|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|477||||477|31.68|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|477||||477|228.72|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|477||||477|21.63|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|477||||477|429.3|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|477||||477|14.47|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|477||||477|25.86|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|477||||477|21.7|443.61|14.47
30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|477||||477|238.5|443.61|14.47
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|351||||351|38.21|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351||||351|24.66|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351||||351|26.2|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351||||351|26.2|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|351||||351|175.85|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351||||351|123.2|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351||||351|29.85|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|351||||351|149.53|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|351||||351|175.5|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351||||351|228.15|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|351||||351|44.26|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|351||||351|27.1|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|GEHA [1415]|GEHA [141500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|351||||351|54.41|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351||||351|29.85|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|351||||351|326.43|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351||||351|210.6|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351||||351|26.6|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351||||351|175.5|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351||||351|25.3|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351||||351|32.64|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351||||351|24.66|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MULTIPLAN [1680]|HMA [168003]|351||||351|36.27|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|351||||351|27.23|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351||||351|26.6|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|Self-pay|Self-pay|351||||351|105.3|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351||||351|73.71|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|351||||351|23.7|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351||||351|35.3|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351||||351|168.3|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|UMR [2035]|UMR OPTIONS [203501]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351||||351|24.09|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351||||351|315.9|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|351||||351|16.12|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|351||||351|27.1|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|351||||351|24.18|326.43|16.12
30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|351||||351|175.5|326.43|16.12
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|398||||398|39.45|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|398||||398|25.45|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|398||||398|27.03|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|398||||398|27.03|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|398||||398|199.4|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|398||||398|139.7|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|398||||398|30.81|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|398||||398|169.55|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|398||||398|199|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|398||||398|258.7|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|CORESOURCE [1315]|CORESOURCE [131500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|398||||398|58.11|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|398||||398|35.58|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|GEHA [1415]|GEHA [141500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|398||||398|56.14|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HEALTHNET [1495]|HEALTHNET [149500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|398||||398|30.81|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|398||||398|370.14|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|398||||398|238.8|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|398||||398|27.45|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|398||||398|199|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|398||||398|26.11|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|398||||398|33.68|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|398||||398|25.45|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MULTIPLAN [1680]|HMA [168003]|398||||398|37.43|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MULTIPLAN [1680]|IHC HS [168011]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|398||||398|28.09|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|398||||398|27.45|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|Self-pay|Self-pay|398||||398|119.4|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|398||||398|83.58|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|398||||398|24.45|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|398||||398|36.43|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|TRUSTMARK [2030]|STARMARK [203000]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|398||||398|190.84|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|UMR [2035]|UMR OPTIONS [203501]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|398||||398|24.86|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|398||||398|358.2|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|398||||398|16.64|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|398||||398|35.58|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|398||||398|24.95|370.14|16.64
30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|398||||398|199|370.14|16.64
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|257||||257|23.55|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|257||||257|15.2|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|257||||257|16.15|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|257||||257|16.15|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|257||||257|128.76|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|257||||257|90.21|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|257||||257|18.4|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|257||||257|109.48|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|257||||257|128.5|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|257||||257|167.05|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|CORESOURCE [1315]|CORESOURCE [131500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|257||||257|22.54|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|257||||257|13.8|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|GEHA [1415]|GEHA [141500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|257||||257|33.53|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HEALTHNET [1495]|HEALTHNET [149500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|257||||257|18.4|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|257||||257|239.01|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|257||||257|154.2|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|257||||257|16.39|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|257||||257|128.5|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|257||||257|15.6|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|257||||257|20.12|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|257||||257|15.2|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MULTIPLAN [1680]|HMA [168003]|257||||257|22.35|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MULTIPLAN [1680]|IHC HS [168011]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|257||||257|16.79|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|257||||257|16.39|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|Self-pay|Self-pay|257||||257|77.1|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|257||||257|53.97|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|257||||257|14.6|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|257||||257|21.75|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|TRUSTMARK [2030]|STARMARK [203000]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|257||||257|123.23|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|UMR [2035]|UMR OPTIONS [203501]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|257||||257|14.85|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|257||||257|231.3|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|257||||257|9.94|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|257||||257|13.8|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|257||||257|14.9|239.01|9.94
30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|257||||257|128.5|239.01|9.94
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|61||||61|8.05|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61||||61|5.2|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61||||61|5.52|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61||||61|5.52|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61||||61|30.56|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61||||61|21.41|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61||||61|6.29|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61||||61|25.99|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61||||61|30.5|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61||||61|39.65|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|CORESOURCE [1315]|CORESOURCE [131500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61||||61|12|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61||||61|7.34|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|GEHA [1415]|GEHA [141500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61||||61|11.48|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HEALTHNET [1495]|HEALTHNET [149500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61||||61|6.29|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61||||61|56.73|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61||||61|36.6|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61||||61|5.61|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61||||61|30.5|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61||||61|5.34|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61||||61|6.89|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61||||61|5.2|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MULTIPLAN [1680]|HMA [168003]|61||||61|7.65|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MULTIPLAN [1680]|IHC HS [168011]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61||||61|5.74|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61||||61|5.61|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|Self-pay|Self-pay|61||||61|18.3|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61||||61|12.81|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61||||61|5|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61||||61|7.45|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|TRUSTMARK [2030]|STARMARK [203000]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61||||61|29.25|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|UMR [2035]|UMR OPTIONS [203501]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61||||61|5.08|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61||||61|54.9|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61||||61|3.4|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61||||61|7.34|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61||||61|5.1|56.73|3.4
30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61||||61|30.5|56.73|3.4
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|222||||222|26.56|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222||||222|18.2|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222||||222|18.2|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|222||||222|111.22|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222||||222|77.92|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222||||222|20.75|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|222||||222|94.57|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|222||||222|111|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222||||222|144.3|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|CORESOURCE [1315]|CORESOURCE [131500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|222||||222|36.44|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|222||||222|22.31|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|GEHA [1415]|GEHA [141500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HEALTHNET [1495]|HEALTHNET [149500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222||||222|20.75|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|222||||222|206.46|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222||||222|133.2|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222||||222|111|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222||||222|17.58|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MULTIPLAN [1680]|HMA [168003]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MULTIPLAN [1680]|IHC HS [168011]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|222||||222|18.92|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|Self-pay|Self-pay|222||||222|66.6|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222||||222|46.62|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|TRUSTMARK [2030]|STARMARK [203000]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222||||222|106.45|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|UMR [2035]|UMR OPTIONS [203501]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222||||222|16.74|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222||||222|199.8|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|222||||222|11.2|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|222||||222|22.31|206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|222||||222||206.46|11.2
30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|222||||222|111|206.46|11.2
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|26.7|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|20.33|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|20.33|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|18.77|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|24.18|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|14.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|18.77|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|19.63|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MULTIPLAN [1680]|HMA [168003]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|21.13|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|Self-pay|Self-pay|242||||242|72.6|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|18.7|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|11.26|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|14.8|225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242||225.06|11.26
30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|11.26
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|AETNA [1015]|AETNA ACO WILCO [101532]|233||||233|28.54|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|233||||233|21.4|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|233||||233|21.4|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|233||||233|116.73|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|233||||233|81.78|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|233||||233|22.29|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|233||||233|99.26|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|233||||233|116.5|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233||||233|151.45|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|CORESOURCE [1315]|CORESOURCE [131500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|233||||233|32.07|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|233||||233|19.63|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|GEHA [1415]|GEHA [141500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HEALTHNET [1495]|HEALTHNET [149500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233||||233|22.29|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|233||||233|216.69|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|233||||233|139.8|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|233||||233|116.5|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|233||||233|20.67|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MULTIPLAN [1680]|HMA [168003]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MULTIPLAN [1680]|IHC HS [168011]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|233||||233|22.24|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|Self-pay|Self-pay|233||||233|69.9|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|233||||233|48.93|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|TRUSTMARK [2030]|STARMARK [203000]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233||||233|111.72|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|UMR [2035]|UMR OPTIONS [203501]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|233||||233|19.69|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|233||||233|209.7|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|233||||233|12.04|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|233||||233|19.63|216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|233||||233||216.69|12.04
30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|233||||233|116.5|216.69|12.04
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|285||||285|21.55|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285||||285|13.9|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285||||285|14.76|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285||||285|14.76|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|285||||285|142.79|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285||||285|100.04|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285||||285|16.83|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|285||||285|121.41|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|285||||285|142.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285||||285|185.25|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|CORESOURCE [1315]|CORESOURCE [131500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|285||||285|22.26|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|GEHA [1415]|GEHA [141500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|285||||285|30.67|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HEALTHNET [1495]|HEALTHNET [149500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285||||285|16.83|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|285||||285|265.05|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285||||285|171|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285||||285|14.99|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285||||285|142.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285||||285|14.26|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285||||285|18.4|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285||||285|13.9|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MULTIPLAN [1680]|HMA [168003]|285||||285|20.45|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MULTIPLAN [1680]|IHC HS [168011]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|285||||285|15.34|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285||||285|14.99|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|Self-pay|Self-pay|285||||285|85.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285||||285|59.85|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|285||||285|13.36|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285||||285|19.9|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|TRUSTMARK [2030]|STARMARK [203000]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285||||285|136.66|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|UMR [2035]|UMR OPTIONS [203501]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285||||285|13.58|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285||||285|256.5|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|285||||285|9.09|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|285||||285|13.63|265.05|9.09
30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|285||||285|142.5|265.05|9.09
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|930||||930|101.8|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930|65.7|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|930||||930|69.79|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|930||||930|69.79|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|930||||930|465.93|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|930||||930|326.43|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|930||||930|79.52|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|930||||930|396.18|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|930||||930|465|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|930||||930|604.5|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|CORESOURCE [1315]|CORESOURCE [131500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|930||||930|81.74|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|930||||930|50.04|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|GEHA [1415]|GEHA [141500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|930||||930|144.92|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|79.52|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|930||||930|864.9|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|558|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|930||||930|70.85|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|465|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|67.4|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|930||||930|86.95|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|930||||930|65.7|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MULTIPLAN [1680]|HMA [168003]|930||||930|96.62|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|930||||930|72.54|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|930||||930|70.85|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|Self-pay|Self-pay|930||||930|279|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|930||||930|195.3|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|930||||930|63.12|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|930||||930|94.04|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|445.94|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|UMR [2035]|UMR OPTIONS [203501]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|930||||930|64.19|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|930||||930|837|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|42.94|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|50.04|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|930||||930|64.41|864.9|42.94
30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|930||||930|465|864.9|42.94
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|335||||335|29.3|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|335||||335|20.09|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|335||||335|20.09|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|335||||335|167.84|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|335||||335|117.59|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|335||||335|22.89|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|335||||335|142.71|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|335||||335|167.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|335||||335|217.75|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|335||||335|31.22|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|335||||335|19.12|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|GEHA [1415]|GEHA [141500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|335||||335|22.89|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|335||||335|311.55|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|335||||335|201|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|335||||335|167.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|335||||335|19.41|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MULTIPLAN [1680]|HMA [168003]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MULTIPLAN [1680]|IHC HS [168011]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|335||||335|20.88|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|Self-pay|Self-pay|335||||335|100.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|335||||335|70.35|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|TRUSTMARK [2030]|STARMARK [203000]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|335||||335|160.63|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|UMR [2035]|UMR OPTIONS [203501]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|335||||335|18.48|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|335||||335|301.5|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|335||||335|12.36|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|335||||335|19.12|311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|335||||335||311.55|12.36
30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|335||||335|167.5|311.55|12.36
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|230||||230|23.24|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230||||230|14.99|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230||||230|15.93|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230||||230|15.93|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|230||||230|115.23|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230||||230|80.73|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230||||230|18.15|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|230||||230|97.98|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|230||||230|115|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230||||230|149.5|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|230||||230|27.52|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|230||||230|16.85|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|GEHA [1415]|GEHA [141500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|230||||230|33.08|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230||||230|18.15|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|230||||230|213.9|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230||||230|138|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230||||230|16.17|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230||||230|115|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230||||230|15.39|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230||||230|19.85|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230||||230|14.99|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MULTIPLAN [1680]|HMA [168003]|230||||230|22.05|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|230||||230|16.56|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230||||230|16.17|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|Self-pay|Self-pay|230||||230|69|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230||||230|48.3|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|230||||230|14.41|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230||||230|21.46|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230||||230|110.29|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|UMR [2035]|UMR OPTIONS [203501]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230||||230|14.66|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230||||230|207|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|230||||230|9.8|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|230||||230|16.85|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|230||||230|14.7|213.9|9.8
30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|230||||230|115|213.9|9.8
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|AETNA [1015]|AETNA ACO WILCO [101532]|198||||198|27.38|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198||||198|18|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198||||198|19.12|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198||||198|19.12|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198||||198|99.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198||||198|69.5|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198||||198|21.38|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198||||198|84.35|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198||||198|99|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198||||198|128.7|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|CORESOURCE [1315]|CORESOURCE [131500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198||||198|26.1|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198||||198|15.98|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|GEHA [1415]|GEHA [141500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198||||198|39.71|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HEALTHNET [1495]|HEALTHNET [149500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198||||198|21.38|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198||||198|184.14|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198||||198|118.8|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198||||198|19.42|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198||||198|99|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198||||198|18.47|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198||||198|23.83|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198||||198|18|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MULTIPLAN [1680]|HMA [168003]|198||||198|26.48|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MULTIPLAN [1680]|IHC HS [168011]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198||||198|19.87|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198||||198|19.42|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|Self-pay|Self-pay|198||||198|59.4|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198||||198|41.58|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198||||198|17.3|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198||||198|25.77|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|TRUSTMARK [2030]|STARMARK [203000]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198||||198|94.94|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|UMR [2035]|UMR OPTIONS [203501]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198||||198|17.59|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198||||198|178.2|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198||||198|11.55|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198||||198|15.98|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198||||198|17.65|184.14|11.55
30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198||||198|99|184.14|11.55
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|308||||308|27.4|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|308||||308|18.79|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|308||||308|18.79|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|308||||308|154.31|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|308||||308|108.11|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|308||||308|21.4|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|308||||308|131.21|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|308||||308|154|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|308||||308|200.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|CORESOURCE [1315]|CORESOURCE [131500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|308||||308|30.65|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|308||||308|18.77|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|GEHA [1415]|GEHA [141500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HEALTHNET [1495]|HEALTHNET [149500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|308||||308|21.4|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|308||||308|286.44|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|308||||308|184.8|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|308||||308|154|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|308||||308|18.15|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MULTIPLAN [1680]|HMA [168003]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MULTIPLAN [1680]|IHC HS [168011]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|308||||308|19.53|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|Self-pay|Self-pay|308||||308|92.4|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|308||||308|64.68|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|TRUSTMARK [2030]|STARMARK [203000]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|308||||308|147.69|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|UMR [2035]|UMR OPTIONS [203501]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|308||||308|17.29|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|308||||308|277.2|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|308||||308|11.56|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|308||||308|18.77|286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|308||||308||286.44|11.56
30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|308||||308|154|286.44|11.56
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|146||||146|17.7|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146||||146|12.14|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146||||146|12.14|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|146||||146|73.15|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146||||146|51.25|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146||||146|13.82|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|146||||146|62.2|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|146||||146|73|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146||||146|94.9|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|CORESOURCE [1315]|CORESOURCE [131500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|146||||146|23.51|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|146||||146|14.39|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|GEHA [1415]|GEHA [141500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HEALTHNET [1495]|HEALTHNET [149500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146||||146|13.82|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|146||||146|135.78|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146||||146|87.6|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146||||146|73|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146||||146|11.72|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MULTIPLAN [1680]|HMA [168003]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MULTIPLAN [1680]|IHC HS [168011]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|146||||146|12.62|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|Self-pay|Self-pay|146||||146|43.8|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146||||146|30.66|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|TRUSTMARK [2030]|STARMARK [203000]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146||||146|70.01|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|UMR [2035]|UMR OPTIONS [203501]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146||||146|11.16|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146||||146|131.4|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|146||||146|7.46|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|146||||146|14.39|135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|146||||146||135.78|7.46
30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|146||||146|73|135.78|7.46
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|207||||207|14.71|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|207||||207|9.49|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|207||||207|10.07|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|207||||207|10.07|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|207||||207|103.71|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|207||||207|72.66|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|207||||207|11.48|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|207||||207|88.18|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|207||||207|103.5|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|207||||207|134.55|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|207||||207|15.17|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|207||||207|9.29|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|GEHA [1415]|GEHA [141500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|207||||207|20.93|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|207||||207|11.48|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|207||||207|192.51|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|207||||207|124.2|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|207||||207|10.23|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|207||||207|103.5|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|207||||207|9.72|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|207||||207|12.56|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|207||||207|9.49|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MULTIPLAN [1680]|HMA [168003]|207||||207|13.95|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MULTIPLAN [1680]|IHC HS [168011]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|207||||207|10.47|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|207||||207|10.23|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|Self-pay|Self-pay|207||||207|62.1|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|207||||207|43.47|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|207||||207|9.11|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|207||||207|13.58|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|TRUSTMARK [2030]|STARMARK [203000]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|207||||207|99.26|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|UMR [2035]|UMR OPTIONS [203501]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|207||||207|9.26|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|207||||207|186.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|207||||207|6.2|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|207||||207|9.29|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|207||||207|9.3|192.51|6.2
30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|207||||207|103.5|192.51|6.2
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|302||||302|26.02|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|302||||302|16.79|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|302||||302|17.83|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|302||||302|17.83|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|302||||302|151.3|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|302||||302|106|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|302||||302|20.32|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|302||||302|128.65|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|302||||302|151|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|302||||302|196.3|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|CORESOURCE [1315]|CORESOURCE [131500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|302||||302|28.27|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|302||||302|17.31|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|GEHA [1415]|GEHA [141500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|302||||302|37.04|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HEALTHNET [1495]|HEALTHNET [149500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|302||||302|20.32|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|302||||302|280.86|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|302||||302|181.2|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|302||||302|18.11|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|302||||302|151|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|302||||302|17.22|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|302||||302|22.22|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|302||||302|16.79|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MULTIPLAN [1680]|HMA [168003]|302||||302|24.69|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MULTIPLAN [1680]|IHC HS [168011]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|302||||302|18.53|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|302||||302|18.11|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|Self-pay|Self-pay|302||||302|90.6|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|302||||302|63.42|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|302||||302|16.13|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|302||||302|24.03|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|TRUSTMARK [2030]|STARMARK [203000]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|302||||302|144.81|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|UMR [2035]|UMR OPTIONS [203501]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|302||||302|16.4|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|302||||302|271.8|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|302||||302|10.97|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|302||||302|17.31|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|302||||302|16.46|280.86|10.97
30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|302||||302|151|280.86|10.97
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|664||||664|12.68|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|664||||664|8.18|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|664||||664|8.69|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|664||||664|8.69|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|664||||664|332.66|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|664||||664|233.06|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|664||||664|9.9|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|664||||664|282.86|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|664||||664|332|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|664||||664|431.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|664||||664|40.71|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|664||||664|24.92|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|GEHA [1415]|GEHA [141500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|664||||664|18.05|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|664||||664|9.9|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|664||||664|617.52|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|664||||664|398.4|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|664||||664|8.82|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|664||||664|332|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|664||||664|8.39|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|664||||664|10.83|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|664||||664|8.18|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MULTIPLAN [1680]|HMA [168003]|664||||664|12.03|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MULTIPLAN [1680]|IHC HS [168011]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|664||||664|9.03|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|664||||664|8.82|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|Self-pay|Self-pay|664||||664|199.2|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|664||||664|139.44|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|664||||664|7.86|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|664||||664|11.71|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|TRUSTMARK [2030]|STARMARK [203000]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|664||||664|318.39|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|UMR [2035]|UMR OPTIONS [203501]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|664||||664|7.99|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|664||||664|597.6|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|664||||664|5.35|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|664||||664|24.92|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|664||||664|8.02|617.52|5.35
30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|664||||664|332|617.52|5.35
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|160||||160|15.65|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|160||||160|11.92|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|160||||160|11.92|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|160||||160|80.16|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|160||||160|56.16|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|160||||160|11|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|160||||160|68.16|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|160||||160|80|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|160||||160|104|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|160||||160|15.89|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|160||||160|9.73|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|GEHA [1415]|GEHA [141500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|160||||160|11|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|160||||160|148.8|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|160||||160|96|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|160||||160|80|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|160||||160|11.51|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MULTIPLAN [1680]|HMA [168003]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|160||||160|12.39|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|Self-pay|Self-pay|160||||160|48|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|160||||160|33.6|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|160||||160|76.72|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|UMR [2035]|UMR OPTIONS [203501]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|160||||160|10.97|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|160||||160|144|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|160||||160|6.6|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|160||||160|9.73|148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|160||||160||148.8|6.6
30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|160||||160|80|148.8|6.6
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|AETNA [1015]|AETNA ACO WILCO [101532]|465||||465|37.08|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|465||||465|26.59|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|465||||465|28.25|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|465||||465|28.25|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|465||||465|232.97|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|465||||465|163.22|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|465||||465|198.09|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|465||||465|232.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|465||||465|302.25|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|CORESOURCE [1315]|CORESOURCE [131500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|CORVEL CORP [2235]|CORVEL CORP [223500]|465||||465|38.33|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|465||||465|23.46|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|GEHA [1415]|GEHA [141500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|465||||465|58.66|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HEALTHNET [1495]|HEALTHNET [149500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HEALTHSMART [1505]|HEALTHSMART [150501]|465||||465|432.45|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|465||||465|279|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|465||||465|28.68|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|465||||465|232.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|465||||465|27.29|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|465||||465|35.19|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|465||||465|26.59|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MULTIPLAN [1680]|HMA [168003]|465||||465|39.11|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MULTIPLAN [1680]|IHC HS [168011]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|465||||465|29.36|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|465||||465|28.68|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|Self-pay|Self-pay|465||||465|139.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|465||||465|97.65|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|465||||465|25.55|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|465||||465|38.06|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|TRUSTMARK [2030]|STARMARK [203000]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|465||||465|222.97|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|UMR [2035]|UMR OPTIONS [203501]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|465||||465|25.99|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|465||||465|418.5|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|465||||465|15.64|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|465||||465|23.46|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|465||||465|26.07|432.45|15.64
30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|465||||465|232.5|432.45|15.64
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|AETNA [1015]|AETNA ACO WILCO [101532]|405||||405|112.04|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|405||||405|80.35|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|405||||405|85.34|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|405||||405|85.34|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|405||||405|202.91|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|405||||405|142.16|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|405||||405|172.53|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|405||||405|202.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|405||||405|263.25|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|CORESOURCE [1315]|CORESOURCE [131500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|405||||405|71.27|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|405||||405|49.95|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|GEHA [1415]|GEHA [141500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|405||||405|177.23|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HEALTHNET [1495]|HEALTHNET [149500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|405||||405|376.65|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|405||||405|243|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|405||||405|86.65|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|405||||405|202.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|405||||405|82.42|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|405||||405|106.34|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|405||||405|80.35|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MULTIPLAN [1680]|HMA [168003]|405||||405|118.16|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MULTIPLAN [1680]|IHC HS [168011]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|405||||405|88.7|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|405||||405|86.65|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|Self-pay|Self-pay|405||||405|121.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|405||||405|85.05|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|405||||405|77.19|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|405||||405|115|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|TRUSTMARK [2030]|STARMARK [203000]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|405||||405|194.2|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|UMR [2035]|UMR OPTIONS [203501]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|405||||405|78.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|405||||405|364.5|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|405||||405|47.26|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|405||||405|49.95|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|405||||405|78.77|376.65|47.26
30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|405||||405|202.5|376.65|47.26
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|144||||144|13.9|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144||||144|10.58|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144||||144|10.58|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|144||||144|72.14|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144||||144|50.54|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144||||144|10.77|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|144||||144|61.34|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|144||||144|72|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144||||144|93.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|144||||144|19.34|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|144||||144|11.84|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|GEHA [1415]|GEHA [141500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144||||144|10.77|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|144||||144|133.92|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144||||144|86.4|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144||||144|72|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144||||144|10.22|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MULTIPLAN [1680]|HMA [168003]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|144||||144|11|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|Self-pay|Self-pay|144||||144|43.2|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144||||144|30.24|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144||||144|69.05|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|UMR [2035]|UMR OPTIONS [203501]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144||||144|9.73|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144||||144|129.6|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|144||||144|5.86|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|144||||144|11.84|133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|144||||144||133.92|5.86
30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|144||||144|72|133.92|5.86
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|437||||437|27.87|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|437||||437|17.98|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|437||||437|19.1|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|437||||437|19.1|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|437||||437|218.94|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|437||||437|153.39|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|437||||437|21.77|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|437||||437|186.16|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|437||||437|218.5|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|437||||437|284.05|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|CORESOURCE [1315]|CORESOURCE [131500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|437||||437|35.43|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|437||||437|21.69|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|GEHA [1415]|GEHA [141500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|437||||437|39.67|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HEALTHNET [1495]|HEALTHNET [149500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|437||||437|21.77|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|437||||437|406.41|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|437||||437|262.2|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|437||||437|19.39|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|437||||437|218.5|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|437||||437|18.44|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|437||||437|23.8|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|437||||437|17.98|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MULTIPLAN [1680]|HMA [168003]|437||||437|26.45|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MULTIPLAN [1680]|IHC HS [168011]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|437||||437|19.85|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|437||||437|19.39|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|Self-pay|Self-pay|437||||437|131.1|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|437||||437|91.77|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|437||||437|17.28|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|437||||437|25.74|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|TRUSTMARK [2030]|STARMARK [203000]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|437||||437|209.54|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|UMR [2035]|UMR OPTIONS [203501]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|437||||437|17.57|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|437||||437|393.3|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|437||||437|11.75|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|437||||437|21.69|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|437||||437|17.63|406.41|11.75
30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|437||||437|218.5|406.41|11.75
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|AETNA [1015]|AETNA ACO WILCO [101532]|186||||186|22.59|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186||||186|15.48|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186||||186|15.48|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186||||186|93.19|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186||||186|65.29|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186||||186|17.64|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186||||186|79.24|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186||||186|93|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186||||186|120.9|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|CORESOURCE [1315]|CORESOURCE [131500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|186||||186|32.7|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186||||186|20.02|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|GEHA [1415]|GEHA [141500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HEALTHNET [1495]|HEALTHNET [149500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186||||186|17.64|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|186||||186|172.98|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186||||186|111.6|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186||||186|93|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186||||186|14.95|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MULTIPLAN [1680]|HMA [168003]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MULTIPLAN [1680]|IHC HS [168011]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|186||||186|16.09|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|Self-pay|Self-pay|186||||186|55.8|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186||||186|39.06|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|TRUSTMARK [2030]|STARMARK [203000]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186||||186|89.19|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|UMR [2035]|UMR OPTIONS [203501]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186||||186|14.24|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186||||186|167.4|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186||||186|9.53|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186||||186|20.02|172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186||||186||172.98|9.53
30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186||||186|93|172.98|9.53
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|AETNA [1015]|AETNA ACO WILCO [101532]|229||||229|6.22|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229||||229|4.01|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229||||229|4.25|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229||||229|4.25|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|229||||229|114.73|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229||||229|80.38|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229||||229|4.85|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|229||||229|97.55|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|229||||229|114.5|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229||||229|148.85|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|CORESOURCE [1315]|CORESOURCE [131500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|229||||229|8.26|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|229||||229|5.06|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|GEHA [1415]|GEHA [141500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|229||||229|8.84|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HEALTHNET [1495]|HEALTHNET [149500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229||||229|4.85|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|229||||229|212.97|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229||||229|137.4|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229||||229|4.32|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229||||229|114.5|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229||||229|4.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229||||229|5.31|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229||||229|4.01|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MULTIPLAN [1680]|HMA [168003]|229||||229|5.9|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MULTIPLAN [1680]|IHC HS [168011]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|229||||229|4.42|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229||||229|4.32|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|Self-pay|Self-pay|229||||229|68.7|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229||||229|48.09|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|229||||229|3.85|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229||||229|5.74|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|TRUSTMARK [2030]|STARMARK [203000]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229||||229|109.81|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|UMR [2035]|UMR OPTIONS [203501]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229||||229|3.91|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229||||229|206.1|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|229||||229|2.62|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|229||||229|5.06|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|229||||229|3.93|212.97|2.62
30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|229||||229|114.5|212.97|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|236||||236|6.22|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236||||236|4.01|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236||||236|4.25|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236||||236|4.25|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|236||||236|118.24|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236||||236|82.84|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236||||236|4.85|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|236||||236|100.54|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|236||||236|118|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236||||236|153.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|CORESOURCE [1315]|CORESOURCE [131500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|236||||236|9.19|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|236||||236|5.63|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|GEHA [1415]|GEHA [141500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|236||||236|8.84|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HEALTHNET [1495]|HEALTHNET [149500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236||||236|4.85|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|236||||236|219.48|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236||||236|141.6|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236||||236|4.32|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236||||236|118|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236||||236|4.1|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236||||236|5.31|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236||||236|4.01|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MULTIPLAN [1680]|HMA [168003]|236||||236|5.9|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MULTIPLAN [1680]|IHC HS [168011]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|236||||236|4.42|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236||||236|4.32|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|Self-pay|Self-pay|236||||236|70.8|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236||||236|49.56|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|236||||236|3.85|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236||||236|5.74|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|TRUSTMARK [2030]|STARMARK [203000]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236||||236|113.16|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|UMR [2035]|UMR OPTIONS [203501]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236||||236|3.91|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236||||236|212.4|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|236||||236|2.62|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|236||||236|5.63|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|236||||236|3.93|219.48|2.62
30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|236||||236|118|219.48|2.62
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|85||||85|7.49|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85||||85|4.85|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85||||85|5.15|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85||||85|5.15|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|85||||85|42.59|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85||||85|29.84|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85||||85|5.86|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|85||||85|36.21|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|85||||85|42.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85||||85|55.25|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|CORESOURCE [1315]|CORESOURCE [131500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|85||||85|11.28|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|85||||85|6.9|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|GEHA [1415]|GEHA [141500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|85||||85|10.69|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HEALTHNET [1495]|HEALTHNET [149500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85||||85|5.86|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|85||||85|79.05|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85||||85|51|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85||||85|5.23|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85||||85|42.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85||||85|4.98|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85||||85|6.41|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85||||85|4.85|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MULTIPLAN [1680]|HMA [168003]|85||||85|7.13|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MULTIPLAN [1680]|IHC HS [168011]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|85||||85|5.35|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85||||85|5.23|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|Self-pay|Self-pay|85||||85|25.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85||||85|17.85|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|85||||85|4.66|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85||||85|6.94|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|TRUSTMARK [2030]|STARMARK [203000]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85||||85|40.76|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|UMR [2035]|UMR OPTIONS [203501]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85||||85|4.74|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85||||85|76.5|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|85||||85|3.16|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|85||||85|6.9|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|85||||85|4.75|79.05|3.16
30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|85||||85|42.5|79.05|3.16
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|501||||501|20.34|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|501||||501|13.13|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|501||||501|13.95|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|501||||501|13.95|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|501||||501|251|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|501||||501|175.85|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|501||||501|15.89|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|501||||501|213.43|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|501||||501|250.5|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|501||||501|325.65|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|CORESOURCE [1315]|CORESOURCE [131500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|501||||501|20.76|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|501||||501|12.71|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|GEHA [1415]|GEHA [141500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|501||||501|28.96|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HEALTHNET [1495]|HEALTHNET [149500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|501||||501|15.89|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|501||||501|465.93|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|501||||501|300.6|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|501||||501|14.16|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|501||||501|250.5|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|501||||501|13.47|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|501||||501|17.37|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|501||||501|13.13|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MULTIPLAN [1680]|HMA [168003]|501||||501|19.31|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MULTIPLAN [1680]|IHC HS [168011]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|501||||501|14.5|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|501||||501|14.16|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|Self-pay|Self-pay|501||||501|150.3|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|501||||501|105.21|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|501||||501|12.61|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|501||||501|18.79|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|TRUSTMARK [2030]|STARMARK [203000]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|501||||501|240.23|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|UMR [2035]|UMR OPTIONS [203501]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|501||||501|12.83|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|501||||501|450.9|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|501||||501|8.58|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|501||||501|12.71|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|501||||501|12.87|465.93|8.58
30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|501||||501|250.5|465.93|8.58
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|AETNA [1015]|AETNA ACO WILCO [101532]|39||||39|6.2|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39||||39|4|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39||||39|4.24|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39||||39|4.24|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39||||39|19.54|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39||||39|13.69|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39||||39|4.84|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39||||39|16.61|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39||||39|19.5|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39||||39|25.35|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|CORESOURCE [1315]|CORESOURCE [131500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39||||39|9.19|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39||||39|5.63|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|GEHA [1415]|GEHA [141500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39||||39|8.82|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HEALTHNET [1495]|HEALTHNET [149500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39||||39|4.84|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39||||39|36.27|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39||||39|23.4|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39||||39|4.31|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39||||39|19.5|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39||||39|4.09|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39||||39|5.29|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39||||39|4|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MULTIPLAN [1680]|HMA [168003]|39||||39|5.88|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MULTIPLAN [1680]|IHC HS [168011]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39||||39|4.41|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39||||39|4.31|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|Self-pay|Self-pay|39||||39|11.7|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39||||39|8.19|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39||||39|3.84|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39||||39|5.72|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|TRUSTMARK [2030]|STARMARK [203000]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39||||39|18.7|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|UMR [2035]|UMR OPTIONS [203501]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39||||39|3.9|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39||||39|35.1|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39||||39|2.62|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39||||39|5.63|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39||||39|3.92|36.27|2.62
30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39||||39|19.5|36.27|2.62
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|181||||181|15.32|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|181||||181|9.89|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|181||||181|10.51|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|181||||181|10.51|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|181||||181|90.68|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|181||||181|63.53|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|181||||181|11.97|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|181||||181|77.11|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|181||||181|90.5|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|181||||181|117.65|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|CORESOURCE [1315]|CORESOURCE [131500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|181||||181|22.49|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|181||||181|13.77|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|GEHA [1415]|GEHA [141500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|181||||181|21.83|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HEALTHNET [1495]|HEALTHNET [149500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|181||||181|11.97|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|181||||181|168.33|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|181||||181|108.6|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|181||||181|10.67|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|181||||181|90.5|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|181||||181|10.15|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|181||||181|13.1|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|181||||181|9.89|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MULTIPLAN [1680]|HMA [168003]|181||||181|14.55|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MULTIPLAN [1680]|IHC HS [168011]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|181||||181|10.92|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|181||||181|10.67|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|Self-pay|Self-pay|181||||181|54.3|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|181||||181|38.01|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|181||||181|9.51|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|181||||181|14.16|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|TRUSTMARK [2030]|STARMARK [203000]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|181||||181|86.79|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|UMR [2035]|UMR OPTIONS [203501]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|181||||181|9.67|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|181||||181|162.9|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|181||||181|6.46|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|181||||181|13.77|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|181||||181|9.7|168.33|6.46
30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|181||||181|90.5|168.33|6.46
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|AETNA [1015]|AETNA ACO WILCO [101532]|204||||204|4.67|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|204||||204|3.35|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|204||||204|3.55|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|204||||204|3.55|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|204||||204|102.2|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|204||||204|71.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|204||||204|86.9|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|204||||204|102|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|204||||204|132.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|CORESOURCE [1315]|CORESOURCE [131500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|204||||204|4.63|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|204||||204|2.83|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|GEHA [1415]|GEHA [141500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|204||||204|7.38|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HEALTHNET [1495]|HEALTHNET [149500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|204||||204|189.72|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|204||||204|122.4|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|204||||204|3.61|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|204||||204|102|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|204||||204|3.43|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|204||||204|4.43|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|204||||204|3.35|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MULTIPLAN [1680]|HMA [168003]|204||||204|4.92|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MULTIPLAN [1680]|IHC HS [168011]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|204||||204|3.69|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|204||||204|3.61|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|Self-pay|Self-pay|204||||204|61.2|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|204||||204|42.84|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|204||||204|3.21|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|204||||204|4.79|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|TRUSTMARK [2030]|STARMARK [203000]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|204||||204|97.82|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|UMR [2035]|UMR OPTIONS [203501]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|204||||204|3.26|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|204||||204|183.6|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|204||||204|1.97|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|204||||204|2.83|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|204||||204|3.28|189.72|1.97
30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|204||||204|102|189.72|1.97
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|AETNA [1015]|AETNA ACO WILCO [101532]|246||||246|11.38|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246||||246|7.34|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|246||||246|7.8|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|246||||246|7.8|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|246||||246|123.25|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|246||||246|86.35|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|246||||246|8.89|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|246||||246|104.8|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|246||||246|123|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|246||||246|159.9|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|CORESOURCE [1315]|CORESOURCE [131500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|246||||246|11.74|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|246||||246|7.19|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|GEHA [1415]|GEHA [141500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|246||||246|16.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HEALTHNET [1495]|HEALTHNET [149500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|246||||246|8.89|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|246||||246|228.78|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|246||||246|147.6|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|246||||246|7.92|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|246||||246|123|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|246||||246|7.54|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|246||||246|9.72|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|246||||246|7.34|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MULTIPLAN [1680]|HMA [168003]|246||||246|10.8|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MULTIPLAN [1680]|IHC HS [168011]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|246||||246|8.11|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|246||||246|7.92|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|Self-pay|Self-pay|246||||246|73.8|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|246||||246|51.66|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|246||||246|7.06|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|246||||246|10.51|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|TRUSTMARK [2030]|STARMARK [203000]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|246||||246|117.96|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|UMR [2035]|UMR OPTIONS [203501]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|246||||246|7.18|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|246||||246|221.4|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|246||||246|4.8|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|246||||246|7.19|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|246||||246|7.2|228.78|4.8
30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|246||||246|123|228.78|4.8
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|253||||253|22.53|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|253||||253|16.74|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|253||||253|16.74|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|253||||253|126.75|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|253||||253|88.8|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|253||||253|17.6|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|253||||253|107.78|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|253||||253|126.5|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|253||||253|164.45|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|CORESOURCE [1315]|CORESOURCE [131500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|253||||253|23.41|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|253||||253|14.34|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|GEHA [1415]|GEHA [141500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HEALTHNET [1495]|HEALTHNET [149500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|253||||253|17.6|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|253||||253|235.29|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|253||||253|151.8|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|253||||253|126.5|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|253||||253|16.16|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MULTIPLAN [1680]|HMA [168003]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MULTIPLAN [1680]|IHC HS [168011]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|253||||253|17.4|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|Self-pay|Self-pay|253||||253|75.9|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|253||||253|53.13|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|TRUSTMARK [2030]|STARMARK [203000]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|253||||253|121.31|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|UMR [2035]|UMR OPTIONS [203501]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|253||||253|15.39|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|253||||253|227.7|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|253||||253|9.5|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|253||||253|14.34|235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|253||||253||235.29|9.5
30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|253||||253|126.5|235.29|9.5
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|210||||210|23.84|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|210||||210|17.1|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|210||||210|18.15|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|210||||210|18.15|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|210||||210|105.21|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|210||||210|73.71|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|210||||210|18.61|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|210||||210|89.46|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|210||||210|105|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|210||||210|136.5|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|CORESOURCE [1315]|CORESOURCE [131500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|210||||210|29.72|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|210||||210|18.2|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|GEHA [1415]|GEHA [141500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|210||||210|37.71|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HEALTHNET [1495]|HEALTHNET [149500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|210||||210|18.61|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|210||||210|195.3|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|210||||210|126|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|210||||210|18.44|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|210||||210|105|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|210||||210|17.54|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|210||||210|22.63|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|210||||210|17.1|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MULTIPLAN [1680]|HMA [168003]|210||||210|25.14|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MULTIPLAN [1680]|IHC HS [168011]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|210||||210|18.86|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|210||||210|18.44|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|Self-pay|Self-pay|210||||210|63|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|210||||210|44.1|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|210||||210|16.42|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|210||||210|24.47|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|TRUSTMARK [2030]|STARMARK [203000]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|210||||210|100.7|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|UMR [2035]|UMR OPTIONS [203501]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|210||||210|16.7|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|210||||210|189|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|210||||210|10.06|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|210||||210|18.2|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|210||||210|16.76|195.3|10.06
30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|210||||210|105|195.3|10.06
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|AETNA [1015]|AETNA ACO WILCO [101532]|406||||406|29.38|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406||||406|18.95|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|406||||406|20.14|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|406||||406|20.14|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|406||||406|203.41|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|406||||406|142.51|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|406||||406|22.94|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|406||||406|172.96|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|406||||406|203|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|406||||406|263.9|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|CORESOURCE [1315]|CORESOURCE [131500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|406||||406|34.05|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|406||||406|20.84|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|GEHA [1415]|GEHA [141500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|406||||406|41.81|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HEALTHNET [1495]|HEALTHNET [149500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406||||406|22.94|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|406||||406|377.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406||||406|243.6|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|406||||406|20.44|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406||||406|203|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|406||||406|19.45|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|406||||406|25.08|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|406||||406|18.95|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MULTIPLAN [1680]|HMA [168003]|406||||406|27.87|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MULTIPLAN [1680]|IHC HS [168011]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|406||||406|20.93|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|406||||406|20.44|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|Self-pay|Self-pay|406||||406|121.8|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|406||||406|85.26|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|406||||406|18.21|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|406||||406|27.13|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|TRUSTMARK [2030]|STARMARK [203000]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406||||406|194.68|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|UMR [2035]|UMR OPTIONS [203501]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|406||||406|18.52|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|406||||406|365.4|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406||||406|12.39|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|406||||406|20.84|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|406||||406|18.58|377.58|12.39
30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|406||||406|203|377.58|12.39
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|AETNA [1015]|AETNA ACO WILCO [101532]|368||||368|29.25|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368||||368|18.89|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368||||368|20.07|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368||||368|20.07|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|368||||368|184.37|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368||||368|129.17|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368||||368|22.86|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|368||||368|156.77|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|368||||368|184|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368||||368|239.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|CORESOURCE [1315]|CORESOURCE [131500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|368||||368|34.68|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|368||||368|21.23|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|GEHA [1415]|GEHA [141500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|368||||368|41.67|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HEALTHNET [1495]|HEALTHNET [149500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368||||368|22.86|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|368||||368|342.24|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368||||368|220.8|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368||||368|20.37|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368||||368|184|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368||||368|19.38|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368||||368|25|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368||||368|18.89|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MULTIPLAN [1680]|HMA [168003]|368||||368|27.78|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MULTIPLAN [1680]|IHC HS [168011]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|368||||368|20.86|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368||||368|20.37|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|Self-pay|Self-pay|368||||368|110.4|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368||||368|77.28|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|368||||368|18.15|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368||||368|27.04|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|TRUSTMARK [2030]|STARMARK [203000]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368||||368|176.46|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|UMR [2035]|UMR OPTIONS [203501]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368||||368|18.46|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368||||368|331.2|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|368||||368|12.34|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|368||||368|21.23|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|368||||368|18.52|342.24|12.34
30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|368||||368|184|342.24|12.34
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|AETNA [1015]|AETNA ACO WILCO [101532]|389||||389|26.34|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|389||||389|17|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|389||||389|18.06|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|389||||389|18.06|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|389||||389|194.89|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|389||||389|136.54|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|389||||389|20.58|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|389||||389|165.71|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|389||||389|194.5|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|389||||389|252.85|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|CORESOURCE [1315]|CORESOURCE [131500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|389||||389|25.15|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|389||||389|15.4|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|GEHA [1415]|GEHA [141500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|389||||389|37.51|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HEALTHNET [1495]|HEALTHNET [149500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|389||||389|20.58|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|389||||389|361.77|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|389||||389|233.4|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|389||||389|18.34|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|389||||389|194.5|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|389||||389|17.44|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|389||||389|22.5|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|389||||389|17|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MULTIPLAN [1680]|HMA [168003]|389||||389|25.01|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MULTIPLAN [1680]|IHC HS [168011]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|389||||389|18.77|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|389||||389|18.34|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|Self-pay|Self-pay|389||||389|116.7|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|389||||389|81.69|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|389||||389|16.34|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|389||||389|24.34|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|TRUSTMARK [2030]|STARMARK [203000]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|389||||389|186.53|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|UMR [2035]|UMR OPTIONS [203501]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|389||||389|16.61|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|389||||389|350.1|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|389||||389|11.11|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|389||||389|15.4|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|389||||389|16.67|361.77|11.11
30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|389||||389|194.5|361.77|11.11
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|226||||226|19.87|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226||||226|12.83|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226||||226|13.64|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226||||226|13.64|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|226||||226|113.23|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226||||226|79.33|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226||||226|15.53|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|226||||226|96.28|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|226||||226|113|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226||||226|146.9|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|CORESOURCE [1315]|CORESOURCE [131500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|226||||226|23.51|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|226||||226|14.39|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|GEHA [1415]|GEHA [141500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|226||||226|28.31|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HEALTHNET [1495]|HEALTHNET [149500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226||||226|15.53|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|226||||226|210.18|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226||||226|135.6|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226||||226|13.84|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226||||226|113|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226||||226|13.17|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226||||226|16.98|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226||||226|12.83|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MULTIPLAN [1680]|HMA [168003]|226||||226|18.87|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MULTIPLAN [1680]|IHC HS [168011]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|226||||226|14.18|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226||||226|13.84|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|Self-pay|Self-pay|226||||226|67.8|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226||||226|47.46|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|226||||226|12.33|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226||||226|18.37|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|TRUSTMARK [2030]|STARMARK [203000]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226||||226|108.37|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|UMR [2035]|UMR OPTIONS [203501]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226||||226|12.55|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226||||226|203.4|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|226||||226|8.38|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|226||||226|14.39|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|226||||226|12.58|210.18|8.38
30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|226||||226|113|210.18|8.38
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|AETNA [1015]|AETNA ACO WILCO [101532]|1173||||1173|106.46|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1173||||1173|72.98|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1173||||1173|72.98|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1173||||1173|587.67|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1173||||1173|411.72|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1173||||1173|83.16|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1173||||1173|499.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1173||||1173|586.5|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1173||||1173|762.45|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|CORESOURCE [1315]|CORESOURCE [131500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1173||||1173|106.13|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1173||||1173|64.98|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|GEHA [1415]|GEHA [141500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HEALTHNET [1495]|HEALTHNET [149500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1173||||1173|83.16|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1173||||1173|1090.89|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1173||||1173|703.8|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1173||||1173|586.5|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1173||||1173|70.49|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MULTIPLAN [1680]|HMA [168003]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MULTIPLAN [1680]|IHC HS [168011]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1173||||1173|75.85|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|Self-pay|Self-pay|1173||||1173|351.9|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1173||||1173|246.33|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|TRUSTMARK [2030]|STARMARK [203000]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1173||||1173|562.45|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|UMR [2035]|UMR OPTIONS [203501]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1173||||1173|67.13|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1173||||1173|1055.7|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1173||||1173|44.9|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1173||||1173|64.98|1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1173||||1173||1090.89|44.9
30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1173||||1173|586.5|1090.89|44.9
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|AETNA [1015]|AETNA ACO WILCO [101532]|299||||299|34.72|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|299||||299|22.4|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|299||||299|23.79|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|299||||299|23.79|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|299||||299|149.8|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|299||||299|104.95|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|299||||299|27.12|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|299||||299|127.37|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|299||||299|149.5|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|299||||299|194.35|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|CORESOURCE [1315]|CORESOURCE [131500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|299||||299|48.36|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|299||||299|29.61|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|GEHA [1415]|GEHA [141500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|299||||299|49.41|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HEALTHNET [1495]|HEALTHNET [149500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|299||||299|27.12|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|299||||299|278.07|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|299||||299|179.4|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|299||||299|24.16|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|299||||299|149.5|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|299||||299|22.97|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|299||||299|29.65|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|299||||299|22.4|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MULTIPLAN [1680]|HMA [168003]|299||||299|32.94|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MULTIPLAN [1680]|IHC HS [168011]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|299||||299|24.73|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|299||||299|24.16|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|Self-pay|Self-pay|299||||299|89.7|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|299||||299|62.79|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|299||||299|21.52|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|299||||299|32.06|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|TRUSTMARK [2030]|STARMARK [203000]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|299||||299|143.37|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|UMR [2035]|UMR OPTIONS [203501]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|299||||299|21.88|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|299||||299|269.1|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|299||||299|14.65|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|299||||299|29.61|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|299||||299|21.96|278.07|14.65
30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|299||||299|149.5|278.07|14.65
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|390||||390|20.34|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390||||390|13.13|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390||||390|13.95|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390||||390|13.95|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|390||||390|195.39|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390||||390|136.89|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390||||390|15.89|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|390||||390|166.14|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|390||||390|195|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390||||390|253.5|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|CORESOURCE [1315]|CORESOURCE [131500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|390||||390|34.3|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|390||||390|21.23|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|GEHA [1415]|GEHA [141500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|390||||390|28.96|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HEALTHNET [1495]|HEALTHNET [149500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390||||390|15.89|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|390||||390|362.7|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390||||390|234|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390||||390|14.16|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390||||390|195|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390||||390|13.47|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390||||390|17.37|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390||||390|13.13|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MULTIPLAN [1680]|HMA [168003]|390||||390|19.31|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MULTIPLAN [1680]|IHC HS [168011]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|390||||390|14.5|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390||||390|14.16|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|Self-pay|Self-pay|390||||390|117|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390||||390|81.9|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|390||||390|12.61|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390||||390|18.79|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|TRUSTMARK [2030]|STARMARK [203000]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390||||390|187.01|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|UMR [2035]|UMR OPTIONS [203501]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390||||390|12.83|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390||||390|351|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|390||||390|8.58|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|390||||390|21.23|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|390||||390|12.87|362.7|8.58
30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|390||||390|195|362.7|8.58
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|AETNA [1015]|AETNA ACO WILCO [101532]|233||||233|28.54|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|233||||233|19.57|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|233||||233|19.57|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|233||||233|116.73|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|233||||233|81.78|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|233||||233|22.29|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|233||||233|99.26|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|233||||233|116.5|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233||||233|151.45|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|CORESOURCE [1315]|CORESOURCE [131500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|233||||233|30.65|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|233||||233|18.76|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|GEHA [1415]|GEHA [141500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HEALTHNET [1495]|HEALTHNET [149500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233||||233|22.29|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|233||||233|216.69|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|233||||233|139.8|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|233||||233|116.5|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|233||||233|18.9|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MULTIPLAN [1680]|HMA [168003]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MULTIPLAN [1680]|IHC HS [168011]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|233||||233|20.34|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|Self-pay|Self-pay|233||||233|69.9|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|233||||233|48.93|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|TRUSTMARK [2030]|STARMARK [203000]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233||||233|111.72|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|UMR [2035]|UMR OPTIONS [203501]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|233||||233|18|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|233||||233|209.7|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|233||||233|12.04|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|233||||233|18.76|216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|233||||233||216.69|12.04
30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|233||||233|116.5|216.69|12.04
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|AETNA [1015]|AETNA ACO WILCO [101532]|201||||201|15.34|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201||||201|9.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201||||201|10.52|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201||||201|10.52|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|201||||201|100.7|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201||||201|70.55|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201||||201|11.99|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|201||||201|85.63|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|201||||201|100.5|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201||||201|130.65|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|CORESOURCE [1315]|CORESOURCE [131500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|201||||201|14.63|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|201||||201|8.96|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|GEHA [1415]|GEHA [141500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|201||||201|21.85|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HEALTHNET [1495]|HEALTHNET [149500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201||||201|11.99|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|201||||201|186.93|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201||||201|120.6|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201||||201|10.68|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201||||201|100.5|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201||||201|10.16|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201||||201|13.11|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201||||201|9.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MULTIPLAN [1680]|HMA [168003]|201||||201|14.57|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MULTIPLAN [1680]|IHC HS [168011]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|201||||201|10.93|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201||||201|10.68|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|Self-pay|Self-pay|201||||201|60.3|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201||||201|42.21|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|201||||201|9.52|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201||||201|14.18|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|TRUSTMARK [2030]|STARMARK [203000]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201||||201|96.38|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|UMR [2035]|UMR OPTIONS [203501]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201||||201|9.68|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201||||201|180.9|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|201||||201|6.47|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|201||||201|8.96|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|201||||201|9.71|186.93|6.47
30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|201||||201|100.5|186.93|6.47
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|145||||145|11.66|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145||||145|8.36|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145||||145|8.89|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145||||145|8.89|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|145||||145|72.65|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145||||145|50.9|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145||||145|9.05|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|145||||145|61.77|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|145||||145|72.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145||||145|94.25|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|CORESOURCE [1315]|CORESOURCE [131500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|145||||145|16.69|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|145||||145|10.22|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|GEHA [1415]|GEHA [141500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|145||||145|18.45|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HEALTHNET [1495]|HEALTHNET [149500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145||||145|9.05|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|145||||145|134.85|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145||||145|87|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145||||145|9.02|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145||||145|72.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145||||145|8.58|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145||||145|11.07|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145||||145|8.36|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MULTIPLAN [1680]|HMA [168003]|145||||145|12.3|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MULTIPLAN [1680]|IHC HS [168011]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|145||||145|9.24|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145||||145|9.02|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|Self-pay|Self-pay|145||||145|43.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145||||145|30.45|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|145||||145|8.04|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145||||145|11.97|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|TRUSTMARK [2030]|STARMARK [203000]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145||||145|69.53|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|UMR [2035]|UMR OPTIONS [203501]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145||||145|8.17|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145||||145|130.5|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|145||||145|4.92|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|145||||145|10.22|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|145||||145|8.2|134.85|4.92
30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|145||||145|72.5|134.85|4.92
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|AETNA [1015]|AETNA ACO WILCO [101532]|230||||230|11.55|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230||||230|7.46|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230||||230|7.92|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230||||230|7.92|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|230||||230|115.23|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230||||230|80.73|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230||||230|9.03|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|230||||230|97.98|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|230||||230|115|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230||||230|149.5|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|CORESOURCE [1315]|CORESOURCE [131500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|230||||230|16.69|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|230||||230|10.22|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|GEHA [1415]|GEHA [141500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|230||||230|16.45|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HEALTHNET [1495]|HEALTHNET [149500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230||||230|9.03|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|230||||230|213.9|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230||||230|138|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230||||230|8.04|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230||||230|115|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230||||230|7.65|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230||||230|9.87|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230||||230|7.46|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MULTIPLAN [1680]|HMA [168003]|230||||230|10.97|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MULTIPLAN [1680]|IHC HS [168011]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|230||||230|8.23|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230||||230|8.04|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|Self-pay|Self-pay|230||||230|69|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230||||230|48.3|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|230||||230|7.16|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230||||230|10.67|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|TRUSTMARK [2030]|STARMARK [203000]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230||||230|110.29|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|UMR [2035]|UMR OPTIONS [203501]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230||||230|7.29|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230||||230|207|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|230||||230|4.87|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|230||||230|10.22|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|230||||230|7.31|213.9|4.87
30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|230||||230|115|213.9|4.87
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|74||||74|6.25|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74||||74|4.28|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74||||74|4.28|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74||||74|37.07|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74||||74|25.97|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74||||74|4.88|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74||||74|31.52|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74||||74|37|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74||||74|48.1|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74||||74|9.07|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74||||74|5.55|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|GEHA [1415]|GEHA [141500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74||||74|4.88|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74||||74|68.82|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74||||74|44.4|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74||||74|37|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74||||74|4.13|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MULTIPLAN [1680]|HMA [168003]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MULTIPLAN [1680]|IHC HS [168011]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74||||74|4.45|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|Self-pay|Self-pay|74||||74|22.2|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74||||74|15.54|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|TRUSTMARK [2030]|STARMARK [203000]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74||||74|35.48|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|UMR [2035]|UMR OPTIONS [203501]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74||||74|3.93|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74||||74|66.6|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74||||74|2.63|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74||||74|5.55|68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74||||74||68.82|2.63
30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74||||74|37|68.82|2.63
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|188||||188|7.49|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|188||||188|5.15|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|188||||188|5.15|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|188||||188|94.19|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|188||||188|65.99|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|188||||188|5.86|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|188||||188|80.09|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|188||||188|94|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|188||||188|122.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|CORESOURCE [1315]|CORESOURCE [131500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|188||||188|11.24|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|188||||188|6.88|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|GEHA [1415]|GEHA [141500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HEALTHNET [1495]|HEALTHNET [149500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|188||||188|5.86|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|188||||188|174.84|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|188||||188|112.8|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|188||||188|94|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|188||||188|4.98|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MULTIPLAN [1680]|HMA [168003]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MULTIPLAN [1680]|IHC HS [168011]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|188||||188|5.35|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|Self-pay|Self-pay|188||||188|56.4|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|188||||188|39.48|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|TRUSTMARK [2030]|STARMARK [203000]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|188||||188|90.15|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|UMR [2035]|UMR OPTIONS [203501]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|188||||188|4.74|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|188||||188|169.2|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|188||||188|3.16|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|188||||188|6.88|174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|188||||188||174.84|3.16
30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|188||||188|94|174.84|3.16
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|AETNA [1015]|AETNA ACO WILCO [101532]|310||||310|26.66|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|310||||310|18.28|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|310||||310|18.28|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|310||||310|155.31|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|310||||310|108.81|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|310||||310|20.83|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|310||||310|132.06|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|310||||310|155|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|310||||310|201.5|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|CORESOURCE [1315]|CORESOURCE [131500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|310||||310|31.12|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|310||||310|19.05|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|GEHA [1415]|GEHA [141500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HEALTHNET [1495]|HEALTHNET [149500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|310||||310|20.83|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|310||||310|288.3|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|310||||310|186|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|310||||310|155|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|310||||310|17.66|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MULTIPLAN [1680]|HMA [168003]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MULTIPLAN [1680]|IHC HS [168011]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|310||||310|19|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|Self-pay|Self-pay|310||||310|93|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|310||||310|65.1|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|TRUSTMARK [2030]|STARMARK [203000]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|310||||310|148.65|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|UMR [2035]|UMR OPTIONS [203501]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|310||||310|16.82|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|310||||310|279|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|310||||310|11.24|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|310||||310|19.05|288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|310||||310||288.3|11.24
30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|310||||310|155|288.3|11.24
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|382||||382|46.67|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|382||||382|30.12|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|382||||382|32|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|382||||382|32|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|382||||382|191.38|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|382||||382|134.08|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|382||||382|36.46|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|382||||382|162.73|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|382||||382|191|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|382||||382|248.3|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|CORESOURCE [1315]|CORESOURCE [131500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|382||||382|51.5|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|382||||382|31.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|GEHA [1415]|GEHA [141500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|382||||382|66.44|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HEALTHNET [1495]|HEALTHNET [149500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|382||||382|36.46|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|382||||382|355.26|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|382||||382|229.2|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|382||||382|32.48|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|382||||382|191|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|382||||382|30.91|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|382||||382|39.87|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|382||||382|30.12|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MULTIPLAN [1680]|HMA [168003]|382||||382|44.3|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MULTIPLAN [1680]|IHC HS [168011]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|382||||382|33.26|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|382||||382|32.48|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|Self-pay|Self-pay|382||||382|114.6|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|382||||382|80.22|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|382||||382|28.94|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|382||||382|43.11|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|TRUSTMARK [2030]|STARMARK [203000]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|382||||382|183.17|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|UMR [2035]|UMR OPTIONS [203501]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|382||||382|29.44|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|382||||382|343.8|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|382||||382|19.69|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|382||||382|31.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|382||||382|29.53|355.26|19.69
30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|382||||382|191|355.26|19.69
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|369||||369|26.66|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|369||||369|18.28|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|369||||369|19.41|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|369||||369|19.41|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|369||||369|184.87|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|369||||369|129.52|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|369||||369|20.83|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|369||||369|157.19|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|369||||369|184.5|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|369||||369|239.85|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|CORESOURCE [1315]|CORESOURCE [131500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|369||||369|29.58|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|369||||369|18.11|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|GEHA [1415]|GEHA [141500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|369||||369|40.32|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HEALTHNET [1495]|HEALTHNET [149500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|369||||369|20.83|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|369||||369|343.17|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|369||||369|221.4|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|369||||369|19.71|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|369||||369|184.5|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|369||||369|18.75|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|369||||369|24.19|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|369||||369|18.28|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MULTIPLAN [1680]|HMA [168003]|369||||369|26.88|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MULTIPLAN [1680]|IHC HS [168011]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|369||||369|20.17|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|369||||369|19.71|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|Self-pay|Self-pay|369||||369|110.7|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|369||||369|77.49|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|369||||369|17.56|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|369||||369|26.16|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|TRUSTMARK [2030]|STARMARK [203000]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|369||||369|176.94|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|UMR [2035]|UMR OPTIONS [203501]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|369||||369|17.86|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|369||||369|332.1|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|369||||369|11.24|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|369||||369|18.11|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|369||||369|17.92|343.17|11.24
30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|369||||369|184.5|343.17|11.24
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|192||||192|31.88|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192||||192|24.29|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192||||192|24.29|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192||||192|96.19|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192||||192|67.39|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192||||192|23.89|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192||||192|81.79|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192||||192|96|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192||||192|124.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|CORESOURCE [1315]|CORESOURCE [131500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192||||192|37.33|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192||||192|22.86|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|GEHA [1415]|GEHA [141500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HEALTHNET [1495]|HEALTHNET [149500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192||||192|23.89|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192||||192|178.56|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192||||192|115.2|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192||||192|96|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192||||192|23.45|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MULTIPLAN [1680]|HMA [168003]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MULTIPLAN [1680]|IHC HS [168011]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192||||192|25.25|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|Self-pay|Self-pay|192||||192|57.6|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192||||192|40.32|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|TRUSTMARK [2030]|STARMARK [203000]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192||||192|92.06|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|UMR [2035]|UMR OPTIONS [203501]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192||||192|22.34|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192||||192|172.8|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192||||192|13.45|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192||||192|22.86|178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192||||192||178.56|13.45
30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192||||192|96|178.56|13.45
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|AETNA [1015]|AETNA ACO WILCO [101532]|228||||228|27.7|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|228||||228|19.4|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|228||||228|19.4|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|228||||228|114.23|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|228||||228|80.03|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|228||||228|21.64|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|228||||228|97.13|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|228||||228|114|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|228||||228|148.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|CORESOURCE [1315]|CORESOURCE [131500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|228||||228|35.13|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|228||||228|21.51|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|GEHA [1415]|GEHA [141500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HEALTHNET [1495]|HEALTHNET [149500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228||||228|21.64|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|228||||228|212.04|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|228||||228|136.8|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228||||228|114|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|228||||228|18.74|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MULTIPLAN [1680]|HMA [168003]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MULTIPLAN [1680]|IHC HS [168011]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|228||||228|20.16|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|Self-pay|Self-pay|228||||228|68.4|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|228||||228|47.88|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|TRUSTMARK [2030]|STARMARK [203000]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228||||228|109.33|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|UMR [2035]|UMR OPTIONS [203501]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|228||||228|17.85|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|228||||228|205.2|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|228||||228|11.68|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|228||||228|21.51|212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|228||||228||212.04|11.68
30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|228||||228|114|212.04|11.68
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|520||||520|20.38|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|520||||520|13.98|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|520||||520|13.98|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|520||||520|260.52|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|520||||520|182.52|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|520||||520|15.92|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|520||||520|221.52|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|520||||520|260|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|520||||520|338|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|CORESOURCE [1315]|CORESOURCE [131500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|520||||520|29.65|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|520||||520|18.15|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|GEHA [1415]|GEHA [141500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HEALTHNET [1495]|HEALTHNET [149500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|520||||520|15.92|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|520||||520|483.6|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|520||||520|312|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|520||||520|260|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|520||||520|13.5|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MULTIPLAN [1680]|HMA [168003]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MULTIPLAN [1680]|IHC HS [168011]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|520||||520|14.53|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|Self-pay|Self-pay|520||||520|156|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|520||||520|109.2|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|TRUSTMARK [2030]|STARMARK [203000]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|520||||520|249.34|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|UMR [2035]|UMR OPTIONS [203501]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|520||||520|12.86|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|520||||520|468|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|520||||520|8.6|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|520||||520|18.15|483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|520||||520||483.6|8.6
30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|520||||520|260|483.6|8.6
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|AETNA [1015]|AETNA ACO WILCO [101532]|385||||385|42.94|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|385||||385|27.71|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|385||||385|29.44|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|385||||385|29.44|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|385||||385|192.89|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|385||||385|135.14|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|385||||385|33.54|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|385||||385|164.01|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|385||||385|192.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|385||||385|250.25|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|CORESOURCE [1315]|CORESOURCE [131500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|CORVEL CORP [2235]|CORVEL CORP [223500]|385||||385|53.48|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|385||||385|32.75|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|GEHA [1415]|GEHA [141500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|385||||385|61.13|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HEALTHNET [1495]|HEALTHNET [149500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|385||||385|33.54|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HEALTHSMART [1505]|HEALTHSMART [150501]|385||||385|358.05|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|385||||385|231|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|385||||385|29.89|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|385||||385|192.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|385||||385|28.43|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|385||||385|36.68|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|385||||385|27.71|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MULTIPLAN [1680]|HMA [168003]|385||||385|40.76|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MULTIPLAN [1680]|IHC HS [168011]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|385||||385|30.6|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|385||||385|29.89|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|Self-pay|Self-pay|385||||385|115.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|385||||385|80.85|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|385||||385|26.63|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|385||||385|39.67|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|TRUSTMARK [2030]|STARMARK [203000]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|385||||385|184.61|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|UMR [2035]|UMR OPTIONS [203501]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|385||||385|27.08|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|385||||385|346.5|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|385||||385|18.11|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|385||||385|32.75|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|385||||385|27.17|358.05|18.11
30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|385||||385|192.5|358.05|18.11
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|330||||330|35.81|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|330||||330|24.54|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|330||||330|24.54|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|330||||330|165.33|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|330||||330|115.83|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|330||||330|27.96|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|330||||330|140.58|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|330||||330|165|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|330||||330|214.5|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|330||||330|49.41|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|330||||330|30.25|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|GEHA [1415]|GEHA [141500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|330||||330|27.96|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|330||||330|306.9|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|330||||330|198|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|330||||330|165|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|330||||330|23.71|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MULTIPLAN [1680]|HMA [168003]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MULTIPLAN [1680]|IHC HS [168011]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|330||||330|25.51|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|Self-pay|Self-pay|330||||330|99|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|330||||330|69.3|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|TRUSTMARK [2030]|STARMARK [203000]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|330||||330|158.24|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|UMR [2035]|UMR OPTIONS [203501]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|330||||330|22.58|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|330||||330|297|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|330||||330|15.1|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|330||||330|30.25|306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|330||||330||306.9|15.1
30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|330||||330|165|306.9|15.1
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|315||||315|38.42|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|315||||315|26.33|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|315||||315|26.33|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|315||||315|157.82|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|315||||315|110.57|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|315||||315|30.01|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|315||||315|134.19|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|315||||315|157.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|315||||315|204.75|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|315||||315|55.79|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|315||||315|34.16|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|GEHA [1415]|GEHA [141500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|315||||315|30.01|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|315||||315|292.95|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|315||||315|189|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|315||||315|157.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|315||||315|25.43|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MULTIPLAN [1680]|HMA [168003]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|315||||315|27.37|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|Self-pay|Self-pay|315||||315|94.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|315||||315|66.15|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|315||||315|151.04|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|315||||315|24.22|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|315||||315|283.5|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|315||||315|16.21|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|315||||315|34.16|292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|315||||315||292.95|16.21
30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|315||||315|157.5|292.95|16.21
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|253||||253|18.22|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|253||||253|11.76|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|253||||253|12.49|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|253||||253|12.49|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|253||||253|126.75|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|253||||253|88.8|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|253||||253|14.24|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|253||||253|107.78|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|253||||253|126.5|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|253||||253|164.45|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|CORESOURCE [1315]|CORESOURCE [131500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|253||||253|21.04|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|253||||253|12.88|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|GEHA [1415]|GEHA [141500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|253||||253|25.94|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HEALTHNET [1495]|HEALTHNET [149500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|253||||253|14.24|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|253||||253|235.29|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|253||||253|151.8|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|253||||253|12.68|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|253||||253|126.5|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|253||||253|12.07|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|253||||253|15.57|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|253||||253|11.76|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MULTIPLAN [1680]|HMA [168003]|253||||253|17.3|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MULTIPLAN [1680]|IHC HS [168011]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|253||||253|12.98|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|253||||253|12.68|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|Self-pay|Self-pay|253||||253|75.9|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|253||||253|53.13|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|253||||253|11.3|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|253||||253|16.83|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|TRUSTMARK [2030]|STARMARK [203000]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|253||||253|121.31|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|UMR [2035]|UMR OPTIONS [203501]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|253||||253|11.5|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|253||||253|227.7|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|253||||253|7.69|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|253||||253|12.88|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|253||||253|11.53|235.29|7.69
30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|253||||253|126.5|235.29|7.69
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|259||||259|13.71|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|259||||259|10.44|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|259||||259|10.44|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|259||||259|129.76|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|259||||259|90.91|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|259||||259|10.47|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|259||||259|110.33|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|259||||259|129.5|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|259||||259|168.35|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|CORESOURCE [1315]|CORESOURCE [131500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|259||||259|18.73|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|259||||259|11.47|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|GEHA [1415]|GEHA [141500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HEALTHNET [1495]|HEALTHNET [149500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|259||||259|10.47|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|259||||259|240.87|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|259||||259|155.4|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|259||||259|129.5|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|259||||259|10.08|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MULTIPLAN [1680]|HMA [168003]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MULTIPLAN [1680]|IHC HS [168011]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|259||||259|10.85|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|Self-pay|Self-pay|259||||259|77.7|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|259||||259|54.39|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|TRUSTMARK [2030]|STARMARK [203000]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|259||||259|124.19|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|UMR [2035]|UMR OPTIONS [203501]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|259||||259|9.6|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|259||||259|233.1|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|259||||259|5.78|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|259||||259|11.47|240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|259||||259||240.87|5.78
30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|259||||259|129.5|240.87|5.78
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|474||||474|26.17|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|474||||474|18.77|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|474||||474|19.94|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|474||||474|19.94|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|474||||474|237.47|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|474||||474|166.37|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|474||||474|201.92|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|474||||474|237|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|474||||474|308.1|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|CORESOURCE [1315]|CORESOURCE [131500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|474||||474|20.49|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|474||||474|12.54|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|GEHA [1415]|GEHA [141500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|474||||474|41.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HEALTHNET [1495]|HEALTHNET [149500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|474||||474|440.82|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|474||||474|284.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|474||||474|20.24|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|474||||474|237|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|474||||474|19.26|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|474||||474|24.84|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|474||||474|18.77|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MULTIPLAN [1680]|HMA [168003]|474||||474|27.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MULTIPLAN [1680]|IHC HS [168011]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|474||||474|20.73|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|474||||474|20.24|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|Self-pay|Self-pay|474||||474|142.2|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|474||||474|99.54|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|474||||474|18.03|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|474||||474|26.86|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|TRUSTMARK [2030]|STARMARK [203000]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|474||||474|227.28|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|UMR [2035]|UMR OPTIONS [203501]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|474||||474|18.35|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|474||||474|426.6|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|474||||474|11.04|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|474||||474|12.54|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|474||||474|18.4|440.82|11.04
30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|474||||474|237|440.82|11.04
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|AETNA [1015]|AETNA ACO WILCO [101532]|625||||625|24.56|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|625||||625|17.62|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|625||||625|18.71|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|625||||625|18.71|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|625||||625|313.13|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|625||||625|219.38|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|625||||625|266.25|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|625||||625|312.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|625||||625|406.25|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|CORESOURCE [1315]|CORESOURCE [131500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|625||||625|20.03|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|625||||625|12.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|GEHA [1415]|GEHA [141500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|625||||625|38.86|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HEALTHNET [1495]|HEALTHNET [149500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|625||||625|581.25|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|625||||625|375|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|625||||625|19|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|625||||625|312.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|625||||625|18.06|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|625||||625|23.31|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|625||||625|17.62|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MULTIPLAN [1680]|HMA [168003]|625||||625|25.91|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MULTIPLAN [1680]|IHC HS [168011]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|625||||625|19.45|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|625||||625|19|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|Self-pay|Self-pay|625||||625|187.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|625||||625|131.25|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|625||||625|16.92|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|625||||625|25.21|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|TRUSTMARK [2030]|STARMARK [203000]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|625||||625|299.69|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|UMR [2035]|UMR OPTIONS [203501]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|625||||625|17.2|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|625||||625|562.5|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|625||||625|10.36|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|625||||625|12.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|625||||625|17.27|581.25|10.36
30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|625||||625|312.5|581.25|10.36
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|229||||229|18.07|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229||||229|11.66|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229||||229|12.38|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229||||229|12.38|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|229||||229|114.73|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229||||229|80.38|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229||||229|14.11|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|229||||229|97.55|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|229||||229|114.5|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229||||229|148.85|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|229||||229|27.64|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|229||||229|16.92|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|GEHA [1415]|GEHA [141500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|229||||229|25.72|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229||||229|14.11|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|229||||229|212.97|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229||||229|137.4|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229||||229|12.57|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229||||229|114.5|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229||||229|11.95|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229||||229|15.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229||||229|11.66|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MULTIPLAN [1680]|HMA [168003]|229||||229|17.15|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|229||||229|12.87|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229||||229|12.57|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|Self-pay|Self-pay|229||||229|68.7|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229||||229|48.09|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|229||||229|11.2|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229||||229|16.69|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229||||229|109.81|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229||||229|11.38|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229||||229|206.1|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|229||||229|7.62|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|229||||229|16.92|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|229||||229|11.43|212.97|7.62
30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|229||||229|114.5|212.97|7.62
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|234||||234|20.47|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234||||234|14.03|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234||||234|14.03|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|234||||234|117.23|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234||||234|82.13|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234||||234|15.98|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|234||||234|99.68|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|234||||234|117|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234||||234|152.1|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|234||||234|29.98|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|234||||234|18.35|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|GEHA [1415]|GEHA [141500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234||||234|15.98|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|234||||234|217.62|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234||||234|140.4|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234||||234|117|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234||||234|13.54|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MULTIPLAN [1680]|HMA [168003]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MULTIPLAN [1680]|IHC HS [168011]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|234||||234|14.58|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|Self-pay|Self-pay|234||||234|70.2|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234||||234|49.14|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|TRUSTMARK [2030]|STARMARK [203000]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234||||234|112.2|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|UMR [2035]|UMR OPTIONS [203501]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234||||234|12.9|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234||||234|210.6|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|234||||234|8.63|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|234||||234|18.35|217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|234||||234||217.62|8.63
30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|234||||234|117|217.62|8.63
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|AETNA [1015]|AETNA ACO WILCO [101532]|205||||205|10.23|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205||||205|6.6|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205||||205|7.01|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205||||205|7.01|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|205||||205|102.71|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205||||205|71.96|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205||||205|7.99|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|205||||205|87.33|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|205||||205|102.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205||||205|133.25|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|CORESOURCE [1315]|CORESOURCE [131500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|205||||205|12.87|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|205||||205|7.88|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|GEHA [1415]|GEHA [141500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|205||||205|14.56|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HEALTHNET [1495]|HEALTHNET [149500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205||||205|7.99|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|205||||205|190.65|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205||||205|123|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205||||205|7.12|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205||||205|102.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205||||205|6.77|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205||||205|8.73|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205||||205|6.6|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MULTIPLAN [1680]|HMA [168003]|205||||205|9.71|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MULTIPLAN [1680]|IHC HS [168011]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|205||||205|7.29|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205||||205|7.12|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|Self-pay|Self-pay|205||||205|61.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205||||205|43.05|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|205||||205|6.34|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205||||205|9.45|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|TRUSTMARK [2030]|STARMARK [203000]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205||||205|98.3|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|UMR [2035]|UMR OPTIONS [203501]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205||||205|6.44|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205||||205|184.5|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|205||||205|4.31|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|205||||205|7.88|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|205||||205|6.47|190.65|4.31
30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|205||||205|102.5|190.65|4.31
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|211||||211|13.81|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211||||211|8.91|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211||||211|9.47|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211||||211|9.47|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|211||||211|105.71|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211||||211|74.06|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211||||211|10.79|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|211||||211|89.89|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|211||||211|105.5|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211||||211|137.15|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|CORESOURCE [1315]|CORESOURCE [131500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|211||||211|19.47|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|211||||211|11.92|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|GEHA [1415]|GEHA [141500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|211||||211|19.67|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HEALTHNET [1495]|HEALTHNET [149500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211||||211|10.79|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|211||||211|196.23|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211||||211|126.6|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211||||211|9.61|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211||||211|105.5|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211||||211|9.15|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211||||211|11.8|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211||||211|8.91|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MULTIPLAN [1680]|HMA [168003]|211||||211|13.11|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MULTIPLAN [1680]|IHC HS [168011]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|211||||211|9.84|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211||||211|9.61|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|Self-pay|Self-pay|211||||211|63.3|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211||||211|44.31|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|211||||211|8.57|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211||||211|12.76|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|TRUSTMARK [2030]|STARMARK [203000]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211||||211|101.17|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|UMR [2035]|UMR OPTIONS [203501]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211||||211|8.71|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211||||211|189.9|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|211||||211|5.83|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|211||||211|11.92|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|211||||211|8.74|196.23|5.83
30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|211||||211|105.5|196.23|5.83
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|188||||188|20.23|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|188||||188|13.87|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|188||||188|13.87|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|188||||188|94.19|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|188||||188|65.99|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|188||||188|15.8|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|188||||188|80.09|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|188||||188|94|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|188||||188|122.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|188||||188|27.89|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|188||||188|17.07|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|GEHA [1415]|GEHA [141500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|188||||188|15.8|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|188||||188|174.84|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|188||||188|112.8|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|188||||188|94|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|188||||188|13.39|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MULTIPLAN [1680]|HMA [168003]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|188||||188|14.42|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|Self-pay|Self-pay|188||||188|56.4|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|188||||188|39.48|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|188||||188|90.15|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|188||||188|12.75|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|188||||188|169.2|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|188||||188|8.53|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|188||||188|17.07|174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|188||||188||174.84|8.53
30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|188||||188|94|174.84|8.53
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|AETNA [1015]|AETNA ACO WILCO [101532]|487||||487|16.88|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|487||||487|11.8|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|487||||487|12.54|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|487||||487|12.54|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|487||||487|243.99|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|487||||487|170.94|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|487||||487|13.19|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|487||||487|207.46|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|487||||487|243.5|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|487||||487|316.55|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|CORESOURCE [1315]|CORESOURCE [131500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|487||||487|19.22|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|487||||487|11.76|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|GEHA [1415]|GEHA [141500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|487||||487|26.03|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HEALTHNET [1495]|HEALTHNET [149500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|487||||487|13.19|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|487||||487|452.91|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|487||||487|292.2|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|487||||487|12.73|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|487||||487|243.5|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|487||||487|12.11|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|487||||487|15.62|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|487||||487|11.8|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MULTIPLAN [1680]|HMA [168003]|487||||487|17.36|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MULTIPLAN [1680]|IHC HS [168011]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|487||||487|13.03|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|487||||487|12.73|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|Self-pay|Self-pay|487||||487|146.1|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|487||||487|102.27|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|487||||487|11.34|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|487||||487|16.89|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|TRUSTMARK [2030]|STARMARK [203000]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|487||||487|233.52|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|UMR [2035]|UMR OPTIONS [203501]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|487||||487|11.54|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|487||||487|438.3|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|487||||487|7.12|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|487||||487|11.76|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|487||||487|11.57|452.91|7.12
30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|487||||487|243.5|452.91|7.12
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|9.54|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|6.16|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|6.55|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|6.55|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|7.45|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|12.2|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|7.47|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242|13.59|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|7.45|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|6.64|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|6.32|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|8.15|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|6.16|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MULTIPLAN [1680]|HMA [168003]|242||||242|9.06|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|6.81|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|6.64|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|Self-pay|Self-pay|242||||242|72.6|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|5.92|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|8.82|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|6.02|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|4.03|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|7.47|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|6.04|225.06|4.03
30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|4.03
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|AETNA [1015]|AETNA ACO WILCO [101532]|277||||277|20.23|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|277||||277|13.85|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|277||||277|13.85|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|277||||277|138.78|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|277||||277|97.23|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|277||||277|15.8|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|277||||277|118|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|277||||277|138.5|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|277||||277|180.05|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|CORESOURCE [1315]|CORESOURCE [131500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|CORVEL CORP [2235]|CORVEL CORP [223500]|277||||277|21.11|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|277||||277|12.92|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|GEHA [1415]|GEHA [141500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HEALTHNET [1495]|HEALTHNET [149500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|277||||277|15.8|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HEALTHSMART [1505]|HEALTHSMART [150501]|277||||277|257.61|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|277||||277|166.2|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|277||||277|138.5|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|277||||277|13.38|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MULTIPLAN [1680]|HMA [168003]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MULTIPLAN [1680]|IHC HS [168011]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|277||||277|14.4|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|Self-pay|Self-pay|277||||277|83.1|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|277||||277|58.17|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|TRUSTMARK [2030]|STARMARK [203000]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|277||||277|132.82|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|UMR [2035]|UMR OPTIONS [203501]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|277||||277|12.74|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|277||||277|249.3|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|277||||277|8.53|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|277||||277|12.92|257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|277||||277||257.61|8.53
30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|277||||277|138.5|257.61|8.53
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|256||||256|31.02|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|256||||256|20.09|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|256||||256|21.35|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|256||||256|21.35|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|256||||256|128.26|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|256||||256|89.86|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|256||||256|24.24|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|256||||256|109.06|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|256||||256|128|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|256||||256|166.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|CORESOURCE [1315]|CORESOURCE [131500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|256||||256|27.65|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|256||||256|16.93|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|GEHA [1415]|GEHA [141500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|256||||256|44.33|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HEALTHNET [1495]|HEALTHNET [149500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|256||||256|24.24|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|256||||256|238.08|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|256||||256|153.6|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|256||||256|21.67|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|256||||256|128|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|256||||256|20.62|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|256||||256|26.6|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|256||||256|20.09|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MULTIPLAN [1680]|HMA [168003]|256||||256|29.55|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MULTIPLAN [1680]|IHC HS [168011]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|256||||256|22.19|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|256||||256|21.67|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|Self-pay|Self-pay|256||||256|76.8|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|256||||256|53.76|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|256||||256|19.31|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|256||||256|28.76|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|TRUSTMARK [2030]|STARMARK [203000]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|256||||256|122.75|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|UMR [2035]|UMR OPTIONS [203501]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|256||||256|19.63|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|256||||256|230.4|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|256||||256|13.09|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|256||||256|16.93|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|256||||256|19.7|238.08|13.09
30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|256||||256|128|238.08|13.09
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|AETNA [1015]|AETNA ACO WILCO [101532]|177||||177|19.13|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177||||177|12.35|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177||||177|13.12|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177||||177|13.12|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|177||||177|88.68|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177||||177|62.13|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177||||177|14.95|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|177||||177|75.4|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|177||||177|88.5|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177||||177|115.05|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|CORESOURCE [1315]|CORESOURCE [131500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|177||||177|25.53|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|177||||177|15.63|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|GEHA [1415]|GEHA [141500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|177||||177|27.25|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HEALTHNET [1495]|HEALTHNET [149500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177||||177|14.95|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|177||||177|164.61|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177||||177|106.2|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177||||177|13.32|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177||||177|88.5|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177||||177|12.67|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177||||177|16.35|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177||||177|12.35|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MULTIPLAN [1680]|HMA [168003]|177||||177|18.17|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MULTIPLAN [1680]|IHC HS [168011]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|177||||177|13.64|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177||||177|13.32|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|Self-pay|Self-pay|177||||177|53.1|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177||||177|37.17|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|177||||177|11.87|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177||||177|17.68|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|TRUSTMARK [2030]|STARMARK [203000]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177||||177|84.87|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|UMR [2035]|UMR OPTIONS [203501]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177||||177|12.07|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177||||177|159.3|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|177||||177|8.07|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|177||||177|15.63|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|177||||177|12.11|164.61|8.07
30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|177||||177|88.5|164.61|8.07
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|AETNA [1015]|AETNA ACO WILCO [101532]|321||||321|34.75|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|321||||321|23.82|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|321||||321|23.82|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|321||||321|160.82|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|321||||321|112.67|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|321||||321|27.14|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|321||||321|136.75|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|321||||321|160.5|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|321||||321|208.65|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|CORESOURCE [1315]|CORESOURCE [131500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|321||||321|30.49|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|321||||321|17.61|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|GEHA [1415]|GEHA [141500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HEALTHNET [1495]|HEALTHNET [149500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|321||||321|27.14|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|321||||321|298.53|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|321||||321|192.6|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|321||||321|160.5|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|321||||321|23.01|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MULTIPLAN [1680]|HMA [168003]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MULTIPLAN [1680]|IHC HS [168011]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|321||||321|24.76|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|Self-pay|Self-pay|321||||321|96.3|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|321||||321|67.41|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|TRUSTMARK [2030]|STARMARK [203000]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|321||||321|153.92|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|UMR [2035]|UMR OPTIONS [203501]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|321||||321|21.91|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|321||||321|288.9|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|321||||321|14.66|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|321||||321|17.61|298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|321||||321||298.53|14.66
30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|321||||321|160.5|298.53|14.66
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|AETNA [1015]|AETNA ACO WILCO [101532]|413||||413|29.88|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|413||||413|20.49|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|413||||413|20.49|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|413||||413|206.91|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|413||||413|144.96|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|413||||413|23.35|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|413||||413|175.94|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|413||||413|206.5|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|413||||413|268.45|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|CORESOURCE [1315]|CORESOURCE [131500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|413||||413|26.99|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|413||||413|16.52|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|GEHA [1415]|GEHA [141500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HEALTHNET [1495]|HEALTHNET [149500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|413||||413|23.35|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|413||||413|384.09|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|413||||413|247.8|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|413||||413|206.5|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|413||||413|19.8|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MULTIPLAN [1680]|HMA [168003]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MULTIPLAN [1680]|IHC HS [168011]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|413||||413|21.3|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|Self-pay|Self-pay|413||||413|123.9|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|413||||413|86.73|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|TRUSTMARK [2030]|STARMARK [203000]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|413||||413|198.03|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|UMR [2035]|UMR OPTIONS [203501]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|413||||413|18.85|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|413||||413|371.7|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|413||||413|12.61|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|413||||413|16.52|384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|413||||413||384.09|12.61
30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|413||||413|206.5|384.09|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|AETNA [1015]|AETNA ACO WILCO [101532]|342||||342|29.88|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|342||||342|20.93|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|342||||342|20.93|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|342||||342|171.34|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|342||||342|120.04|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|342||||342|23.35|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|342||||342|145.69|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|342||||342|171|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|342||||342|222.3|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|CORESOURCE [1315]|CORESOURCE [131500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|342||||342|25.32|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|342||||342|15.13|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|GEHA [1415]|GEHA [141500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HEALTHNET [1495]|HEALTHNET [149500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|342||||342|23.35|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|342||||342|318.06|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|342||||342|205.2|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|342||||342|171|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|342||||342|20.21|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MULTIPLAN [1680]|HMA [168003]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MULTIPLAN [1680]|IHC HS [168011]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|342||||342|21.75|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|Self-pay|Self-pay|342||||342|102.6|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|342||||342|71.82|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|TRUSTMARK [2030]|STARMARK [203000]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|342||||342|163.99|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|UMR [2035]|UMR OPTIONS [203501]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|342||||342|19.25|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|342||||342|307.8|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|342||||342|12.61|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|342||||342|15.13|318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|342||||342||318.06|12.61
30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|342||||342|171|318.06|12.61
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|121||||121|14.48|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|121||||121|10.63|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|121||||121|10.63|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|121||||121|60.62|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|121||||121|42.47|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|121||||121|11.31|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|121||||121|51.55|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|121||||121|60.5|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|121||||121|78.65|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|121||||121|16.06|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|121||||121|9.84|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|GEHA [1415]|GEHA [141500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|121||||121|11.31|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|121||||121|112.53|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|121||||121|72.6|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|121||||121|60.5|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|121||||121|10.26|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MULTIPLAN [1680]|HMA [168003]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|121||||121|11.05|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|Self-pay|Self-pay|121||||121|36.3|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|121||||121|25.41|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|121||||121|58.02|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|UMR [2035]|UMR OPTIONS [203501]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|121||||121|9.77|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|121||||121|108.9|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|121||||121|6.11|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|121||||121|9.84|112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|121||||121||112.53|6.11
30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|121||||121|60.5|112.53|6.11
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|326||||326|10.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|326||||326|7.03|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|326||||326|7.47|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|326||||326|7.47|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|326||||326|163.33|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|326||||326|114.43|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|326||||326|8.51|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|326||||326|138.88|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|326||||326|163|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|326||||326|211.9|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|CORESOURCE [1315]|CORESOURCE [131500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|326||||326|15.66|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|326||||326|9.59|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|GEHA [1415]|GEHA [141500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|326||||326|15.5|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HEALTHNET [1495]|HEALTHNET [149500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|326||||326|8.51|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|326||||326|303.18|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|326||||326|195.6|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|326||||326|7.58|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|326||||326|163|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|326||||326|7.21|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|326||||326|9.3|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|326||||326|7.03|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MULTIPLAN [1680]|HMA [168003]|326||||326|10.34|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MULTIPLAN [1680]|IHC HS [168011]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|326||||326|7.76|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|326||||326|7.58|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|Self-pay|Self-pay|326||||326|97.8|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|326||||326|68.46|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|326||||326|6.75|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|326||||326|10.06|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|TRUSTMARK [2030]|STARMARK [203000]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|326||||326|156.32|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|UMR [2035]|UMR OPTIONS [203501]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|326||||326|6.87|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|326||||326|293.4|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|326||||326|4.59|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|326||||326|9.59|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|326||||326|6.89|303.18|4.59
30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|326||||326|163|303.18|4.59
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|AETNA [1015]|AETNA ACO WILCO [101532]|219||||219|20.47|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219||||219|14.61|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219||||219|15.51|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219||||219|15.51|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|219||||219|109.72|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219||||219|76.87|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219||||219|15.98|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|219||||219|93.29|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|219||||219|109.5|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219||||219|142.35|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|CORESOURCE [1315]|CORESOURCE [131500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|219||||219|34.43|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|219||||219|21.08|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|GEHA [1415]|GEHA [141500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|219||||219|32.22|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HEALTHNET [1495]|HEALTHNET [149500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219||||219|15.98|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|219||||219|203.67|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219||||219|131.4|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219||||219|15.75|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219||||219|109.5|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219||||219|14.98|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219||||219|19.33|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219||||219|14.61|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MULTIPLAN [1680]|HMA [168003]|219||||219|21.48|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MULTIPLAN [1680]|IHC HS [168011]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|219||||219|16.12|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219||||219|15.75|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|Self-pay|Self-pay|219||||219|65.7|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219||||219|45.99|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|219||||219|14.03|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219||||219|20.91|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|TRUSTMARK [2030]|STARMARK [203000]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219||||219|105.01|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|UMR [2035]|UMR OPTIONS [203501]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219||||219|14.27|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219||||219|197.1|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|219||||219|8.63|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|219||||219|21.08|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|219||||219|14.32|203.67|8.63
30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|219||||219|109.5|203.67|8.63
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|AETNA [1015]|AETNA ACO WILCO [101532]|606||||606|65.87|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|606||||606|50.17|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|606||||606|50.17|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|606||||606|303.61|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|606||||606|212.71|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|606||||606|46.31|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|606||||606|258.16|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|606||||606|303|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|606||||606|393.9|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|CORESOURCE [1315]|CORESOURCE [131500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|606||||606|51.33|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|606||||606|31.43|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|GEHA [1415]|GEHA [141500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HEALTHNET [1495]|HEALTHNET [149500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|606||||606|46.31|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|606||||606|563.58|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|606||||606|363.6|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|606||||606|303|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|606||||606|48.46|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MULTIPLAN [1680]|HMA [168003]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MULTIPLAN [1680]|IHC HS [168011]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|606||||606|52.15|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|Self-pay|Self-pay|606||||606|181.8|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|606||||606|127.26|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|TRUSTMARK [2030]|STARMARK [203000]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|606||||606|290.58|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|UMR [2035]|UMR OPTIONS [203501]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|606||||606|46.15|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|606||||606|545.4|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|606||||606|27.79|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|606||||606|31.43|563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|606||||606||563.58|27.79
30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|606||||606|303|563.58|27.79
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|458||||458|48.16|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|458||||458|36.69|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|458||||458|36.69|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|458||||458|229.46|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|458||||458|160.76|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|458||||458|33.86|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|458||||458|195.11|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|458||||458|229|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|458||||458|297.7|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|CORESOURCE [1315]|CORESOURCE [131500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|458||||458|42.26|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|458||||458|25.87|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|GEHA [1415]|GEHA [141500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HEALTHNET [1495]|HEALTHNET [149500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|458||||458|33.86|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|458||||458|425.94|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|458||||458|274.8|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|458||||458|229|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|458||||458|35.44|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MULTIPLAN [1680]|HMA [168003]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MULTIPLAN [1680]|IHC HS [168011]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|458||||458|38.13|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|Self-pay|Self-pay|458||||458|137.4|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|458||||458|96.18|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|TRUSTMARK [2030]|STARMARK [203000]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|458||||458|219.61|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|UMR [2035]|UMR OPTIONS [203501]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|458||||458|33.75|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|458||||458|412.2|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|458||||458|20.32|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|458||||458|25.87|425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|458||||458||425.94|20.32
30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|458||||458|229|425.94|20.32
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|561||||561|49.87|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|561||||561|34.87|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|561||||561|37.04|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|561||||561|37.04|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|561||||561|281.06|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|561||||561|196.91|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|561||||561|38.95|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|561||||561|238.99|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|561||||561|280.5|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|561||||561|364.65|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|561||||561|80.99|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|561||||561|49.59|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|GEHA [1415]|GEHA [141500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|561||||561|76.93|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|561||||561|38.95|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|561||||561|521.73|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|561||||561|336.6|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|561||||561|37.61|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|561||||561|280.5|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|561||||561|35.78|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|561||||561|46.16|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|561||||561|34.87|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MULTIPLAN [1680]|HMA [168003]|561||||561|51.29|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MULTIPLAN [1680]|IHC HS [168011]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|561||||561|38.5|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|561||||561|37.61|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|Self-pay|Self-pay|561||||561|168.3|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|561||||561|117.81|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|561||||561|33.51|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|561||||561|49.92|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|TRUSTMARK [2030]|STARMARK [203000]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|561||||561|269|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|UMR [2035]|UMR OPTIONS [203501]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|561||||561|34.07|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|561||||561|504.9|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|561||||561|21.04|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|561||||561|49.59|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|561||||561|34.19|521.73|21.04
30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD QUAN PARTICLE NUMBER(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|561||||561|280.5|521.73|21.04
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|AETNA [1015]|AETNA ACO WILCO [101532]|109||||109|12.95|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109||||109|8.88|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109||||109|8.88|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109||||109|54.61|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109||||109|38.26|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109||||109|10.12|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109||||109|46.43|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109||||109|54.5|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109||||109|70.85|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|CORESOURCE [1315]|CORESOURCE [131500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|109||||109|14.22|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109||||109|8.71|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|GEHA [1415]|GEHA [141500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HEALTHNET [1495]|HEALTHNET [149500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109||||109|10.12|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|109||||109|101.37|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109||||109|65.4|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109||||109|54.5|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109||||109|8.57|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MULTIPLAN [1680]|HMA [168003]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MULTIPLAN [1680]|IHC HS [168011]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|109||||109|9.23|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|Self-pay|Self-pay|109||||109|32.7|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109||||109|22.89|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|TRUSTMARK [2030]|STARMARK [203000]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109||||109|52.27|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|UMR [2035]|UMR OPTIONS [203501]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109||||109|8.16|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109||||109|98.1|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109||||109|5.46|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109||||109|8.71|101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109||||109||101.37|5.46
30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109||||109|54.5|101.37|5.46
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|AETNA [1015]|AETNA ACO WILCO [101532]|117||||117|15.08|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117||||117|10.71|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117||||117|11.38|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117||||117|11.38|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|117||||117|58.62|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117||||117|41.07|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117||||117|11.78|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|117||||117|49.84|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|117||||117|58.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117||||117|76.05|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|CORESOURCE [1315]|CORESOURCE [131500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|117||||117|14.95|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|117||||117|9.15|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|GEHA [1415]|GEHA [141500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|117||||117|23.63|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HEALTHNET [1495]|HEALTHNET [149500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117||||117|11.78|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|117||||117|108.81|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117||||117|70.2|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117||||117|11.55|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117||||117|58.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117||||117|10.99|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117||||117|14.18|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117||||117|10.71|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MULTIPLAN [1680]|HMA [168003]|117||||117|15.75|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MULTIPLAN [1680]|IHC HS [168011]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|117||||117|11.83|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117||||117|11.55|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|Self-pay|Self-pay|117||||117|35.1|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117||||117|24.57|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|117||||117|10.29|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117||||117|15.33|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|TRUSTMARK [2030]|STARMARK [203000]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117||||117|56.1|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|UMR [2035]|UMR OPTIONS [203501]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117||||117|10.47|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117||||117|105.3|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|117||||117|6.36|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|117||||117|9.15|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|117||||117|10.5|108.81|6.36
30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|117||||117|58.5|108.81|6.36
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|223||||223|27.17|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223||||223|18.63|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223||||223|18.63|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|223||||223|111.72|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223||||223|78.27|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223||||223|21.22|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|223||||223|95|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|223||||223|111.5|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223||||223|144.95|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|CORESOURCE [1315]|CORESOURCE [131500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|223||||223|32.89|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|223||||223|20.13|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|GEHA [1415]|GEHA [141500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HEALTHNET [1495]|HEALTHNET [149500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223||||223|21.22|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|223||||223|207.39|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223||||223|133.8|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223||||223|111.5|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223||||223|17.99|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MULTIPLAN [1680]|HMA [168003]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MULTIPLAN [1680]|IHC HS [168011]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|223||||223|19.36|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|Self-pay|Self-pay|223||||223|66.9|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223||||223|46.83|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|TRUSTMARK [2030]|STARMARK [203000]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223||||223|106.93|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|UMR [2035]|UMR OPTIONS [203501]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223||||223|17.13|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223||||223|200.7|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|223||||223|11.46|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|223||||223|20.13|207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|223||||223||207.39|11.46
30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|223||||223|111.5|207.39|11.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|218||||218|10.58|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218||||218|6.83|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218||||218|7.26|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218||||218|7.26|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|218||||218|109.22|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218||||218|76.52|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218||||218|8.27|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|218||||218|92.87|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|218||||218|109|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218||||218|141.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|218||||218|12.94|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|218||||218|7.92|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|GEHA [1415]|GEHA [141500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|218||||218|15.08|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218||||218|8.27|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|218||||218|202.74|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218||||218|130.8|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218||||218|7.37|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218||||218|109|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218||||218|7.02|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218||||218|9.05|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218||||218|6.83|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MULTIPLAN [1680]|HMA [168003]|218||||218|10.05|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MULTIPLAN [1680]|IHC HS [168011]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|218||||218|7.55|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218||||218|7.37|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|Self-pay|Self-pay|218||||218|65.4|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218||||218|45.78|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|218||||218|6.57|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218||||218|9.78|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|TRUSTMARK [2030]|STARMARK [203000]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218||||218|104.53|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|UMR [2035]|UMR OPTIONS [203501]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218||||218|6.68|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218||||218|196.2|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|218||||218|4.46|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|218||||218|7.92|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|218||||218|6.7|202.74|4.46
30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|218||||218|109|202.74|4.46
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|AETNA [1015]|AETNA ACO WILCO [101532]|423||||423|38.88|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|423||||423|27.18|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|423||||423|28.87|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|423||||423|28.87|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|423||||423|211.92|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|423||||423|148.47|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|423||||423|30.37|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|423||||423|180.2|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|423||||423|211.5|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|423||||423|274.95|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|CORESOURCE [1315]|CORESOURCE [131500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|423||||423|50.41|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|423||||423|30.86|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|GEHA [1415]|GEHA [141500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|423||||423|59.96|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HEALTHNET [1495]|HEALTHNET [149500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|423||||423|30.37|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|423||||423|393.39|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|423||||423|253.8|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|423||||423|29.32|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|423||||423|211.5|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|423||||423|27.89|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|423||||423|35.98|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|423||||423|27.18|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MULTIPLAN [1680]|HMA [168003]|423||||423|39.98|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MULTIPLAN [1680]|IHC HS [168011]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|423||||423|30.01|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|423||||423|29.32|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|Self-pay|Self-pay|423||||423|126.9|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|423||||423|88.83|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|423||||423|26.12|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|423||||423|38.91|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|TRUSTMARK [2030]|STARMARK [203000]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|423||||423|202.83|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|UMR [2035]|UMR OPTIONS [203501]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|423||||423|26.56|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|423||||423|380.7|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|423||||423|16.4|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|423||||423|30.86|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|423||||423|26.65|393.39|16.4
30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|423||||423|211.5|393.39|16.4
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|314||||314|34.29|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|314||||314|24.59|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|314||||314|26.12|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|314||||314|26.12|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|314||||314|157.31|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|314||||314|110.21|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|314||||314|133.76|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|314||||314|157|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|314||||314|204.1|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|CORESOURCE [1315]|CORESOURCE [131500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|314||||314|30.65|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|314||||314|18.76|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|GEHA [1415]|GEHA [141500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|314||||314|54.25|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HEALTHNET [1495]|HEALTHNET [149500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|314||||314|292.02|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|314||||314|188.4|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|314||||314|26.52|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|314||||314|157|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|314||||314|25.22|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|314||||314|32.55|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|314||||314|24.59|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MULTIPLAN [1680]|HMA [168003]|314||||314|36.17|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MULTIPLAN [1680]|IHC HS [168011]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|314||||314|27.15|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|314||||314|26.52|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|Self-pay|Self-pay|314||||314|94.2|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|314||||314|65.94|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|314||||314|23.63|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|314||||314|35.2|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|TRUSTMARK [2030]|STARMARK [203000]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|314||||314|150.56|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|UMR [2035]|UMR OPTIONS [203501]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|314||||314|24.02|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|314||||314|282.6|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|314||||314|14.47|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|314||||314|18.76|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|314||||314|24.11|292.02|14.47
30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|314||||314|157|292.02|14.47
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|236||||236|25.69|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236||||236|16.59|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236||||236|17.61|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236||||236|17.61|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|236||||236|118.24|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236||||236|82.84|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236||||236|20.07|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|236||||236|100.54|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|236||||236|118|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236||||236|153.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|CORESOURCE [1315]|CORESOURCE [131500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|236||||236|28.95|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|236||||236|17.73|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|GEHA [1415]|GEHA [141500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|236||||236|36.59|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HEALTHNET [1495]|HEALTHNET [149500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236||||236|20.07|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|236||||236|219.48|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236||||236|141.6|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236||||236|17.89|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236||||236|118|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236||||236|17.01|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236||||236|21.95|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236||||236|16.59|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MULTIPLAN [1680]|HMA [168003]|236||||236|24.39|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MULTIPLAN [1680]|IHC HS [168011]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|236||||236|18.3|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236||||236|17.89|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|Self-pay|Self-pay|236||||236|70.8|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236||||236|49.56|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|236||||236|15.93|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236||||236|23.74|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|TRUSTMARK [2030]|STARMARK [203000]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236||||236|113.16|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|UMR [2035]|UMR OPTIONS [203501]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236||||236|16.2|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236||||236|212.4|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|236||||236|10.84|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|236||||236|17.73|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|236||||236|16.26|219.48|10.84
30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|236||||236|118|219.48|10.84
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|AETNA [1015]|AETNA ACO WILCO [101532]|326||||326|26.77|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|326||||326|17.28|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|326||||326|18.35|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|326||||326|18.35|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|326||||326|163.33|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|326||||326|114.43|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|326||||326|20.92|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|326||||326|138.88|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|326||||326|163|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|326||||326|211.9|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|CORESOURCE [1315]|CORESOURCE [131500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|326||||326|33.79|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|326||||326|20.69|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|GEHA [1415]|GEHA [141500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|326||||326|38.12|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HEALTHNET [1495]|HEALTHNET [149500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|326||||326|20.92|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|326||||326|303.18|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|326||||326|195.6|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|326||||326|18.63|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|326||||326|163|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|326||||326|17.72|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|326||||326|22.87|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|326||||326|17.28|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MULTIPLAN [1680]|HMA [168003]|326||||326|25.41|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MULTIPLAN [1680]|IHC HS [168011]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|326||||326|19.07|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|326||||326|18.63|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|Self-pay|Self-pay|326||||326|97.8|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|326||||326|68.46|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|326||||326|16.6|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|326||||326|24.73|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|TRUSTMARK [2030]|STARMARK [203000]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|326||||326|156.32|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|UMR [2035]|UMR OPTIONS [203501]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|326||||326|16.88|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|326||||326|293.4|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|326||||326|11.29|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|326||||326|20.69|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|326||||326|16.94|303.18|11.29
30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|326||||326|163|303.18|11.29
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|AETNA [1015]|AETNA ACO WILCO [101532]|375||||375|27.19|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|375||||375|17.54|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|375||||375|18.64|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|375||||375|18.64|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|375||||375|187.88|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|375||||375|131.63|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|375||||375|21.24|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|375||||375|159.75|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|375||||375|187.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|375||||375|243.75|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|CORESOURCE [1315]|CORESOURCE [131500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|375||||375|35.59|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|375||||375|21.79|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|GEHA [1415]|GEHA [141500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|375||||375|38.7|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HEALTHNET [1495]|HEALTHNET [149500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|375||||375|21.24|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|375||||375|348.75|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|375||||375|225|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|375||||375|18.92|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|375||||375|187.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|375||||375|18|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|375||||375|23.22|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|375||||375|17.54|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MULTIPLAN [1680]|HMA [168003]|375||||375|25.8|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MULTIPLAN [1680]|IHC HS [168011]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|375||||375|19.37|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|375||||375|18.92|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|Self-pay|Self-pay|375||||375|112.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|375||||375|78.75|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|375||||375|16.86|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|375||||375|25.11|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|TRUSTMARK [2030]|STARMARK [203000]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|375||||375|179.81|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|UMR [2035]|UMR OPTIONS [203501]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|375||||375|17.14|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|375||||375|337.5|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|375||||375|11.47|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|375||||375|21.79|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|375||||375|17.2|348.75|11.47
30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|375||||375|187.5|348.75|11.47
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|359||||359|20.41|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|359||||359|13.18|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|359||||359|13.99|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|359||||359|13.99|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|359||||359|179.86|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|359||||359|126.01|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|359||||359|15.95|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|359||||359|152.93|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|359||||359|179.5|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|359||||359|233.35|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|CORESOURCE [1315]|CORESOURCE [131500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|359||||359|24.83|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|359||||359|15.2|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|GEHA [1415]|GEHA [141500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|359||||359|29.07|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HEALTHNET [1495]|HEALTHNET [149500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|359||||359|15.95|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|359||||359|333.87|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|359||||359|215.4|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|359||||359|14.21|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|359||||359|179.5|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|359||||359|13.51|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|359||||359|17.44|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|359||||359|13.18|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MULTIPLAN [1680]|HMA [168003]|359||||359|19.38|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MULTIPLAN [1680]|IHC HS [168011]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|359||||359|14.54|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|359||||359|14.21|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|Self-pay|Self-pay|359||||359|107.7|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|359||||359|75.39|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|359||||359|12.66|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|359||||359|18.86|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|TRUSTMARK [2030]|STARMARK [203000]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|359||||359|172.14|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|UMR [2035]|UMR OPTIONS [203501]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|359||||359|12.87|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|359||||359|323.1|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|359||||359|8.61|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|359||||359|15.2|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|359||||359|12.92|333.87|8.61
30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|359||||359|179.5|333.87|8.61
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|AETNA [1015]|AETNA ACO WILCO [101532]|494||||494|55.84|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494||||494|40.05|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494||||494|42.53|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494||||494|42.53|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|494||||494|247.49|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494||||494|173.39|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494||||494|41.9|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|494||||494|210.44|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|494||||494|247|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494||||494|321.1|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|CORESOURCE [1315]|CORESOURCE [131500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|494||||494|46.38|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|494||||494|28.25|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|GEHA [1415]|GEHA [141500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|494||||494|88.34|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HEALTHNET [1495]|HEALTHNET [149500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494||||494|41.9|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|494||||494|459.42|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494||||494|296.4|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494||||494|43.19|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494||||494|247|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494||||494|41.08|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494||||494|53|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494||||494|40.05|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MULTIPLAN [1680]|HMA [168003]|494||||494|58.89|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MULTIPLAN [1680]|IHC HS [168011]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|494||||494|44.2|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494||||494|43.19|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|Self-pay|Self-pay|494||||494|148.2|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494||||494|103.74|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|494||||494|38.47|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494||||494|57.32|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|TRUSTMARK [2030]|STARMARK [203000]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494||||494|236.87|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|UMR [2035]|UMR OPTIONS [203501]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494||||494|39.12|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494||||494|444.6|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|494||||494|23.56|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|494||||494|28.25|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|494||||494|39.26|459.42|23.56
30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|494||||494|247|459.42|23.56
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|AETNA [1015]|AETNA ACO WILCO [101532]|417||||417|21.49|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|417||||417|13.87|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|417||||417|14.73|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|417||||417|14.73|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|417||||417|208.92|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|417||||417|146.37|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|417||||417|16.79|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|417||||417|177.64|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|417||||417|208.5|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|417||||417|271.05|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|CORESOURCE [1315]|CORESOURCE [131500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|417||||417|18.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|417||||417|10.92|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|GEHA [1415]|GEHA [141500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|417||||417|30.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HEALTHNET [1495]|HEALTHNET [149500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|417||||417|16.79|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|417||||417|387.81|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|417||||417|250.2|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|417||||417|14.96|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|417||||417|208.5|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|417||||417|14.23|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|417||||417|18.36|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|417||||417|13.87|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MULTIPLAN [1680]|HMA [168003]|417||||417|20.4|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MULTIPLAN [1680]|IHC HS [168011]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|417||||417|15.31|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|417||||417|14.96|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|Self-pay|Self-pay|417||||417|125.1|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|417||||417|87.57|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|417||||417|13.33|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|417||||417|19.86|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|TRUSTMARK [2030]|STARMARK [203000]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|417||||417|199.95|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|UMR [2035]|UMR OPTIONS [203501]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|417||||417|13.55|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|417||||417|375.3|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|417||||417|9.07|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|417||||417|10.92|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|417||||417|13.6|387.81|9.07
30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|417||||417|208.5|387.81|9.07
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|420||||420|38.73|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|420||||420|26.56|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|420||||420|26.56|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|420||||420|210.42|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|420||||420|147.42|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|420||||420|30.26|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|420||||420|178.92|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|420||||420|210|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|420||||420|273|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|CORESOURCE [1315]|CORESOURCE [131500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|420||||420|37.93|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|420||||420|23.22|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|GEHA [1415]|GEHA [141500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HEALTHNET [1495]|HEALTHNET [149500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|420||||420|30.26|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|420||||420|390.6|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|420||||420|252|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|420||||420|210|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|420||||420|25.65|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MULTIPLAN [1680]|HMA [168003]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MULTIPLAN [1680]|IHC HS [168011]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|420||||420|27.61|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|Self-pay|Self-pay|420||||420|126|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|420||||420|88.2|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|TRUSTMARK [2030]|STARMARK [203000]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|420||||420|201.39|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|UMR [2035]|UMR OPTIONS [203501]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|420||||420|24.43|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|420||||420|378|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|420||||420|16.34|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|420||||420|23.22|390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|420||||420||390.6|16.34
30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|420||||420|210|390.6|16.34
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|AETNA [1015]|AETNA ACO WILCO [101532]|145||||145|17.63|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145||||145|11.37|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145||||145|12.08|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145||||145|12.08|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|145||||145|72.65|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145||||145|50.9|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145||||145|13.77|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|145||||145|61.77|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|145||||145|72.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145||||145|94.25|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|CORESOURCE [1315]|CORESOURCE [131500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|145||||145|22.97|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|145||||145|14.06|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|GEHA [1415]|GEHA [141500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|145||||145|25.09|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HEALTHNET [1495]|HEALTHNET [149500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145||||145|13.77|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|145||||145|134.85|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145||||145|87|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145||||145|12.27|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145||||145|72.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145||||145|11.67|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145||||145|15.05|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145||||145|11.37|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MULTIPLAN [1680]|HMA [168003]|145||||145|16.73|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MULTIPLAN [1680]|IHC HS [168011]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|145||||145|12.56|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145||||145|12.27|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|Self-pay|Self-pay|145||||145|43.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145||||145|30.45|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|145||||145|10.93|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145||||145|16.28|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|TRUSTMARK [2030]|STARMARK [203000]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145||||145|69.53|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|UMR [2035]|UMR OPTIONS [203501]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145||||145|11.11|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145||||145|130.5|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|145||||145|7.43|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|145||||145|14.06|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|145||||145|11.15|134.85|7.43
30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|145||||145|72.5|134.85|7.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|AETNA [1015]|AETNA ACO WILCO [101532]|393||||393|38.96|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|393||||393|27.94|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|393||||393|29.68|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|393||||393|29.68|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|393||||393|196.89|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|393||||393|137.94|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|393||||393|167.42|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|393||||393|196.5|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|393||||393|255.45|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|CORESOURCE [1315]|CORESOURCE [131500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|393||||393|47.02|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|393||||393|28.79|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|GEHA [1415]|GEHA [141500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|393||||393|61.63|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HEALTHNET [1495]|HEALTHNET [149500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|393||||393|365.49|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|393||||393|235.8|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|393||||393|30.13|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|393||||393|196.5|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|393||||393|28.67|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|393||||393|36.98|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|393||||393|27.94|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MULTIPLAN [1680]|HMA [168003]|393||||393|41.09|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MULTIPLAN [1680]|IHC HS [168011]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|393||||393|30.85|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|393||||393|30.13|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|Self-pay|Self-pay|393||||393|117.9|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|393||||393|82.53|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|393||||393|26.84|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|393||||393|39.99|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|TRUSTMARK [2030]|STARMARK [203000]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|393||||393|188.44|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|UMR [2035]|UMR OPTIONS [203501]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|393||||393|27.31|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|393||||393|353.7|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|393||||393|16.43|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|393||||393|28.79|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|393||||393|27.39|365.49|16.43
30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|393||||393|196.5|365.49|16.43
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|213||||213|33.57|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213||||213|25.56|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213||||213|25.56|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213||||213|106.71|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213||||213|74.76|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213||||213|23.6|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213||||213|90.74|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213||||213|106.5|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213||||213|138.45|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|CORESOURCE [1315]|CORESOURCE [131500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|213||||213|33.49|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213||||213|20.5|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|GEHA [1415]|GEHA [141500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HEALTHNET [1495]|HEALTHNET [149500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213||||213|23.6|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|213||||213|198.09|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213||||213|127.8|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213||||213|106.5|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213||||213|24.69|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MULTIPLAN [1680]|HMA [168003]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MULTIPLAN [1680]|IHC HS [168011]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|213||||213|26.57|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|Self-pay|Self-pay|213||||213|63.9|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213||||213|44.73|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|TRUSTMARK [2030]|STARMARK [203000]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213||||213|102.13|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|UMR [2035]|UMR OPTIONS [203501]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213||||213|23.51|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213||||213|191.7|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213||||213|14.16|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213||||213|20.5|198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213||||213||198.09|14.16
30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213||||213|106.5|198.09|14.16
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|355||||355|30.17|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|355||||355|21.63|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|355||||355|22.98|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|355||||355|22.98|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|355||||355|177.86|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|355||||355|124.61|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|355||||355|151.23|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|355||||355|177.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|355||||355|230.75|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|CORESOURCE [1315]|CORESOURCE [131500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|355||||355|28.53|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|355||||355|17.47|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|GEHA [1415]|GEHA [141500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|355||||355|47.72|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HEALTHNET [1495]|HEALTHNET [149500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|355||||355|330.15|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|355||||355|213|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|355||||355|23.33|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|355||||355|177.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|355||||355|22.2|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|355||||355|28.63|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|355||||355|21.63|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MULTIPLAN [1680]|HMA [168003]|355||||355|31.82|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MULTIPLAN [1680]|IHC HS [168011]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|355||||355|23.88|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|355||||355|23.33|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|Self-pay|Self-pay|355||||355|106.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|355||||355|74.55|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|355||||355|20.79|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|355||||355|30.97|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|TRUSTMARK [2030]|STARMARK [203000]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|355||||355|170.22|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|UMR [2035]|UMR OPTIONS [203501]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|355||||355|21.14|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|355||||355|319.5|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|355||||355|12.73|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|355||||355|17.47|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|355||||355|21.21|330.15|12.73
30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|355||||355|177.5|330.15|12.73
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|10.45|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|6.74|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|7.16|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|7.16|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|8.16|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|14.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|8.95|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242|14.87|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|8.16|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|7.27|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|6.91|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|8.92|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|6.74|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MULTIPLAN [1680]|HMA [168003]|242||||242|9.92|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|7.44|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|7.27|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|Self-pay|Self-pay|242||||242|72.6|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|6.48|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|9.65|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|6.58|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|4.41|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|8.95|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|6.61|225.06|4.41
30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|4.41
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|240||||240|10.76|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240||||240|6.96|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240||||240|7.39|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240||||240|7.39|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|240||||240|120.24|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240||||240|84.24|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240||||240|8.42|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|240||||240|102.24|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|240||||240|120|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240||||240|156|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|240||||240|14.99|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|240||||240|9.18|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|GEHA [1415]|GEHA [141500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|240||||240|15.35|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240||||240|8.42|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|240||||240|223.2|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240||||240|144|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240||||240|7.5|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240||||240|120|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240||||240|7.14|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240||||240|9.21|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240||||240|6.96|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MULTIPLAN [1680]|HMA [168003]|240||||240|10.23|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MULTIPLAN [1680]|IHC HS [168011]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|240||||240|7.68|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240||||240|7.5|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|Self-pay|Self-pay|240||||240|72|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240||||240|50.4|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|240||||240|6.68|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240||||240|9.96|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|TRUSTMARK [2030]|STARMARK [203000]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240||||240|115.08|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|UMR [2035]|UMR OPTIONS [203501]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240||||240|6.8|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240||||240|216|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|240||||240|4.54|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|240||||240|9.18|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|240||||240|6.82|223.2|4.54
30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|240||||240|120|223.2|4.54
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|410||||410|47.16|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|410||||410|30.45|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|410||||410|32.34|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|410||||410|32.34|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|410||||410|205.41|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|410||||410|143.91|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|410||||410|36.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|410||||410|174.66|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|410||||410|205|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|410||||410|266.5|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|CORESOURCE [1315]|CORESOURCE [131500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|410||||410|46.74|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|410||||410|28.62|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|GEHA [1415]|GEHA [141500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|410||||410|67.16|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HEALTHNET [1495]|HEALTHNET [149500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|410||||410|36.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|410||||410|381.3|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|410||||410|246|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|410||||410|32.84|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|410||||410|205|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|410||||410|31.24|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|410||||410|40.3|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|410||||410|30.45|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MULTIPLAN [1680]|HMA [168003]|410||||410|44.78|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MULTIPLAN [1680]|IHC HS [168011]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|410||||410|33.61|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|410||||410|32.84|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|Self-pay|Self-pay|410||||410|123|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|410||||410|86.1|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|410||||410|29.25|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|410||||410|43.58|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|TRUSTMARK [2030]|STARMARK [203000]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|410||||410|196.6|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|UMR [2035]|UMR OPTIONS [203501]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|410||||410|29.75|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|410||||410|369|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|410||||410|19.9|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|410||||410|28.62|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|410||||410|29.85|381.3|19.9
30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|410||||410|205|381.3|19.9
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|168||||168|20.55|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|168||||168|14.74|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|168||||168|15.65|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|168||||168|15.65|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|168||||168|84.17|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|168||||168|58.97|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|168||||168|15.89|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|168||||168|71.57|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|168||||168|84|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|168||||168|109.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|CORESOURCE [1315]|CORESOURCE [131500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|168||||168|26.67|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|168||||168|16.33|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|GEHA [1415]|GEHA [141500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|168||||168|32.51|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HEALTHNET [1495]|HEALTHNET [149500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|168||||168|15.89|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|168||||168|156.24|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|168||||168|100.8|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|168||||168|15.9|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|168||||168|84|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|168||||168|15.12|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|168||||168|19.51|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|168||||168|14.74|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MULTIPLAN [1680]|HMA [168003]|168||||168|21.68|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MULTIPLAN [1680]|IHC HS [168011]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|168||||168|16.27|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|168||||168|15.9|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|Self-pay|Self-pay|168||||168|50.4|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|168||||168|35.28|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|168||||168|14.16|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|168||||168|21.1|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|TRUSTMARK [2030]|STARMARK [203000]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|168||||168|80.56|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|UMR [2035]|UMR OPTIONS [203501]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|168||||168|14.4|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|168||||168|151.2|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|168||||168|8.67|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|168||||168|16.33|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|168||||168|14.45|156.24|8.67
30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|168||||168|84|156.24|8.67
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|AETNA [1015]|AETNA ACO WILCO [101532]|1160||||1160|101.8|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1160||||1160|69.79|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1160||||1160|69.79|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1160||||1160|581.16|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1160||||1160|407.16|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1160||||1160|79.52|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1160||||1160|494.16|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1160||||1160|580|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1160||||1160|754|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|CORESOURCE [1315]|CORESOURCE [131500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1160||||1160|87.88|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1160||||1160|53.58|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|GEHA [1415]|GEHA [141500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HEALTHNET [1495]|HEALTHNET [149500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1160||||1160|79.52|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1160||||1160|1078.8|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1160||||1160|696|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1160||||1160|580|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1160||||1160|67.4|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MULTIPLAN [1680]|HMA [168003]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MULTIPLAN [1680]|IHC HS [168011]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1160||||1160|72.54|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|Self-pay|Self-pay|1160||||1160|348|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1160||||1160|243.6|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|TRUSTMARK [2030]|STARMARK [203000]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1160||||1160|556.22|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|UMR [2035]|UMR OPTIONS [203501]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1160||||1160|64.19|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1160||||1160|1044|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1160||||1160|42.94|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1160||||1160|53.58|1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1160||||1160||1078.8|42.94
30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1160||||1160|580|1078.8|42.94
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|AETNA [1015]|AETNA ACO WILCO [101532]|781||||781|65.23|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|781||||781|42.11|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|781||||781|44.72|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|781||||781|44.72|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|781||||781|391.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|781||||781|274.13|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|781||||781|50.96|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|781||||781|332.71|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|781||||781|390.5|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|781||||781|507.65|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|CORESOURCE [1315]|CORESOURCE [131500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|781||||781|67.54|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|781||||781|41.35|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|GEHA [1415]|GEHA [141500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|781||||781|92.88|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HEALTHNET [1495]|HEALTHNET [149500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|781||||781|50.96|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|781||||781|726.33|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|781||||781|468.6|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|781||||781|45.41|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|781||||781|390.5|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|781||||781|43.2|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|781||||781|55.73|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|781||||781|42.11|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MULTIPLAN [1680]|HMA [168003]|781||||781|61.92|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MULTIPLAN [1680]|IHC HS [168011]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|781||||781|46.48|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|781||||781|45.41|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|Self-pay|Self-pay|781||||781|234.3|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|781||||781|164.01|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|781||||781|40.45|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|781||||781|60.27|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|TRUSTMARK [2030]|STARMARK [203000]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|781||||781|374.49|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|UMR [2035]|UMR OPTIONS [203501]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|781||||781|41.14|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|781||||781|702.9|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|781||||781|27.52|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|781||||781|41.35|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|781||||781|41.28|726.33|27.52
30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|781||||781|390.5|726.33|27.52
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|77||||77|5.66|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77||||77|3.65|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77||||77|3.88|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77||||77|3.88|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|77||||77|38.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77||||77|27.03|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77||||77|4.42|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|77||||77|32.8|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|77||||77|38.5|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77||||77|50.05|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|77||||77|6.57|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|77||||77|4.02|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|GEHA [1415]|GEHA [141500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|77||||77|8.06|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77||||77|4.42|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|77||||77|71.61|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77||||77|46.2|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77||||77|3.94|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77||||77|38.5|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77||||77|3.75|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77||||77|4.83|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77||||77|3.65|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MULTIPLAN [1680]|HMA [168003]|77||||77|5.37|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MULTIPLAN [1680]|IHC HS [168011]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|77||||77|4.03|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77||||77|3.94|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|Self-pay|Self-pay|77||||77|23.1|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77||||77|16.17|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|77||||77|3.51|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77||||77|5.23|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|TRUSTMARK [2030]|STARMARK [203000]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77||||77|36.92|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|UMR [2035]|UMR OPTIONS [203501]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77||||77|69.3|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|77||||77|2.39|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|77||||77|4.02|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|77||||77|3.58|71.61|2.39
30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|77||||77|38.5|71.61|2.39
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|360||||360|31.02|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|360||||360|20.02|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|360||||360|21.27|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|360||||360|21.27|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|360||||360|180.36|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|360||||360|126.36|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|360||||360|24.24|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|360||||360|153.36|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|360||||360|180|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|360||||360|234|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|CORESOURCE [1315]|CORESOURCE [131500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|360||||360|29.37|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|360||||360|17.95|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|GEHA [1415]|GEHA [141500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|360||||360|44.17|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HEALTHNET [1495]|HEALTHNET [149500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|360||||360|24.24|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|360||||360|334.8|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|360||||360|216|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|360||||360|21.59|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|360||||360|180|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|360||||360|20.54|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|360||||360|26.5|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|360||||360|20.02|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MULTIPLAN [1680]|HMA [168003]|360||||360|29.45|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MULTIPLAN [1680]|IHC HS [168011]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|360||||360|22.11|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|360||||360|21.59|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|Self-pay|Self-pay|360||||360|108|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|360||||360|75.6|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|360||||360|19.24|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|360||||360|28.66|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|TRUSTMARK [2030]|STARMARK [203000]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|360||||360|172.62|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|UMR [2035]|UMR OPTIONS [203501]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|360||||360|19.56|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|360||||360|324|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|360||||360|13.09|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|360||||360|17.95|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|360||||360|19.63|334.8|13.09
30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|360||||360|180|334.8|13.09
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|530||||530|8.69|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|530||||530|5.61|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|530||||530|5.96|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|530||||530|5.96|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|530||||530|265.53|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|530||||530|186.03|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|530||||530|6.79|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|530||||530|225.78|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|530||||530|265|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|530||||530|344.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|CORESOURCE [1315]|CORESOURCE [131500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|530||||530|9.19|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|530||||530|5.63|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|GEHA [1415]|GEHA [141500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|530||||530|12.38|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HEALTHNET [1495]|HEALTHNET [149500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|530||||530|6.79|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|530||||530|492.9|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|530||||530|318|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|530||||530|6.05|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|530||||530|265|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|530||||530|5.75|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|530||||530|7.43|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|530||||530|5.61|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MULTIPLAN [1680]|HMA [168003]|530||||530|8.25|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MULTIPLAN [1680]|IHC HS [168011]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|530||||530|6.19|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|530||||530|6.05|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|Self-pay|Self-pay|530||||530|159|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|530||||530|111.3|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|530||||530|5.39|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|530||||530|8.03|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|TRUSTMARK [2030]|STARMARK [203000]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|530||||530|254.14|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|UMR [2035]|UMR OPTIONS [203501]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|530||||530|5.48|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|530||||530|477|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|530||||530|3.67|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|530||||530|5.63|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|530||||530|5.5|492.9|3.67
30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|530||||530|265|492.9|3.67
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|AETNA [1015]|AETNA ACO WILCO [101532]|128||||128|11.68|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128||||128|8.28|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128||||128|8.28|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128||||128|64.13|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128||||128|44.93|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128||||128|9.12|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128||||128|54.53|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128||||128|64|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128||||128|83.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|CORESOURCE [1315]|CORESOURCE [131500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128||||128|20.97|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128||||128|12.84|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|GEHA [1415]|GEHA [141500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HEALTHNET [1495]|HEALTHNET [149500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128||||128|9.12|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128||||128|119.04|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128||||128|76.8|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128||||128|64|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128||||128|7.99|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MULTIPLAN [1680]|HMA [168003]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MULTIPLAN [1680]|IHC HS [168011]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128||||128|8.61|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|Self-pay|Self-pay|128||||128|38.4|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128||||128|26.88|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|TRUSTMARK [2030]|STARMARK [203000]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128||||128|61.38|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|UMR [2035]|UMR OPTIONS [203501]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128||||128|7.61|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128||||128|115.2|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128||||128|4.93|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128||||128|12.84|119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128||||128||119.04|4.93
30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128||||128|64|119.04|4.93
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|119||||119|15.27|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119||||119|10.47|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119||||119|10.47|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119||||119|59.62|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119||||119|41.77|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119||||119|11.93|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119||||119|50.69|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119||||119|59.5|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119||||119|77.35|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|CORESOURCE [1315]|CORESOURCE [131500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119||||119|17.56|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119||||119|10.75|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|GEHA [1415]|GEHA [141500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HEALTHNET [1495]|HEALTHNET [149500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119||||119|11.93|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119||||119|110.67|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119||||119|71.4|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119||||119|59.5|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119||||119|10.11|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MULTIPLAN [1680]|HMA [168003]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MULTIPLAN [1680]|IHC HS [168011]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119||||119|10.88|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|Self-pay|Self-pay|119||||119|35.7|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119||||119|24.99|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|TRUSTMARK [2030]|STARMARK [203000]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119||||119|57.06|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|UMR [2035]|UMR OPTIONS [203501]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119||||119|9.62|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119||||119|107.1|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119||||119|6.44|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119||||119|10.75|110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119||||119||110.67|6.44
30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119||||119|59.5|110.67|6.44
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|272||||272|8.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|272||||272|5.28|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|272||||272|5.61|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|272||||272|5.61|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|272||||272|136.27|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|272||||272|95.47|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|272||||272|6.39|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|272||||272|115.87|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|272||||272|136|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|272||||272|176.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|CORESOURCE [1315]|CORESOURCE [131500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|272||||272|11.35|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|272||||272|6.95|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|GEHA [1415]|GEHA [141500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|272||||272|11.66|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HEALTHNET [1495]|HEALTHNET [149500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|272||||272|6.39|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|272||||272|252.96|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|272||||272|163.2|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|272||||272|5.7|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|272||||272|136|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|272||||272|5.42|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|272||||272|6.99|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|272||||272|5.28|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MULTIPLAN [1680]|HMA [168003]|272||||272|7.77|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MULTIPLAN [1680]|IHC HS [168011]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|272||||272|5.83|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|272||||272|5.7|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|Self-pay|Self-pay|272||||272|81.6|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|272||||272|57.12|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|272||||272|5.08|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|272||||272|7.56|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|TRUSTMARK [2030]|STARMARK [203000]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|272||||272|130.42|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|UMR [2035]|UMR OPTIONS [203501]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|272||||272|5.17|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|272||||272|244.8|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|272||||272|3.45|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|272||||272|6.95|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|272||||272|5.18|252.96|3.45
30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|272||||272|136|252.96|3.45
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|AETNA [1015]|AETNA ACO WILCO [101532]|427||||427|23.37|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|427||||427|15.08|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|427||||427|16.01|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|427||||427|16.01|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|427||||427|213.93|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|427||||427|149.88|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|427||||427|18.25|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|427||||427|181.9|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|427||||427|213.5|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|427||||427|277.55|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|CORESOURCE [1315]|CORESOURCE [131500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|427||||427|30.65|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|427||||427|18.77|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|GEHA [1415]|GEHA [141500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|427||||427|33.26|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HEALTHNET [1495]|HEALTHNET [149500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|427||||427|18.25|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|427||||427|397.11|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|427||||427|256.2|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|427||||427|16.26|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|427||||427|213.5|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|427||||427|15.47|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|427||||427|19.95|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|427||||427|15.08|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MULTIPLAN [1680]|HMA [168003]|427||||427|22.17|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MULTIPLAN [1680]|IHC HS [168011]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|427||||427|16.64|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|427||||427|16.26|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|Self-pay|Self-pay|427||||427|128.1|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|427||||427|89.67|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|427||||427|14.48|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|427||||427|21.58|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|TRUSTMARK [2030]|STARMARK [203000]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|427||||427|204.75|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|UMR [2035]|UMR OPTIONS [203501]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|427||||427|14.73|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|427||||427|384.3|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|427||||427|9.86|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|427||||427|18.77|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|427||||427|14.78|397.11|9.86
30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|427||||427|213.5|397.11|9.86
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|AETNA [1015]|AETNA ACO WILCO [101532]|244||||244|26.1|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244||||244|17.9|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244||||244|17.9|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|244||||244|122.24|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244||||244|85.64|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244||||244|20.39|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|244||||244|103.94|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|244||||244|122|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244||||244|158.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|CORESOURCE [1315]|CORESOURCE [131500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|244||||244|39.17|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|244||||244|23.98|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|GEHA [1415]|GEHA [141500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HEALTHNET [1495]|HEALTHNET [149500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244||||244|20.39|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|244||||244|226.92|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244||||244|146.4|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244||||244|122|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244||||244|17.29|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MULTIPLAN [1680]|HMA [168003]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MULTIPLAN [1680]|IHC HS [168011]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|244||||244|18.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|Self-pay|Self-pay|244||||244|73.2|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244||||244|51.24|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|TRUSTMARK [2030]|STARMARK [203000]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244||||244|117|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|UMR [2035]|UMR OPTIONS [203501]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244||||244|16.46|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244||||244|219.6|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|244||||244|11.01|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|244||||244|23.98|226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|244||||244||226.92|11.01
30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|244||||244|122|226.92|11.01
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|7.49|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|4.83|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|5.14|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|5.14|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|5.85|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|9.54|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|5.84|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242|10.67|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|5.85|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|5.21|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|4.97|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|6.4|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|4.83|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MULTIPLAN [1680]|HMA [168003]|242||||242|7.11|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|5.34|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|5.21|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|Self-pay|Self-pay|242||||242|72.6|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|4.65|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|6.92|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|4.73|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|3.16|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|5.84|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|4.74|225.06|3.16
30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|3.16
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|74||||74|8.22|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74||||74|5.9|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74||||74|6.26|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74||||74|6.26|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74||||74|37.07|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74||||74|25.97|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74||||74|6.39|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74||||74|31.52|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74||||74|37|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74||||74|48.1|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74||||74|9.54|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74||||74|5.84|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|GEHA [1415]|GEHA [141500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74||||74|13.01|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74||||74|6.39|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74||||74|68.82|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74||||74|44.4|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74||||74|6.36|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74||||74|37|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74||||74|6.05|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74||||74|7.8|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74||||74|5.9|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MULTIPLAN [1680]|HMA [168003]|74||||74|8.67|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MULTIPLAN [1680]|IHC HS [168011]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74||||74|6.51|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74||||74|6.36|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|Self-pay|Self-pay|74||||74|22.2|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74||||74|15.54|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74||||74|5.66|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74||||74|8.44|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|TRUSTMARK [2030]|STARMARK [203000]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74||||74|35.48|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|UMR [2035]|UMR OPTIONS [203501]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74||||74|5.76|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74||||74|66.6|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74||||74|3.47|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74||||74|5.84|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74||||74|5.78|68.82|3.47
30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74||||74|37|68.82|3.47
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|139||||139|13.34|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139||||139|9.14|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139||||139|9.14|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139||||139|69.64|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139||||139|48.79|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139||||139|10.42|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139||||139|59.21|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139||||139|69.5|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139||||139|90.35|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|CORESOURCE [1315]|CORESOURCE [131500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139||||139|19.58|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139||||139|11.99|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|GEHA [1415]|GEHA [141500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HEALTHNET [1495]|HEALTHNET [149500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139||||139|10.42|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139||||139|129.27|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139||||139|83.4|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139||||139|69.5|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139||||139|8.83|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MULTIPLAN [1680]|HMA [168003]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MULTIPLAN [1680]|IHC HS [168011]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139||||139|9.5|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|Self-pay|Self-pay|139||||139|41.7|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139||||139|29.19|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|TRUSTMARK [2030]|STARMARK [203000]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139||||139|66.65|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|UMR [2035]|UMR OPTIONS [203501]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139||||139|8.41|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139||||139|125.1|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139||||139|5.63|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139||||139|11.99|129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139||||139||129.27|5.63
30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139||||139|69.5|129.27|5.63
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|AETNA [1015]|AETNA ACO WILCO [101532]|340||||340|139.55|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|340||||340|100.07|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|340||||340|106.29|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|340||||340|106.29|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|340||||340|170.34|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|340||||340|119.34|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|340||||340|144.84|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|340||||340|170|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|340||||340|221|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|CORESOURCE [1315]|CORESOURCE [131500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|CORVEL CORP [2235]|CORVEL CORP [223500]|340||||340|92.37|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|340||||340|63.7|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|GEHA [1415]|GEHA [141500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|340||||340|220.75|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HEALTHNET [1495]|HEALTHNET [149500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HEALTHSMART [1505]|HEALTHSMART [150501]|340||||340|316.2|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|340||||340|204|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|340||||340|107.92|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|340||||340|170|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|340||||340|102.66|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|340||||340|132.45|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|340||||340|100.07|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MULTIPLAN [1680]|HMA [168003]|340||||340|147.17|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MULTIPLAN [1680]|IHC HS [168011]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|340||||340|110.48|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|340||||340|107.92|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|Self-pay|Self-pay|340||||340|102|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|340||||340|71.4|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|340||||340|96.15|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|340||||340|143.24|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|TRUSTMARK [2030]|STARMARK [203000]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|340||||340|163.03|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|UMR [2035]|UMR OPTIONS [203501]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|340||||340|97.77|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|340||||340|306|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|340||||340|58.87|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|340||||340|63.7|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|340||||340|98.11|316.2|58.87
30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|340||||340|170|316.2|58.87
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|AETNA [1015]|AETNA ACO WILCO [101532]|238||||238|23.25|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238||||238|15.94|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238||||238|15.94|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|238||||238|119.24|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238||||238|83.54|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238||||238|18.16|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|238||||238|101.39|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|238||||238|119|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238||||238|154.7|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|CORESOURCE [1315]|CORESOURCE [131500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|238||||238|37.24|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|238||||238|22.8|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|GEHA [1415]|GEHA [141500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HEALTHNET [1495]|HEALTHNET [149500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238||||238|18.16|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|238||||238|221.34|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238||||238|142.8|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238||||238|119|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238||||238|15.4|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MULTIPLAN [1680]|HMA [168003]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MULTIPLAN [1680]|IHC HS [168011]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|238||||238|16.57|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|Self-pay|Self-pay|238||||238|71.4|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238||||238|49.98|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|TRUSTMARK [2030]|STARMARK [203000]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238||||238|114.12|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|UMR [2035]|UMR OPTIONS [203501]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238||||238|14.67|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238||||238|214.2|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|238||||238|9.81|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|238||||238|22.8|221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|238||||238||221.34|9.81
30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|238||||238|119|221.34|9.81
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|434||||434|55.63|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|434||||434|42.37|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|434||||434|42.37|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|434||||434|217.43|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|434||||434|152.33|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|434||||434|39.11|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|434||||434|184.88|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|434||||434|217|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|434||||434|282.1|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|CORESOURCE [1315]|CORESOURCE [131500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|434||||434|59.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|434||||434|36.49|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|GEHA [1415]|GEHA [141500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HEALTHNET [1495]|HEALTHNET [149500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|434||||434|39.11|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|434||||434|403.62|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|434||||434|260.4|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|434||||434|217|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|434||||434|40.93|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MULTIPLAN [1680]|HMA [168003]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MULTIPLAN [1680]|IHC HS [168011]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|434||||434|44.04|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|Self-pay|Self-pay|434||||434|130.2|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|434||||434|91.14|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|TRUSTMARK [2030]|STARMARK [203000]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|434||||434|208.1|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|UMR [2035]|UMR OPTIONS [203501]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|434||||434|38.98|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|434||||434|390.6|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|434||||434|23.47|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|434||||434|36.49|403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|434||||434||403.62|23.47
30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|434||||434|217|403.62|23.47
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|215||||215|7.27|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215||||215|4.86|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215||||215|5.15|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215||||215|5.15|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|215||||215|107.72|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215||||215|75.47|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215||||215|5.68|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|215||||215|91.59|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|215||||215|107.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215||||215|139.75|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|215||||215|9.19|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|215||||215|5.63|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|GEHA [1415]|GEHA [141500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|215||||215|10.71|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215||||215|5.68|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|215||||215|199.95|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215||||215|129|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215||||215|5.24|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215||||215|107.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215||||215|4.98|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215||||215|6.43|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215||||215|4.86|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MULTIPLAN [1680]|HMA [168003]|215||||215|7.14|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|215||||215|5.35|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215||||215|5.24|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|Self-pay|Self-pay|215||||215|64.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215||||215|45.15|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|215||||215|4.66|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215||||215|6.95|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215||||215|103.09|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|UMR [2035]|UMR OPTIONS [203501]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215||||215|4.74|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215||||215|193.5|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|215||||215|3.07|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|215||||215|5.63|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|215||||215|4.76|199.95|3.07
30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|215||||215|107.5|199.95|3.07
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|AETNA [1015]|AETNA ACO WILCO [101532]|211||||211|6.81|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211||||211|4.82|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211||||211|5.13|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211||||211|5.13|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|211||||211|105.71|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211||||211|74.06|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211||||211|5.32|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|211||||211|89.89|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|211||||211|105.5|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211||||211|137.15|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|CORESOURCE [1315]|CORESOURCE [131500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|211||||211|11.02|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|211||||211|6.75|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|GEHA [1415]|GEHA [141500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|211||||211|10.64|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HEALTHNET [1495]|HEALTHNET [149500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211||||211|5.32|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|211||||211|196.23|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211||||211|126.6|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211||||211|5.2|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211||||211|105.5|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211||||211|4.95|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211||||211|6.39|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211||||211|4.82|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MULTIPLAN [1680]|HMA [168003]|211||||211|7.1|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MULTIPLAN [1680]|IHC HS [168011]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|211||||211|5.33|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211||||211|5.2|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|Self-pay|Self-pay|211||||211|63.3|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211||||211|44.31|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|211||||211|4.64|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211||||211|6.91|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|TRUSTMARK [2030]|STARMARK [203000]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211||||211|101.17|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|UMR [2035]|UMR OPTIONS [203501]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211||||211|4.72|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211||||211|189.9|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|211||||211|2.87|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|211||||211|6.75|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|211||||211|4.73|196.23|2.87
30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|211||||211|105.5|196.23|2.87
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|420||||420|23.06|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|420||||420|14.88|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|420||||420|15.8|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|420||||420|15.8|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|420||||420|210.42|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|420||||420|147.42|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|420||||420|18.01|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|420||||420|178.92|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|420||||420|210|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|420||||420|273|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|CORESOURCE [1315]|CORESOURCE [131500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|420||||420|25.11|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|420||||420|15.38|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|GEHA [1415]|GEHA [141500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|420||||420|32.83|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HEALTHNET [1495]|HEALTHNET [149500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|420||||420|18.01|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|420||||420|390.6|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|420||||420|252|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|420||||420|16.05|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|420||||420|210|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|420||||420|15.26|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|420||||420|19.7|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|420||||420|14.88|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MULTIPLAN [1680]|HMA [168003]|420||||420|21.89|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MULTIPLAN [1680]|IHC HS [168011]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|420||||420|16.42|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|420||||420|16.05|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|Self-pay|Self-pay|420||||420|126|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|420||||420|88.2|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|420||||420|14.3|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|420||||420|21.3|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|TRUSTMARK [2030]|STARMARK [203000]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|420||||420|201.39|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|UMR [2035]|UMR OPTIONS [203501]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|420||||420|14.53|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|420||||420|378|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|420||||420|9.73|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|420||||420|15.38|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|420||||420|14.59|390.6|9.73
30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|420||||420|210|390.6|9.73
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|251||||251|32.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|251||||251|21.08|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|251||||251|22.4|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|251||||251|22.4|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|251||||251|125.75|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|251||||251|88.1|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|251||||251|25.52|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|251||||251|106.93|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|251||||251|125.5|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|251||||251|163.15|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|CORESOURCE [1315]|CORESOURCE [131500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|251||||251|36.91|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|251||||251|22.6|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|GEHA [1415]|GEHA [141500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|251||||251|46.51|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HEALTHNET [1495]|HEALTHNET [149500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|251||||251|25.52|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|251||||251|233.43|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|251||||251|150.6|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|251||||251|22.74|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|251||||251|125.5|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|251||||251|21.63|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|251||||251|27.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|251||||251|21.08|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MULTIPLAN [1680]|HMA [168003]|251||||251|31.01|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MULTIPLAN [1680]|IHC HS [168011]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|251||||251|23.28|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|251||||251|22.74|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|Self-pay|Self-pay|251||||251|75.3|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|251||||251|52.71|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|251||||251|20.26|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|251||||251|30.18|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|TRUSTMARK [2030]|STARMARK [203000]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|251||||251|120.35|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|UMR [2035]|UMR OPTIONS [203501]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|251||||251|20.6|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|251||||251|225.9|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|251||||251|13.78|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|251||||251|22.6|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|251||||251|20.67|233.43|13.78
30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|251||||251|125.5|233.43|13.78
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|310||||310|32.97|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|310||||310|21.28|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|310||||310|22.6|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|310||||310|22.6|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|310||||310|155.31|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|310||||310|108.81|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|310||||310|25.76|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|310||||310|132.06|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|310||||310|155|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|310||||310|201.5|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|CORESOURCE [1315]|CORESOURCE [131500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|310||||310|42.34|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|310||||310|25.92|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|GEHA [1415]|GEHA [141500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|310||||310|46.94|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HEALTHNET [1495]|HEALTHNET [149500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|310||||310|25.76|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|310||||310|288.3|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|310||||310|186|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|310||||310|22.95|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|310||||310|155|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|310||||310|21.83|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|310||||310|28.16|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|310||||310|21.28|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MULTIPLAN [1680]|HMA [168003]|310||||310|31.29|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MULTIPLAN [1680]|IHC HS [168011]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|310||||310|23.49|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|310||||310|22.95|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|Self-pay|Self-pay|310||||310|93|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|310||||310|65.1|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|310||||310|20.44|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|310||||310|30.46|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|TRUSTMARK [2030]|STARMARK [203000]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|310||||310|148.65|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|UMR [2035]|UMR OPTIONS [203501]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|310||||310|20.79|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|310||||310|279|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|310||||310|13.91|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|310||||310|25.92|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|310||||310|20.86|288.3|13.91
30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|310||||310|155|288.3|13.91
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|AETNA [1015]|AETNA ACO WILCO [101532]|143||||143|42.35|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|143||||143|27.76|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|143||||143|29.5|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|143||||143|29.5|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|143||||143|71.64|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|143||||143|50.19|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|143||||143|33.08|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|143||||143|60.92|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|143||||143|71.5|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|143||||143|92.95|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|CORESOURCE [1315]|CORESOURCE [131500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|143||||143|40.33|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|143||||143|24.69|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|GEHA [1415]|GEHA [141500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|143||||143|61.25|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HEALTHNET [1495]|HEALTHNET [149500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|143||||143|33.08|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|143||||143|132.99|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|143||||143|85.8|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|143||||143|29.94|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|143||||143|71.5|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|143||||143|28.49|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|143||||143|36.75|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|143||||143|27.76|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MULTIPLAN [1680]|HMA [168003]|143||||143|40.83|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MULTIPLAN [1680]|IHC HS [168011]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|143||||143|30.66|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|143||||143|29.94|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|Self-pay|Self-pay|143||||143|42.9|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|143||||143|30.03|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|143||||143|26.68|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|143||||143|39.74|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|TRUSTMARK [2030]|STARMARK [203000]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|143||||143|68.57|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|UMR [2035]|UMR OPTIONS [203501]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|143||||143|27.13|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|143||||143|128.7|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|143||||143|17.86|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|143||||143|24.69|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|143||||143|27.22|132.99|17.86
30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|143||||143|71.5|132.99|17.86
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|419||||419|30.62|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|419||||419|19.77|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|419||||419|21|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|419||||419|21|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|419||||419|209.92|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|419||||419|147.07|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|419||||419|23.92|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|419||||419|178.49|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|419||||419|209.5|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|419||||419|272.35|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|CORESOURCE [1315]|CORESOURCE [131500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|419||||419|42.11|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|419||||419|25.78|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|GEHA [1415]|GEHA [141500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|419||||419|43.61|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HEALTHNET [1495]|HEALTHNET [149500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|419||||419|23.92|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|419||||419|389.67|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|419||||419|251.4|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|419||||419|21.32|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|419||||419|209.5|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|419||||419|20.28|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|419||||419|26.16|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|419||||419|19.77|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MULTIPLAN [1680]|HMA [168003]|419||||419|29.07|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MULTIPLAN [1680]|IHC HS [168011]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|419||||419|21.83|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|419||||419|21.32|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|Self-pay|Self-pay|419||||419|125.7|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|419||||419|87.99|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|419||||419|18.99|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|419||||419|28.29|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|TRUSTMARK [2030]|STARMARK [203000]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|419||||419|200.91|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|UMR [2035]|UMR OPTIONS [203501]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|419||||419|19.31|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|419||||419|377.1|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|419||||419|12.92|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|419||||419|25.78|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|419||||419|19.38|389.67|12.92
30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|419||||419|209.5|389.67|12.92
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|414||||414|59.42|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|414||||414|45.25|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|414||||414|45.25|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|414||||414|207.41|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|414||||414|145.31|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|414||||414|41.77|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|414||||414|176.36|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|414||||414|207|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|414||||414|269.1|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|414||||414|56.38|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|414||||414|34.52|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|GEHA [1415]|GEHA [141500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|414||||414|41.77|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|414||||414|385.02|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|414||||414|248.4|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|414||||414|207|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|414||||414|43.71|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MULTIPLAN [1680]|HMA [168003]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MULTIPLAN [1680]|IHC HS [168011]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|414||||414|47.03|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|Self-pay|Self-pay|414||||414|124.2|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|414||||414|86.94|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|TRUSTMARK [2030]|STARMARK [203000]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|414||||414|198.51|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|UMR [2035]|UMR OPTIONS [203501]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|414||||414|41.63|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|414||||414|372.6|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|414||||414|25.06|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|414||||414|34.52|385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|414||||414||385.02|25.06
30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|414||||414|207|385.02|25.06
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|250||||250|29.08|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250||||250|18.76|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250||||250|19.93|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250||||250|19.93|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|250||||250|125.25|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250||||250|87.75|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250||||250|22.71|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|250||||250|106.5|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|250||||250|125|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250||||250|162.5|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|250||||250|27.68|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|250||||250|16.95|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|GEHA [1415]|GEHA [141500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|250||||250|41.38|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250||||250|22.71|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|250||||250|232.5|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250||||250|150|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250||||250|20.23|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250||||250|125|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250||||250|19.25|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250||||250|24.83|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250||||250|18.76|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MULTIPLAN [1680]|HMA [168003]|250||||250|27.59|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|250||||250|20.71|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250||||250|20.23|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|Self-pay|Self-pay|250||||250|75|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250||||250|52.5|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|250||||250|18.02|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250||||250|26.85|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250||||250|119.88|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250||||250|18.34|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250||||250|225|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|250||||250|12.26|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|250||||250|16.95|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|250||||250|18.39|232.5|12.26
30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|250||||250|125|232.5|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|223||||223|29.08|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223||||223|18.76|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223||||223|19.93|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223||||223|19.93|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|223||||223|111.72|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223||||223|78.27|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223||||223|22.71|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|223||||223|95|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|223||||223|111.5|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223||||223|144.95|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|223||||223|27.68|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|223||||223|16.95|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|GEHA [1415]|GEHA [141500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|223||||223|41.38|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223||||223|22.71|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|223||||223|207.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223||||223|133.8|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223||||223|20.23|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223||||223|111.5|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223||||223|19.25|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223||||223|24.83|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223||||223|18.76|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MULTIPLAN [1680]|HMA [168003]|223||||223|27.59|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MULTIPLAN [1680]|IHC HS [168011]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|223||||223|20.71|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223||||223|20.23|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|Self-pay|Self-pay|223||||223|66.9|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223||||223|46.83|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|223||||223|18.02|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223||||223|26.85|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|TRUSTMARK [2030]|STARMARK [203000]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223||||223|106.93|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|UMR [2035]|UMR OPTIONS [203501]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223||||223|18.34|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223||||223|200.7|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|223||||223|12.26|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|223||||223|16.95|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|223||||223|18.39|207.39|12.26
30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|223||||223|111.5|207.39|12.26
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|226||||226|5.79|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226||||226|3.74|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226||||226|3.98|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226||||226|3.98|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|226||||226|113.23|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226||||226|79.33|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226||||226|4.53|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|226||||226|96.28|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|226||||226|113|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226||||226|146.9|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|226||||226|11.37|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|226||||226|6.96|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|GEHA [1415]|GEHA [141500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|226||||226|8.26|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226||||226|4.53|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|226||||226|210.18|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226||||226|135.6|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226||||226|4.04|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226||||226|113|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226||||226|3.84|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226||||226|4.95|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226||||226|3.74|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MULTIPLAN [1680]|HMA [168003]|226||||226|5.51|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|226||||226|4.14|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226||||226|4.04|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|Self-pay|Self-pay|226||||226|67.8|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226||||226|47.46|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|226||||226|3.6|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226||||226|5.36|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226||||226|108.37|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|UMR [2035]|UMR OPTIONS [203501]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226||||226|3.66|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226||||226|203.4|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|226||||226|2.44|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|226||||226|6.96|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|226||||226|3.67|210.18|2.44
30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|226||||226|113|210.18|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|237||||237|5.79|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237||||237|3.74|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237||||237|3.98|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237||||237|3.98|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|237||||237|118.74|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237||||237|83.19|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237||||237|4.53|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|237||||237|100.96|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|237||||237|118.5|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237||||237|154.05|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|237||||237|9.87|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|237||||237|6.04|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|GEHA [1415]|GEHA [141500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|237||||237|8.26|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237||||237|4.53|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|237||||237|220.41|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237||||237|142.2|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237||||237|4.04|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237||||237|118.5|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237||||237|3.84|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237||||237|4.95|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237||||237|3.74|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MULTIPLAN [1680]|HMA [168003]|237||||237|5.51|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MULTIPLAN [1680]|IHC HS [168011]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|237||||237|4.14|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237||||237|4.04|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|Self-pay|Self-pay|237||||237|71.1|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237||||237|49.77|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|237||||237|3.6|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237||||237|5.36|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|TRUSTMARK [2030]|STARMARK [203000]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237||||237|113.64|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|UMR [2035]|UMR OPTIONS [203501]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237||||237|3.66|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237||||237|213.3|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|237||||237|2.44|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|237||||237|6.04|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|237||||237|3.67|220.41|2.44
30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|237||||237|118.5|220.41|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|AETNA [1015]|AETNA ACO WILCO [101532]|238||||238|5.79|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238||||238|4.08|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238||||238|4.33|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238||||238|4.33|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|238||||238|119.24|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238||||238|83.54|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238||||238|4.53|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|238||||238|101.39|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|238||||238|119|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238||||238|154.7|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|CORESOURCE [1315]|CORESOURCE [131500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|238||||238|9.87|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|238||||238|6.04|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|GEHA [1415]|GEHA [141500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|238||||238|9|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HEALTHNET [1495]|HEALTHNET [149500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238||||238|4.53|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|238||||238|221.34|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238||||238|142.8|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238||||238|4.4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238||||238|119|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238||||238|4.19|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238||||238|5.4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238||||238|4.08|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MULTIPLAN [1680]|HMA [168003]|238||||238|6|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MULTIPLAN [1680]|IHC HS [168011]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|238||||238|4.5|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238||||238|4.4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|Self-pay|Self-pay|238||||238|71.4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238||||238|49.98|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|238||||238|3.92|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238||||238|5.84|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|TRUSTMARK [2030]|STARMARK [203000]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238||||238|114.12|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|UMR [2035]|UMR OPTIONS [203501]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238||||238|3.99|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238||||238|214.2|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|238||||238|2.44|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|238||||238|6.04|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|238||||238|4|221.34|2.44
30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|238||||238|119|221.34|2.44
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|258||||258|23.8|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|258||||258|16.31|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|258||||258|16.31|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|258||||258|129.26|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|258||||258|90.56|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|258||||258|18.59|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|258||||258|109.91|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|258||||258|129|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|258||||258|167.7|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|258||||258|27.86|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|258||||258|17.06|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|GEHA [1415]|GEHA [141500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|258||||258|18.59|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|258||||258|239.94|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|258||||258|154.8|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|258||||258|129|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|258||||258|15.75|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MULTIPLAN [1680]|HMA [168003]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|258||||258|16.95|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|Self-pay|Self-pay|258||||258|77.4|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|258||||258|54.18|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|258||||258|123.71|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|UMR [2035]|UMR OPTIONS [203501]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|258||||258|15|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|258||||258|232.2|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|258||||258|10.04|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|258||||258|17.06|239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|258||||258||239.94|10.04
30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|258||||258|129|239.94|10.04
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|353||||353|16.97|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|353||||353|10.95|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|353||||353|11.64|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|353||||353|11.64|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|353||||353|176.85|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|353||||353|123.9|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|353||||353|13.26|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|353||||353|150.38|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|353||||353|176.5|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|353||||353|229.45|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|353||||353|33.63|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|353||||353|20.59|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|GEHA [1415]|GEHA [141500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|353||||353|24.17|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|353||||353|13.26|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|353||||353|328.29|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|353||||353|211.8|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|353||||353|11.81|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|353||||353|176.5|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|353||||353|11.24|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|353||||353|14.5|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|353||||353|10.95|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MULTIPLAN [1680]|HMA [168003]|353||||353|16.11|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|353||||353|12.1|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|353||||353|11.81|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|Self-pay|Self-pay|353||||353|105.9|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|353||||353|74.13|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|353||||353|10.53|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|353||||353|15.68|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|353||||353|169.26|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|UMR [2035]|UMR OPTIONS [203501]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|353||||353|10.71|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|353||||353|317.7|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|353||||353|7.16|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|353||||353|20.59|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|353||||353|10.74|328.29|7.16
30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|353||||353|176.5|328.29|7.16
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|AETNA [1015]|AETNA ACO WILCO [101532]|215||||215|28.18|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215||||215|18.19|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215||||215|19.32|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215||||215|19.32|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|215||||215|107.72|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215||||215|75.47|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215||||215|22.01|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|215||||215|91.59|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|215||||215|107.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215||||215|139.75|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|CORESOURCE [1315]|CORESOURCE [131500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|215||||215|47.45|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|215||||215|29.05|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|GEHA [1415]|GEHA [141500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|215||||215|40.12|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HEALTHNET [1495]|HEALTHNET [149500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215||||215|22.01|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|215||||215|199.95|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215||||215|129|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215||||215|19.61|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215||||215|107.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215||||215|18.66|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215||||215|24.07|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215||||215|18.19|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MULTIPLAN [1680]|HMA [168003]|215||||215|26.75|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MULTIPLAN [1680]|IHC HS [168011]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|215||||215|20.08|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215||||215|19.61|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|Self-pay|Self-pay|215||||215|64.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215||||215|45.15|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|215||||215|17.47|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215||||215|26.03|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|TRUSTMARK [2030]|STARMARK [203000]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215||||215|103.09|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|UMR [2035]|UMR OPTIONS [203501]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215||||215|17.77|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215||||215|193.5|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|215||||215|11.89|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|215||||215|29.05|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|215||||215|17.83|199.95|11.89
30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|215||||215|107.5|199.95|11.89
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|AETNA [1015]|AETNA ACO WILCO [101532]|247||||247|26.91|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247||||247|18.45|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247||||247|18.45|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|247||||247|123.75|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247||||247|86.7|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247||||247|21.02|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|247||||247|105.22|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|247||||247|123.5|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247||||247|160.55|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|CORESOURCE [1315]|CORESOURCE [131500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|247||||247|40.07|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|247||||247|24.75|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|GEHA [1415]|GEHA [141500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HEALTHNET [1495]|HEALTHNET [149500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247||||247|21.02|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|247||||247|229.71|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247||||247|148.2|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247||||247|123.5|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247||||247|17.82|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MULTIPLAN [1680]|HMA [168003]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MULTIPLAN [1680]|IHC HS [168011]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|247||||247|19.18|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|Self-pay|Self-pay|247||||247|74.1|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247||||247|51.87|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|TRUSTMARK [2030]|STARMARK [203000]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247||||247|118.44|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|UMR [2035]|UMR OPTIONS [203501]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247||||247|16.97|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247||||247|222.3|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|247||||247|11.35|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|247||||247|24.75|229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|247||||247||229.71|11.35
30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|247||||247|123.5|229.71|11.35
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|AETNA [1015]|AETNA ACO WILCO [101532]|1591||||1591|41.55|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1591||||1591|29.79|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1591||||1591|31.65|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1591||||1591|31.65|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1591||||1591|797.09|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1591||||1591|558.44|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1591||||1591|677.77|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1591||||1591|795.5|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1591||||1591|1034.15|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|CORESOURCE [1315]|CORESOURCE [131500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1591||||1591|45.09|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1591||||1591|28.23|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|GEHA [1415]|GEHA [141500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1591||||1591|65.72|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HEALTHNET [1495]|HEALTHNET [149500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1591||||1591|1479.63|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1591||||1591|954.6|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1591||||1591|32.13|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1591||||1591|795.5|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1591||||1591|30.57|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1591||||1591|39.43|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1591||||1591|29.79|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MULTIPLAN [1680]|HMA [168003]|1591||||1591|43.82|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MULTIPLAN [1680]|IHC HS [168011]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1591||||1591|32.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1591||||1591|32.13|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|Self-pay|Self-pay|1591||||1591|477.3|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1591||||1591|334.11|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1591||||1591|28.63|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1591||||1591|42.65|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|TRUSTMARK [2030]|STARMARK [203000]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1591||||1591|762.88|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|UMR [2035]|UMR OPTIONS [203501]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1591||||1591|29.11|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1591||||1591|1431.9|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1591||||1591|17.53|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1591||||1591|28.23|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1591||||1591|29.21|1479.63|17.53
30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1591||||1591|795.5|1479.63|17.53
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|379||||379|22.67|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|379||||379|15.55|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|379||||379|15.55|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|379||||379|189.88|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|379||||379|133.03|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|379||||379|17.71|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|379||||379|161.45|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|379||||379|189.5|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|379||||379|246.35|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|CORESOURCE [1315]|CORESOURCE [131500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|379||||379|31.61|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|379||||379|19.35|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|GEHA [1415]|GEHA [141500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HEALTHNET [1495]|HEALTHNET [149500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|379||||379|17.71|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|379||||379|352.47|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|379||||379|227.4|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|379||||379|189.5|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|379||||379|15.02|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MULTIPLAN [1680]|HMA [168003]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MULTIPLAN [1680]|IHC HS [168011]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|379||||379|16.16|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|Self-pay|Self-pay|379||||379|113.7|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|379||||379|79.59|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|TRUSTMARK [2030]|STARMARK [203000]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|379||||379|181.73|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|UMR [2035]|UMR OPTIONS [203501]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|379||||379|14.3|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|379||||379|341.1|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|379||||379|9.56|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|379||||379|19.35|352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|379||||379||352.47|9.56
30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|379||||379|189.5|352.47|9.56
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|266||||266|37.97|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|266||||266|28.92|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|266||||266|28.92|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|266||||266|133.27|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|266||||266|93.37|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|266||||266|26.69|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|266||||266|113.32|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|266||||266|133|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|266||||266|172.9|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|266||||266|30.31|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|266||||266|18.55|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|GEHA [1415]|GEHA [141500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|266||||266|26.69|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|266||||266|247.38|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|266||||266|159.6|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|266||||266|133|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|266||||266|27.93|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MULTIPLAN [1680]|HMA [168003]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MULTIPLAN [1680]|IHC HS [168011]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|266||||266|30.06|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|Self-pay|Self-pay|266||||266|79.8|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|266||||266|55.86|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|TRUSTMARK [2030]|STARMARK [203000]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|266||||266|127.55|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|UMR [2035]|UMR OPTIONS [203501]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|266||||266|26.6|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|266||||266|239.4|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|266||||266|16.01|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|266||||266|18.55|247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|266||||266||247.38|16.01
30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|266||||266|133|247.38|16.01
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|AETNA [1015]|AETNA ACO WILCO [101532]|469||||469|44.41|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469||||469|28.66|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469||||469|30.44|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469||||469|30.44|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|469||||469|234.97|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469||||469|164.62|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469||||469|34.69|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|469||||469|199.79|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|469||||469|234.5|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469||||469|304.85|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|CORESOURCE [1315]|CORESOURCE [131500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|CORVEL CORP [2235]|CORVEL CORP [223500]|469||||469|47.59|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|469||||469|29.13|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|GEHA [1415]|GEHA [141500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|469||||469|63.23|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HEALTHNET [1495]|HEALTHNET [149500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469||||469|34.69|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HEALTHSMART [1505]|HEALTHSMART [150501]|469||||469|436.17|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469||||469|281.4|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469||||469|30.91|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469||||469|234.5|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469||||469|29.4|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469||||469|37.94|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469||||469|28.66|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MULTIPLAN [1680]|HMA [168003]|469||||469|42.15|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MULTIPLAN [1680]|IHC HS [168011]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|469||||469|31.64|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469||||469|30.91|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|Self-pay|Self-pay|469||||469|140.7|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469||||469|98.49|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|469||||469|27.54|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469||||469|41.03|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|TRUSTMARK [2030]|STARMARK [203000]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469||||469|224.89|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|UMR [2035]|UMR OPTIONS [203501]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469||||469|28|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469||||469|422.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|469||||469|18.73|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|469||||469|29.13|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|469||||469|28.1|436.17|18.73
30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|469||||469|234.5|436.17|18.73
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|143||||143|20.6|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|143||||143|15.69|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|143||||143|15.69|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|143||||143|71.64|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|143||||143|50.19|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|143||||143|14.48|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|143||||143|60.92|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|143||||143|71.5|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|143||||143|92.95|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|CORESOURCE [1315]|CORESOURCE [131500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|143||||143|21.46|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|143||||143|13.14|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|GEHA [1415]|GEHA [141500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HEALTHNET [1495]|HEALTHNET [149500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|143||||143|14.48|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|143||||143|132.99|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|143||||143|85.8|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|143||||143|71.5|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|143||||143|15.15|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MULTIPLAN [1680]|HMA [168003]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MULTIPLAN [1680]|IHC HS [168011]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|143||||143|16.31|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|Self-pay|Self-pay|143||||143|42.9|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|143||||143|30.03|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|TRUSTMARK [2030]|STARMARK [203000]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|143||||143|68.57|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|UMR [2035]|UMR OPTIONS [203501]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|143||||143|14.43|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|143||||143|128.7|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|143||||143|8.69|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|143||||143|13.14|132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|143||||143||132.99|8.69
30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|143||||143|71.5|132.99|8.69
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|174||||174|14.92|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|174||||174|10.22|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|174||||174|10.22|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|174||||174|87.17|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|174||||174|61.07|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|174||||174|11.66|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|174||||174|74.12|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|174||||174|87|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|174||||174|113.1|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|CORESOURCE [1315]|CORESOURCE [131500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|174||||174|20.3|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|174||||174|12.43|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|GEHA [1415]|GEHA [141500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HEALTHNET [1495]|HEALTHNET [149500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|174||||174|11.66|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|174||||174|161.82|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|174||||174|104.4|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|174||||174|87|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|174||||174|9.88|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MULTIPLAN [1680]|HMA [168003]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MULTIPLAN [1680]|IHC HS [168011]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|174||||174|10.62|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|Self-pay|Self-pay|174||||174|52.2|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|174||||174|36.54|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|TRUSTMARK [2030]|STARMARK [203000]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|174||||174|83.43|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|UMR [2035]|UMR OPTIONS [203501]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|174||||174|9.41|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|174||||174|156.6|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|174||||174|6.29|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|174||||174|12.43|161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|174||||174||161.82|6.29
30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|174||||174|87|161.82|6.29
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|AETNA [1015]|AETNA ACO WILCO [101532]|169||||169|18.39|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169||||169|12.6|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169||||169|12.6|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169||||169|84.67|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169||||169|59.32|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169||||169|14.36|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169||||169|71.99|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169||||169|84.5|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169||||169|109.85|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|CORESOURCE [1315]|CORESOURCE [131500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169||||169|26.9|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169||||169|16.47|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|GEHA [1415]|GEHA [141500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HEALTHNET [1495]|HEALTHNET [149500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169||||169|14.36|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169||||169|157.17|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169||||169|101.4|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169||||169|84.5|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169||||169|12.17|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MULTIPLAN [1680]|HMA [168003]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MULTIPLAN [1680]|IHC HS [168011]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169||||169|13.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|Self-pay|Self-pay|169||||169|50.7|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169||||169|35.49|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|TRUSTMARK [2030]|STARMARK [203000]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169||||169|81.04|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|UMR [2035]|UMR OPTIONS [203501]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169||||169|11.59|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169||||169|152.1|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169||||169|7.76|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169||||169|16.47|157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169||||169||157.17|7.76
30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169||||169|84.5|157.17|7.76
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1074||||1074|101.32|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1074||||1074|77.18|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1074||||1074|77.18|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1074||||1074|538.07|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1074||||1074|376.97|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1074||||1074|71.23|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1074||||1074|457.52|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1074||||1074|537|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1074||||1074|698.1|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|CORESOURCE [1315]|CORESOURCE [131500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1074||||1074|87.79|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1074||||1074|53.75|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|GEHA [1415]|GEHA [141500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HEALTHNET [1495]|HEALTHNET [149500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1074||||1074|71.23|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1074||||1074|998.82|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1074||||1074|644.4|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1074||||1074|537|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1074||||1074|74.54|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MULTIPLAN [1680]|HMA [168003]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MULTIPLAN [1680]|IHC HS [168011]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1074||||1074|80.22|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|Self-pay|Self-pay|1074||||1074|322.2|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1074||||1074|225.54|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|TRUSTMARK [2030]|STARMARK [203000]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1074||||1074|514.98|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|UMR [2035]|UMR OPTIONS [203501]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1074||||1074|70.99|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1074||||1074|966.6|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1074||||1074|42.74|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1074||||1074|53.75|998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1074||||1074||998.82|42.74
30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1074||||1074|537|998.82|42.74
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|AETNA [1015]|AETNA ACO WILCO [101532]|536||||536|57.79|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|536||||536|37.3|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|536||||536|39.63|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|536||||536|39.63|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|536||||536|268.54|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|536||||536|188.14|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|536||||536|45.14|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|536||||536|228.34|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|536||||536|268|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|536||||536|348.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|CORESOURCE [1315]|CORESOURCE [131500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|536||||536|76.09|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|536||||536|46.58|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|GEHA [1415]|GEHA [141500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|536||||536|82.28|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HEALTHNET [1495]|HEALTHNET [149500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|536||||536|45.14|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|536||||536|498.48|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|536||||536|321.6|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|536||||536|40.23|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|536||||536|268|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|536||||536|38.28|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|536||||536|49.37|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|536||||536|37.3|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MULTIPLAN [1680]|HMA [168003]|536||||536|54.86|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MULTIPLAN [1680]|IHC HS [168011]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|536||||536|41.19|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|536||||536|40.23|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|Self-pay|Self-pay|536||||536|160.8|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|536||||536|112.56|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|536||||536|35.84|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|536||||536|53.39|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|TRUSTMARK [2030]|STARMARK [203000]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|536||||536|257.01|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|UMR [2035]|UMR OPTIONS [203501]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|536||||536|36.45|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|536||||536|482.4|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|536||||536|24.38|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|536||||536|46.58|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|536||||536|36.57|498.48|24.38
30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY NON-ENDOCRINE(SPECIFY RECEPTOR)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|536||||536|268|498.48|24.38
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|375||||375|34.76|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|375||||375|22.43|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|375||||375|23.82|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|375||||375|23.82|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|375||||375|187.88|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|375||||375|131.63|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|375||||375|27.15|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|375||||375|159.75|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|375||||375|187.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|375||||375|243.75|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|CORESOURCE [1315]|CORESOURCE [131500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|375||||375|42.36|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|375||||375|25.93|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|GEHA [1415]|GEHA [141500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|375||||375|49.48|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HEALTHNET [1495]|HEALTHNET [149500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|375||||375|27.15|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|375||||375|348.75|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|375||||375|225|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|375||||375|24.19|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|375||||375|187.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|375||||375|23.01|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|375||||375|29.69|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|375||||375|22.43|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MULTIPLAN [1680]|HMA [168003]|375||||375|32.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MULTIPLAN [1680]|IHC HS [168011]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|375||||375|24.76|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|375||||375|24.19|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|Self-pay|Self-pay|375||||375|112.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|375||||375|78.75|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|375||||375|21.55|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|375||||375|32.11|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|TRUSTMARK [2030]|STARMARK [203000]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|375||||375|179.81|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|UMR [2035]|UMR OPTIONS [203501]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|375||||375|21.91|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|375||||375|337.5|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|375||||375|14.66|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|375||||375|25.93|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|375||||375|21.99|348.75|14.66
30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|375||||375|187.5|348.75|14.66
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|AETNA [1015]|AETNA ACO WILCO [101532]|246||||246|31.99|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246||||246|20.64|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|246||||246|21.93|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|246||||246|21.93|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|246||||246|123.25|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|246||||246|86.35|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|246||||246|24.98|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|246||||246|104.8|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|246||||246|123|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|246||||246|159.9|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|CORESOURCE [1315]|CORESOURCE [131500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|246||||246|40.2|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|246||||246|24.61|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|GEHA [1415]|GEHA [141500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|246||||246|45.54|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HEALTHNET [1495]|HEALTHNET [149500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|246||||246|24.98|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|246||||246|228.78|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|246||||246|147.6|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|246||||246|22.26|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|246||||246|123|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|246||||246|21.18|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|246||||246|27.32|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|246||||246|20.64|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MULTIPLAN [1680]|HMA [168003]|246||||246|30.36|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MULTIPLAN [1680]|IHC HS [168011]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|246||||246|22.79|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|246||||246|22.26|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|Self-pay|Self-pay|246||||246|73.8|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|246||||246|51.66|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|246||||246|19.84|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|246||||246|29.55|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|TRUSTMARK [2030]|STARMARK [203000]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|246||||246|117.96|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|UMR [2035]|UMR OPTIONS [203501]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|246||||246|20.17|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|246||||246|221.4|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|246||||246|13.49|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|246||||246|24.61|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|246||||246|20.24|228.78|13.49
30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|246||||246|123|228.78|13.49
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|154||||154|40.35|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154||||154|27.66|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154||||154|27.66|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|154||||154|77.15|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154||||154|54.05|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154||||154|31.52|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|154||||154|65.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|154||||154|77|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154||||154|100.1|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|154||||154|55.77|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|154||||154|34.15|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|GEHA [1415]|GEHA [141500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154||||154|31.52|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|154||||154|143.22|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154||||154|92.4|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154||||154|77|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154||||154|26.72|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MULTIPLAN [1680]|HMA [168003]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MULTIPLAN [1680]|IHC HS [168011]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|154||||154|28.75|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|Self-pay|Self-pay|154||||154|46.2|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154||||154|32.34|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|TRUSTMARK [2030]|STARMARK [203000]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154||||154|73.84|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|UMR [2035]|UMR OPTIONS [203501]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154||||154|25.44|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154||||154|138.6|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|154||||154|17.02|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|154||||154|34.15|143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|154||||154||143.22|17.02
30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|154||||154|77|143.22|17.02
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|1316||||1316|48.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1316||||1316|31.6|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1316||||1316|33.56|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1316||||1316|33.56|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1316||||1316|659.32|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1316||||1316|461.92|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1316||||1316|38.25|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1316||||1316|560.62|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1316||||1316|658|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1316||||1316|855.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|CORESOURCE [1315]|CORESOURCE [131500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1316||||1316|49.92|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1316||||1316|30.56|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|GEHA [1415]|GEHA [141500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1316||||1316|69.71|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HEALTHNET [1495]|HEALTHNET [149500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1316||||1316|38.25|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1316||||1316|1223.88|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1316||||1316|789.6|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1316||||1316|34.08|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1316||||1316|658|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1316||||1316|32.41|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1316||||1316|41.82|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1316||||1316|31.6|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MULTIPLAN [1680]|HMA [168003]|1316||||1316|46.47|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MULTIPLAN [1680]|IHC HS [168011]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1316||||1316|34.88|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1316||||1316|34.08|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|Self-pay|Self-pay|1316||||1316|394.8|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1316||||1316|276.36|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1316||||1316|30.36|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1316||||1316|45.23|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|TRUSTMARK [2030]|STARMARK [203000]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1316||||1316|631.02|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|UMR [2035]|UMR OPTIONS [203501]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1316||||1316|30.87|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1316||||1316|1184.4|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1316||||1316|20.66|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1316||||1316|30.56|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1316||||1316|30.98|1223.88|20.66
30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1316||||1316|658|1223.88|20.66
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|281||||281|34.35|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281||||281|22.16|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281||||281|23.55|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281||||281|23.55|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|281||||281|140.78|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281||||281|98.63|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281||||281|26.83|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|281||||281|119.71|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|281||||281|140.5|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281||||281|182.65|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|281||||281|32.82|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|281||||281|20.1|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|GEHA [1415]|GEHA [141500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|281||||281|48.89|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281||||281|26.83|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|281||||281|261.33|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281||||281|168.6|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281||||281|23.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281||||281|140.5|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281||||281|22.74|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281||||281|29.34|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281||||281|22.16|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MULTIPLAN [1680]|HMA [168003]|281||||281|32.6|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MULTIPLAN [1680]|IHC HS [168011]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|281||||281|24.48|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281||||281|23.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|Self-pay|Self-pay|281||||281|84.3|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281||||281|59.01|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|281||||281|21.3|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281||||281|31.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|TRUSTMARK [2030]|STARMARK [203000]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281||||281|134.74|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|UMR [2035]|UMR OPTIONS [203501]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281||||281|21.66|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281||||281|252.9|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|281||||281|14.49|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|281||||281|20.1|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|281||||281|21.73|261.33|14.49
30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|281||||281|140.5|261.33|14.49
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|AETNA [1015]|AETNA ACO WILCO [101532]|425||||425|37.2|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|425||||425|27.32|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|425||||425|27.32|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|425||||425|212.93|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|425||||425|149.18|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|425||||425|29.06|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|425||||425|181.05|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|425||||425|212.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|425||||425|276.25|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|CORESOURCE [1315]|CORESOURCE [131500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|425||||425|49.67|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|425||||425|30.41|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|GEHA [1415]|GEHA [141500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HEALTHNET [1495]|HEALTHNET [149500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|425||||425|29.06|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|425||||425|395.25|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|425||||425|255|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|425||||425|212.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|425||||425|26.38|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MULTIPLAN [1680]|HMA [168003]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MULTIPLAN [1680]|IHC HS [168011]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|425||||425|28.4|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|Self-pay|Self-pay|425||||425|127.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|425||||425|89.25|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|TRUSTMARK [2030]|STARMARK [203000]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|425||||425|203.79|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|UMR [2035]|UMR OPTIONS [203501]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|425||||425|25.12|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|425||||425|382.5|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|425||||425|15.69|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|425||||425|30.41|395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|425||||425||395.25|15.69
30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|425||||425|212.5|395.25|15.69
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|284||||284|7.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|284||||284|4.91|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|284||||284|5.21|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|284||||284|5.21|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|284||||284|142.28|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|284||||284|99.68|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|284||||284|5.94|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|284||||284|120.98|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|284||||284|142|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|284||||284|184.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|284||||284|8.52|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|284||||284|5.22|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|GEHA [1415]|GEHA [141500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|284||||284|10.82|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|284||||284|5.94|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|284||||284|264.12|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|284||||284|170.4|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|284||||284|5.29|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|284||||284|142|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|284||||284|5.03|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|284||||284|6.49|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|284||||284|4.91|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MULTIPLAN [1680]|HMA [168003]|284||||284|7.22|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|284||||284|5.42|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|284||||284|5.29|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|Self-pay|Self-pay|284||||284|85.2|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|284||||284|59.64|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|284||||284|4.71|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|284||||284|7.02|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|284||||284|136.18|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|UMR [2035]|UMR OPTIONS [203501]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|284||||284|4.79|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|284||||284|255.6|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|284||||284|3.21|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|284||||284|5.22|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|284||||284|4.81|264.12|3.21
30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|284||||284|142|264.12|3.21
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|AETNA [1015]|AETNA ACO WILCO [101532]|250||||250|7.68|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250||||250|5.16|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250||||250|5.49|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250||||250|5.49|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|250||||250|125.25|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250||||250|87.75|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250||||250|6|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|250||||250|106.5|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|250||||250|125|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250||||250|162.5|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|CORESOURCE [1315]|CORESOURCE [131500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|250||||250|8.61|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|250||||250|5.27|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|GEHA [1415]|GEHA [141500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|250||||250|11.39|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HEALTHNET [1495]|HEALTHNET [149500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250||||250|6|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|250||||250|232.5|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250||||250|150|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250||||250|5.57|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250||||250|125|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250||||250|5.3|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250||||250|6.83|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250||||250|5.16|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MULTIPLAN [1680]|HMA [168003]|250||||250|7.59|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MULTIPLAN [1680]|IHC HS [168011]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|250||||250|5.71|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250||||250|5.57|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|Self-pay|Self-pay|250||||250|75|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250||||250|52.5|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|250||||250|4.96|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250||||250|7.39|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|TRUSTMARK [2030]|STARMARK [203000]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250||||250|119.88|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|UMR [2035]|UMR OPTIONS [203501]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250||||250|5.05|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250||||250|225|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|250||||250|3.24|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|250||||250|5.27|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|250||||250|5.06|232.5|3.24
30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|250||||250|125|232.5|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|82||||82|7.68|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82||||82|5.27|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82||||82|5.27|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82||||82|41.08|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82||||82|28.78|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82||||82|6|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82||||82|34.93|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82||||82|41|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82||||82|53.3|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82||||82|9.81|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82||||82|6.01|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|GEHA [1415]|GEHA [141500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82||||82|6|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82||||82|76.26|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82||||82|49.2|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82||||82|41|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82||||82|5.09|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MULTIPLAN [1680]|HMA [168003]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82||||82|5.48|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|Self-pay|Self-pay|82||||82|24.6|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82||||82|17.22|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82||||82|39.32|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82||||82|4.84|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82||||82|73.8|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82||||82|3.24|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82||||82|6.01|76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82||||82||76.26|3.24
30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82||||82|41|76.26|3.24
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|378||||378|33.61|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|378||||378|21.69|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|378||||378|23.03|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|378||||378|23.03|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|378||||378|189.38|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|378||||378|132.68|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|378||||378|26.25|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|378||||378|161.03|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|378||||378|189|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|378||||378|245.7|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|CORESOURCE [1315]|CORESOURCE [131500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|378||||378|33.72|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|378||||378|20.65|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|GEHA [1415]|GEHA [141500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|378||||378|47.84|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HEALTHNET [1495]|HEALTHNET [149500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|378||||378|26.25|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|378||||378|351.54|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|378||||378|226.8|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|378||||378|23.39|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|378||||378|189|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|378||||378|22.24|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|378||||378|28.7|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|378||||378|21.69|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MULTIPLAN [1680]|HMA [168003]|378||||378|31.89|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MULTIPLAN [1680]|IHC HS [168011]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|378||||378|23.94|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|378||||378|23.39|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|Self-pay|Self-pay|378||||378|113.4|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|378||||378|79.38|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|378||||378|20.83|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|378||||378|31.04|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|TRUSTMARK [2030]|STARMARK [203000]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|378||||378|181.25|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|UMR [2035]|UMR OPTIONS [203501]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|378||||378|21.18|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|378||||378|340.2|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|378||||378|14.18|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|378||||378|20.65|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|378||||378|21.26|351.54|14.18
30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|378||||378|189|351.54|14.18
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|312||||312|28.88|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|312||||312|19.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|312||||312|19.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|312||||312|156.31|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|312||||312|109.51|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|312||||312|22.56|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|312||||312|132.91|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|312||||312|156|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|312||||312|202.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|CORESOURCE [1315]|CORESOURCE [131500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|312||||312|27.68|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|312||||312|16.95|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|GEHA [1415]|GEHA [141500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HEALTHNET [1495]|HEALTHNET [149500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|312||||312|22.56|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|312||||312|290.16|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|312||||312|187.2|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|312||||312|156|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|312||||312|19.12|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MULTIPLAN [1680]|HMA [168003]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MULTIPLAN [1680]|IHC HS [168011]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|312||||312|20.58|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|Self-pay|Self-pay|312||||312|93.6|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|312||||312|65.52|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|TRUSTMARK [2030]|STARMARK [203000]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|312||||312|149.6|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|UMR [2035]|UMR OPTIONS [203501]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|312||||312|18.21|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|312||||312|280.8|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|312||||312|12.19|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|312||||312|16.95|290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|312||||312||290.16|12.19
30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|312||||312|156|290.16|12.19
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|276||||276|11.52|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|276||||276|8.26|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|276||||276|8.77|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|276||||276|8.77|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|276||||276|138.28|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|276||||276|96.88|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|276||||276|8.63|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|276||||276|117.58|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|276||||276|138|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|276||||276|179.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|276||||276|10.68|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|276||||276|6.54|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|GEHA [1415]|GEHA [141500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|276||||276|18.23|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|276||||276|8.63|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|276||||276|256.68|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|276||||276|165.6|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|276||||276|8.91|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|276||||276|138|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|276||||276|8.47|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|276||||276|10.94|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|276||||276|8.26|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MULTIPLAN [1680]|HMA [168003]|276||||276|12.15|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MULTIPLAN [1680]|IHC HS [168011]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|276||||276|9.12|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|276||||276|8.91|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|Self-pay|Self-pay|276||||276|82.8|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|276||||276|57.96|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|276||||276|7.94|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|276||||276|11.83|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|TRUSTMARK [2030]|STARMARK [203000]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|276||||276|132.34|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|UMR [2035]|UMR OPTIONS [203501]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|276||||276|8.07|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|276||||276|248.4|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|276||||276|4.86|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|276||||276|6.54|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|276||||276|8.1|256.68|4.86
30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|276||||276|138|256.68|4.86
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|51||||51|4.67|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51||||51|3.55|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51||||51|3.55|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51||||51|25.55|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51||||51|17.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51||||51|3.28|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51||||51|21.73|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51||||51|25.5|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51||||51|33.15|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51||||51|4.84|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51||||51|2.96|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|GEHA [1415]|GEHA [141500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51||||51|3.28|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51||||51|47.43|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51||||51|30.6|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51||||51|25.5|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51||||51|3.43|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MULTIPLAN [1680]|HMA [168003]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MULTIPLAN [1680]|IHC HS [168011]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51||||51|3.69|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|Self-pay|Self-pay|51||||51|15.3|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51||||51|10.71|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|TRUSTMARK [2030]|STARMARK [203000]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51||||51|24.45|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|UMR [2035]|UMR OPTIONS [203501]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51||||51|3.26|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51||||51|45.9|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51||||51|1.97|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51||||51|2.96|47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51||||51||47.43|1.97
30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51||||51|25.5|47.43|1.97
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|AETNA [1015]|AETNA ACO WILCO [101532]|101||||101|8.69|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101||||101|5.96|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101||||101|5.96|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|101||||101|50.6|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101||||101|35.45|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101||||101|6.79|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|101||||101|43.03|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|101||||101|50.5|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101||||101|65.65|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|CORESOURCE [1315]|CORESOURCE [131500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|101||||101|9.07|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|101||||101|5.55|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|GEHA [1415]|GEHA [141500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HEALTHNET [1495]|HEALTHNET [149500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101||||101|6.79|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|101||||101|93.93|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101||||101|60.6|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101||||101|50.5|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101||||101|5.75|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MULTIPLAN [1680]|HMA [168003]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MULTIPLAN [1680]|IHC HS [168011]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|101||||101|6.19|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|Self-pay|Self-pay|101||||101|30.3|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101||||101|21.21|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|TRUSTMARK [2030]|STARMARK [203000]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101||||101|48.43|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|UMR [2035]|UMR OPTIONS [203501]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101||||101|5.48|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101||||101|90.9|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|101||||101|3.67|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|101||||101|5.55|93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|101||||101||93.93|3.67
30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|101||||101|50.5|93.93|3.67
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|198||||198|18.22|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198||||198|12.49|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198||||198|12.49|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198||||198|99.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198||||198|69.5|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198||||198|14.23|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198||||198|84.35|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198||||198|99|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198||||198|128.7|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198||||198|21.26|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198||||198|13.01|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|GEHA [1415]|GEHA [141500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198||||198|14.23|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198||||198|184.14|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198||||198|118.8|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198||||198|99|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198||||198|12.07|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MULTIPLAN [1680]|HMA [168003]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MULTIPLAN [1680]|IHC HS [168011]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198||||198|12.98|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|Self-pay|Self-pay|198||||198|59.4|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198||||198|41.58|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|TRUSTMARK [2030]|STARMARK [203000]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198||||198|94.94|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|UMR [2035]|UMR OPTIONS [203501]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198||||198|11.5|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198||||198|178.2|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198||||198|7.69|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198||||198|13.01|184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198||||198||184.14|7.69
30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198||||198|99|184.14|7.69
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|101||||101|7.81|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101||||101|5.95|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101||||101|5.95|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|101||||101|50.6|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101||||101|35.45|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101||||101|5.86|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|101||||101|43.03|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|101||||101|50.5|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101||||101|65.65|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|101||||101|7.76|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|101||||101|4.75|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|GEHA [1415]|GEHA [141500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101||||101|5.86|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|101||||101|93.93|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101||||101|60.6|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101||||101|50.5|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101||||101|5.74|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MULTIPLAN [1680]|HMA [168003]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MULTIPLAN [1680]|IHC HS [168011]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|101||||101|6.18|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|Self-pay|Self-pay|101||||101|30.3|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101||||101|21.21|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|TRUSTMARK [2030]|STARMARK [203000]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101||||101|48.43|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|UMR [2035]|UMR OPTIONS [203501]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101||||101|5.47|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101||||101|90.9|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|101||||101|3.29|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|101||||101|4.75|93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|101||||101||93.93|3.29
30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|101||||101|50.5|93.93|3.29
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|373||||373|40.25|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|373||||373|25.98|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|373||||373|27.59|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|373||||373|27.59|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|373||||373|186.87|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|373||||373|130.92|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|373||||373|31.45|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|373||||373|158.9|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|373||||373|186.5|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|373||||373|242.45|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|373||||373|60.63|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|373||||373|37.12|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|GEHA [1415]|GEHA [141500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|373||||373|57.31|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|373||||373|31.45|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|373||||373|346.89|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|373||||373|223.8|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|373||||373|28.02|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|373||||373|186.5|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|373||||373|26.65|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|373||||373|34.38|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|373||||373|25.98|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MULTIPLAN [1680]|HMA [168003]|373||||373|38.21|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MULTIPLAN [1680]|IHC HS [168011]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|373||||373|28.68|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|373||||373|28.02|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|Self-pay|Self-pay|373||||373|111.9|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|373||||373|78.33|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|373||||373|24.96|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|373||||373|37.19|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|TRUSTMARK [2030]|STARMARK [203000]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|373||||373|178.85|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|UMR [2035]|UMR OPTIONS [203501]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|373||||373|25.38|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|373||||373|335.7|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|373||||373|16.98|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|373||||373|37.12|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|373||||373|25.47|346.89|16.98
30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|373||||373|186.5|346.89|16.98
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|571||||571|40.79|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|571||||571|26.33|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|571||||571|27.96|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|571||||571|27.96|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|571||||571|286.07|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|571||||571|200.42|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|571||||571|31.87|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|571||||571|243.25|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|571||||571|285.5|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|571||||571|371.15|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|CORESOURCE [1315]|CORESOURCE [131500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|571||||571|54.8|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|571||||571|33.55|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|GEHA [1415]|GEHA [141500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|571||||571|58.07|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HEALTHNET [1495]|HEALTHNET [149500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|571||||571|31.87|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|571||||571|531.03|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|571||||571|342.6|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|571||||571|28.39|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|571||||571|285.5|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|571||||571|27.01|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|571||||571|34.84|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|571||||571|26.33|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MULTIPLAN [1680]|HMA [168003]|571||||571|38.72|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MULTIPLAN [1680]|IHC HS [168011]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|571||||571|29.06|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|571||||571|28.39|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|Self-pay|Self-pay|571||||571|171.3|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|571||||571|119.91|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|571||||571|25.29|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|571||||571|37.68|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|TRUSTMARK [2030]|STARMARK [203000]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|571||||571|273.79|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|UMR [2035]|UMR OPTIONS [203501]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|571||||571|25.73|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|571||||571|513.9|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|571||||571|17.21|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|571||||571|33.55|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|571||||571|25.81|531.03|17.21
30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|571||||571|285.5|531.03|17.21
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|AETNA [1015]|AETNA ACO WILCO [101532]|372||||372|33.56|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|372||||372|21.65|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|372||||372|23.01|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|372||||372|23.01|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|372||||372|186.37|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|372||||372|130.57|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|372||||372|26.21|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|372||||372|158.47|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|372||||372|186|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|372||||372|241.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|CORESOURCE [1315]|CORESOURCE [131500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|372||||372|44.13|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|372||||372|27.02|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|GEHA [1415]|GEHA [141500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|372||||372|47.77|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HEALTHNET [1495]|HEALTHNET [149500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|372||||372|26.21|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|372||||372|345.96|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|372||||372|223.2|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|372||||372|23.35|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|372||||372|186|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|372||||372|22.22|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|372||||372|28.66|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|372||||372|21.65|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MULTIPLAN [1680]|HMA [168003]|372||||372|31.85|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MULTIPLAN [1680]|IHC HS [168011]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|372||||372|23.92|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|372||||372|23.35|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|Self-pay|Self-pay|372||||372|111.6|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|372||||372|78.12|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|372||||372|20.81|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|372||||372|31|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|TRUSTMARK [2030]|STARMARK [203000]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|372||||372|178.37|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|UMR [2035]|UMR OPTIONS [203501]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|372||||372|21.16|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|372||||372|334.8|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|372||||372|14.15|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|372||||372|27.02|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|372||||372|21.23|345.96|14.15
30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|372||||372|186|345.96|14.15
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|214||||214|18.39|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|214||||214|12.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|214||||214|12.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|214||||214|107.21|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|214||||214|75.11|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|214||||214|14.36|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|214||||214|91.16|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|214||||214|107|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|214||||214|139.1|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|CORESOURCE [1315]|CORESOURCE [131500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|214||||214|26.23|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|214||||214|16.06|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|GEHA [1415]|GEHA [141500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HEALTHNET [1495]|HEALTHNET [149500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|214||||214|14.36|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|214||||214|199.02|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|214||||214|128.4|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|214||||214|107|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|214||||214|12.17|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MULTIPLAN [1680]|HMA [168003]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MULTIPLAN [1680]|IHC HS [168011]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|214||||214|13.1|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|Self-pay|Self-pay|214||||214|64.2|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|214||||214|44.94|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|TRUSTMARK [2030]|STARMARK [203000]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|214||||214|102.61|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|UMR [2035]|UMR OPTIONS [203501]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|214||||214|11.59|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|214||||214|192.6|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|214||||214|7.76|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|214||||214|16.06|199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|214||||214||199.02|7.76
30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|214||||214|107|199.02|7.76
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|487||||487|25.38|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|487||||487|16.38|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|487||||487|17.4|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|487||||487|17.4|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|487||||487|243.99|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|487||||487|170.94|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|487||||487|19.83|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|487||||487|207.46|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|487||||487|243.5|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|487||||487|316.55|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|487||||487|24.67|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|487||||487|15.11|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|GEHA [1415]|GEHA [141500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|487||||487|36.14|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|487||||487|19.83|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|487||||487|452.91|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|487||||487|292.2|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|487||||487|17.67|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|487||||487|243.5|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|487||||487|16.81|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|487||||487|21.68|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|487||||487|16.38|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MULTIPLAN [1680]|HMA [168003]|487||||487|24.09|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MULTIPLAN [1680]|IHC HS [168011]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|487||||487|18.09|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|487||||487|17.67|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|Self-pay|Self-pay|487||||487|146.1|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|487||||487|102.27|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|487||||487|15.74|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|487||||487|23.45|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|TRUSTMARK [2030]|STARMARK [203000]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|487||||487|233.52|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|UMR [2035]|UMR OPTIONS [203501]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|487||||487|16.01|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|487||||487|438.3|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|487||||487|10.7|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|487||||487|15.11|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|487||||487|16.06|452.91|10.7
30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|487||||487|243.5|452.91|10.7
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|170||||170|10.85|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170||||170|7.01|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170||||170|7.45|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170||||170|7.45|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170||||170|85.17|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170||||170|59.67|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170||||170|8.48|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170||||170|72.42|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170||||170|85|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170||||170|110.5|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170||||170|12.97|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170||||170|7.94|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|GEHA [1415]|GEHA [141500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170||||170|15.46|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170||||170|8.48|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170||||170|158.1|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170||||170|102|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170||||170|7.56|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170||||170|85|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170||||170|7.19|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170||||170|9.27|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170||||170|7.01|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MULTIPLAN [1680]|HMA [168003]|170||||170|10.31|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170||||170|7.74|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170||||170|7.56|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|Self-pay|Self-pay|170||||170|51|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170||||170|35.7|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170||||170|6.73|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170||||170|10.03|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170||||170|81.52|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170||||170|6.85|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170||||170|153|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170||||170|4.58|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170||||170|7.94|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170||||170|6.87|158.1|4.58
30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170||||170|85|158.1|4.58
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|350||||350|14.26|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350||||350|9.2|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350||||350|9.77|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350||||350|9.77|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|350||||350|175.35|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350||||350|122.85|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350||||350|11.13|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|350||||350|149.1|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|350||||350|175|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350||||350|227.5|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|350||||350|14.51|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|350||||350|8.88|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|GEHA [1415]|GEHA [141500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|350||||350|20.3|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350||||350|11.13|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|350||||350|325.5|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350||||350|210|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350||||350|9.92|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350||||350|175|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350||||350|9.44|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350||||350|12.18|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350||||350|9.2|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MULTIPLAN [1680]|HMA [168003]|350||||350|13.53|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MULTIPLAN [1680]|IHC HS [168011]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|350||||350|10.15|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350||||350|9.92|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|Self-pay|Self-pay|350||||350|105|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350||||350|73.5|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|350||||350|8.84|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350||||350|13.17|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|TRUSTMARK [2030]|STARMARK [203000]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350||||350|167.83|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|UMR [2035]|UMR OPTIONS [203501]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350||||350|8.99|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350||||350|315|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|350||||350|6.01|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|350||||350|8.88|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|350||||350|9.02|325.5|6.01
30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|350||||350|175|325.5|6.01
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|203||||203|23.37|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203||||203|16.01|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203||||203|16.01|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|203||||203|101.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203||||203|71.25|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203||||203|18.25|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|203||||203|86.48|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|203||||203|101.5|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203||||203|131.95|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|203||||203|23.71|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|203||||203|14.52|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|GEHA [1415]|GEHA [141500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203||||203|18.25|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|203||||203|188.79|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203||||203|121.8|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203||||203|101.5|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203||||203|15.47|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MULTIPLAN [1680]|HMA [168003]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MULTIPLAN [1680]|IHC HS [168011]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|203||||203|16.64|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|Self-pay|Self-pay|203||||203|60.9|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203||||203|42.63|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|TRUSTMARK [2030]|STARMARK [203000]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203||||203|97.34|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|UMR [2035]|UMR OPTIONS [203501]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203||||203|14.73|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203||||203|182.7|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|203||||203|9.86|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|203||||203|14.52|188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|203||||203||188.79|9.86
30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|203||||203|101.5|188.79|9.86
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|AETNA [1015]|AETNA ACO WILCO [101532]|356||||356|26.56|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356||||356|17.14|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356||||356|18.2|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356||||356|18.2|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|356||||356|178.36|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356||||356|124.96|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356||||356|20.75|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|356||||356|151.66|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|356||||356|178|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356||||356|231.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|CORESOURCE [1315]|CORESOURCE [131500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|356||||356|27.72|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|356||||356|16.97|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|GEHA [1415]|GEHA [141500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|356||||356|37.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HEALTHNET [1495]|HEALTHNET [149500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356||||356|20.75|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|356||||356|331.08|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356||||356|213.6|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356||||356|18.48|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356||||356|178|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356||||356|17.58|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356||||356|22.68|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356||||356|17.14|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MULTIPLAN [1680]|HMA [168003]|356||||356|25.2|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MULTIPLAN [1680]|IHC HS [168011]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|356||||356|18.92|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356||||356|18.48|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|Self-pay|Self-pay|356||||356|106.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356||||356|74.76|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|356||||356|16.46|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356||||356|24.53|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|TRUSTMARK [2030]|STARMARK [203000]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356||||356|170.7|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|UMR [2035]|UMR OPTIONS [203501]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356||||356|16.74|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356||||356|320.4|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|356||||356|11.2|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|356||||356|16.97|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|356||||356|16.8|331.08|11.2
30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|356||||356|178|331.08|11.2
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|AETNA [1015]|AETNA ACO WILCO [101532]|614||||614|80.38|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|614||||614|51.88|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|614||||614|55.11|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|614||||614|55.11|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|614||||614|307.61|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|614||||614|215.51|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|614||||614|62.78|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|614||||614|261.56|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|614||||614|307|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|614||||614|399.1|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|CORESOURCE [1315]|CORESOURCE [131500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|614||||614|93.88|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|614||||614|57.48|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|GEHA [1415]|GEHA [141500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|614||||614|114.44|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HEALTHNET [1495]|HEALTHNET [149500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|614||||614|62.78|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|614||||614|571.02|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|614||||614|368.4|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|614||||614|55.95|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|614||||614|307|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|614||||614|53.23|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|614||||614|68.66|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|614||||614|51.88|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MULTIPLAN [1680]|HMA [168003]|614||||614|76.29|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MULTIPLAN [1680]|IHC HS [168011]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|614||||614|57.28|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|614||||614|55.95|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|Self-pay|Self-pay|614||||614|184.2|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|614||||614|128.94|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|614||||614|49.84|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|614||||614|74.26|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|TRUSTMARK [2030]|STARMARK [203000]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|614||||614|294.41|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|UMR [2035]|UMR OPTIONS [203501]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|614||||614|50.69|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|614||||614|552.6|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|614||||614|33.91|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|614||||614|57.48|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|614||||614|50.86|571.02|33.91
30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|614||||614|307|571.02|33.91
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|AETNA [1015]|AETNA ACO WILCO [101532]|214||||214|22.4|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|214||||214|14.46|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|214||||214|15.36|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|214||||214|15.36|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|214||||214|107.21|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|214||||214|75.11|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|214||||214|17.51|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|214||||214|91.16|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|214||||214|107|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|214||||214|139.1|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|CORESOURCE [1315]|CORESOURCE [131500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|CORVEL CORP [2235]|CORVEL CORP [223500]|214||||214|29.65|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|214||||214|18.15|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|GEHA [1415]|GEHA [141500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|214||||214|31.91|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HEALTHNET [1495]|HEALTHNET [149500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|214||||214|17.51|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HEALTHSMART [1505]|HEALTHSMART [150501]|214||||214|199.02|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|214||||214|128.4|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|214||||214|15.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|214||||214|107|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|214||||214|14.84|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|214||||214|19.14|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|214||||214|14.46|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MULTIPLAN [1680]|HMA [168003]|214||||214|21.27|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MULTIPLAN [1680]|IHC HS [168011]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|214||||214|15.96|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|214||||214|15.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|Self-pay|Self-pay|214||||214|64.2|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|214||||214|44.94|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|214||||214|13.9|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|214||||214|20.7|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|TRUSTMARK [2030]|STARMARK [203000]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|214||||214|102.61|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|UMR [2035]|UMR OPTIONS [203501]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|214||||214|14.14|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|214||||214|192.6|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|214||||214|9.45|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|214||||214|18.15|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|214||||214|14.18|199.02|9.45
30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|214||||214|107|199.02|9.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|AETNA [1015]|AETNA ACO WILCO [101532]|341||||341|8.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|341||||341|5.28|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|341||||341|5.61|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|341||||341|5.61|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|341||||341|170.84|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|341||||341|119.69|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|341||||341|6.39|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|341||||341|145.27|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|341||||341|170.5|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|341||||341|221.65|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|CORESOURCE [1315]|CORESOURCE [131500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|341||||341|10.25|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|341||||341|6.27|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|GEHA [1415]|GEHA [141500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|341||||341|11.66|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HEALTHNET [1495]|HEALTHNET [149500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|341||||341|6.39|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|341||||341|317.13|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|341||||341|204.6|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|341||||341|5.7|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|341||||341|170.5|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|341||||341|5.42|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|341||||341|6.99|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|341||||341|5.28|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MULTIPLAN [1680]|HMA [168003]|341||||341|7.77|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MULTIPLAN [1680]|IHC HS [168011]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|341||||341|5.83|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|341||||341|5.7|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|Self-pay|Self-pay|341||||341|102.3|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|341||||341|71.61|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|341||||341|5.08|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|341||||341|7.56|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|TRUSTMARK [2030]|STARMARK [203000]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|341||||341|163.51|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|UMR [2035]|UMR OPTIONS [203501]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|341||||341|5.17|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|341||||341|306.9|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|341||||341|3.45|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|341||||341|6.27|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|341||||341|5.18|317.13|3.45
30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|341||||341|170.5|317.13|3.45
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|AETNA [1015]|AETNA ACO WILCO [101532]|247||||247|8.38|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247||||247|5.41|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247||||247|5.74|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247||||247|5.74|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|247||||247|123.75|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247||||247|86.7|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247||||247|6.54|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|247||||247|105.22|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|247||||247|123.5|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247||||247|160.55|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|CORESOURCE [1315]|CORESOURCE [131500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|247||||247|10.89|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|247||||247|6.67|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|GEHA [1415]|GEHA [141500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|247||||247|11.93|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HEALTHNET [1495]|HEALTHNET [149500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247||||247|6.54|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|247||||247|229.71|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247||||247|148.2|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247||||247|5.83|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247||||247|123.5|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247||||247|5.54|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247||||247|7.16|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247||||247|5.41|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MULTIPLAN [1680]|HMA [168003]|247||||247|7.95|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MULTIPLAN [1680]|IHC HS [168011]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|247||||247|5.97|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247||||247|5.83|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|Self-pay|Self-pay|247||||247|74.1|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247||||247|51.87|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|247||||247|5.19|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247||||247|7.74|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|TRUSTMARK [2030]|STARMARK [203000]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247||||247|118.44|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|UMR [2035]|UMR OPTIONS [203501]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247||||247|5.28|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247||||247|222.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|247||||247|3.53|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|247||||247|6.67|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|247||||247|5.3|229.71|3.53
30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|247||||247|123.5|229.71|3.53
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|258||||258|20.17|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|258||||258|13.02|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|258||||258|13.82|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|258||||258|13.82|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|258||||258|129.26|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|258||||258|90.56|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|258||||258|15.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|258||||258|109.91|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|258||||258|129|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|258||||258|167.7|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|CORESOURCE [1315]|CORESOURCE [131500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|258||||258|19.37|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|258||||258|11.86|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|GEHA [1415]|GEHA [141500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|258||||258|28.71|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HEALTHNET [1495]|HEALTHNET [149500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|258||||258|15.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|258||||258|239.94|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|258||||258|154.8|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|258||||258|14.04|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|258||||258|129|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|258||||258|13.35|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|258||||258|17.23|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|258||||258|13.02|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MULTIPLAN [1680]|HMA [168003]|258||||258|19.14|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MULTIPLAN [1680]|IHC HS [168011]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|258||||258|14.36|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|258||||258|14.04|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|Self-pay|Self-pay|258||||258|77.4|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|258||||258|54.18|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|258||||258|12.5|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|258||||258|18.63|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|TRUSTMARK [2030]|STARMARK [203000]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|258||||258|123.71|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|UMR [2035]|UMR OPTIONS [203501]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|258||||258|12.71|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|258||||258|232.2|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|258||||258|8.51|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|258||||258|11.86|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|258||||258|12.76|239.94|8.51
30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|258||||258|129|239.94|8.51
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|9.07|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|5.85|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|6.22|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|6.22|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|7.09|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|10.93|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|6.69|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242|12.92|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|7.09|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|6.31|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|6.01|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|7.75|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|5.85|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MULTIPLAN [1680]|HMA [168003]|242||||242|8.61|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|6.46|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|6.31|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|Self-pay|Self-pay|242||||242|72.6|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|5.63|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|8.38|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|5.73|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|3.83|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|6.69|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|5.74|225.06|3.83
30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|3.83
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|AETNA [1015]|AETNA ACO WILCO [101532]|116||||116|10.21|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116||||116|6.6|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116||||116|7.01|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116||||116|7.01|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116||||116|58.12|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116||||116|40.72|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116||||116|7.98|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116||||116|49.42|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116||||116|58|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116||||116|75.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|CORESOURCE [1315]|CORESOURCE [131500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|116||||116|12.94|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116||||116|7.92|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|GEHA [1415]|GEHA [141500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116||||116|14.56|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HEALTHNET [1495]|HEALTHNET [149500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116||||116|7.98|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|116||||116|107.88|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116||||116|69.6|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116||||116|7.12|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116||||116|58|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116||||116|6.77|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116||||116|8.73|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116||||116|6.6|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MULTIPLAN [1680]|HMA [168003]|116||||116|9.71|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MULTIPLAN [1680]|IHC HS [168011]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|116||||116|7.29|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116||||116|7.12|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|Self-pay|Self-pay|116||||116|34.8|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116||||116|24.36|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116||||116|6.34|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116||||116|9.45|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|TRUSTMARK [2030]|STARMARK [203000]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116||||116|55.62|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|UMR [2035]|UMR OPTIONS [203501]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116||||116|6.44|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116||||116|104.4|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116||||116|4.31|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116||||116|7.92|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116||||116|6.47|107.88|4.31
30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116||||116|58|107.88|4.31
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|251||||251|22.4|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|251||||251|14.46|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|251||||251|15.36|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|251||||251|15.36|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|251||||251|125.75|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|251||||251|88.1|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|251||||251|17.51|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|251||||251|106.93|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|251||||251|125.5|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|251||||251|163.15|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|251||||251|22.56|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|251||||251|13.81|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|GEHA [1415]|GEHA [141500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|251||||251|31.91|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|251||||251|17.51|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|251||||251|233.43|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|251||||251|150.6|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|251||||251|15.6|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|251||||251|125.5|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|251||||251|14.84|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|251||||251|19.14|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|251||||251|14.46|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MULTIPLAN [1680]|HMA [168003]|251||||251|21.27|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|251||||251|15.96|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|251||||251|15.6|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|Self-pay|Self-pay|251||||251|75.3|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|251||||251|52.71|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|251||||251|13.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|251||||251|20.7|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|251||||251|120.35|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|251||||251|14.14|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|251||||251|225.9|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|251||||251|9.45|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|251||||251|13.81|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|251||||251|14.18|233.43|9.45
30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|251||||251|125.5|233.43|9.45
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|426||||426|26.77|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|426||||426|17.28|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|426||||426|18.35|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|426||||426|18.35|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|426||||426|213.43|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|426||||426|149.53|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|426||||426|20.92|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|426||||426|181.48|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|426||||426|213|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|426||||426|276.9|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|426||||426|35.26|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|426||||426|21.59|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|GEHA [1415]|GEHA [141500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|426||||426|38.12|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|426||||426|20.92|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|426||||426|396.18|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|426||||426|255.6|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|426||||426|18.63|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|426||||426|213|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|426||||426|17.72|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|426||||426|22.87|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|426||||426|17.28|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MULTIPLAN [1680]|HMA [168003]|426||||426|25.41|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MULTIPLAN [1680]|IHC HS [168011]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|426||||426|19.07|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|426||||426|18.63|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|Self-pay|Self-pay|426||||426|127.8|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|426||||426|89.46|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|426||||426|16.6|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|426||||426|24.73|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|TRUSTMARK [2030]|STARMARK [203000]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|426||||426|204.27|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|UMR [2035]|UMR OPTIONS [203501]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|426||||426|16.88|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|426||||426|383.4|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|426||||426|11.29|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|426||||426|21.59|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|426||||426|16.94|396.18|11.29
30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|426||||426|213|396.18|11.29
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|AETNA [1015]|AETNA ACO WILCO [101532]|190||||190|24.91|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|190||||190|16.08|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|190||||190|17.07|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|190||||190|17.07|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|190||||190|95.19|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|190||||190|66.69|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|190||||190|19.46|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|190||||190|80.94|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|190||||190|95|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|190||||190|123.5|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|CORESOURCE [1315]|CORESOURCE [131500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|190||||190|34.58|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|190||||190|21.17|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|GEHA [1415]|GEHA [141500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|190||||190|35.46|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HEALTHNET [1495]|HEALTHNET [149500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|190||||190|19.46|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|190||||190|176.7|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|190||||190|114|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|190||||190|17.34|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|190||||190|95|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|190||||190|16.49|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|190||||190|21.28|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|190||||190|16.08|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MULTIPLAN [1680]|HMA [168003]|190||||190|23.64|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MULTIPLAN [1680]|IHC HS [168011]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|190||||190|17.74|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|190||||190|17.34|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|Self-pay|Self-pay|190||||190|57|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|190||||190|39.9|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|190||||190|15.44|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|190||||190|23.01|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|TRUSTMARK [2030]|STARMARK [203000]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|190||||190|91.11|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|UMR [2035]|UMR OPTIONS [203501]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|190||||190|15.71|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|190||||190|171|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|190||||190|10.51|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|190||||190|21.17|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|190||||190|15.76|176.7|10.51
30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|190||||190|95|176.7|10.51
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|267||||267|17.74|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267||||267|12.72|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267||||267|13.51|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267||||267|13.51|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267||||267|133.77|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267||||267|93.72|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267||||267|113.74|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267||||267|133.5|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267||||267|173.55|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|CORESOURCE [1315]|CORESOURCE [131500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267||||267|16.53|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267||||267|10.12|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|GEHA [1415]|GEHA [141500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267||||267|28.06|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HEALTHNET [1495]|HEALTHNET [149500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267||||267|248.31|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267||||267|160.2|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267||||267|13.72|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267||||267|133.5|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267||||267|13.04|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267||||267|16.83|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267||||267|12.72|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MULTIPLAN [1680]|HMA [168003]|267||||267|18.71|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MULTIPLAN [1680]|IHC HS [168011]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267||||267|14.04|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267||||267|13.72|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|Self-pay|Self-pay|267||||267|80.1|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267||||267|56.07|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267||||267|12.22|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267||||267|18.21|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|TRUSTMARK [2030]|STARMARK [203000]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267||||267|128.03|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|UMR [2035]|UMR OPTIONS [203501]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267||||267|12.42|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267||||267|240.3|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267||||267|7.48|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267||||267|10.12|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267||||267|12.47|248.31|7.48
30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267||||267|133.5|248.31|7.48
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|192||||192|16.44|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192||||192|11.51|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192||||192|11.51|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192||||192|96.19|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192||||192|67.39|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192||||192|12.84|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192||||192|81.79|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192||||192|96|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192||||192|124.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|CORESOURCE [1315]|CORESOURCE [131500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192||||192|21.1|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192||||192|12.92|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|GEHA [1415]|GEHA [141500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HEALTHNET [1495]|HEALTHNET [149500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192||||192|12.84|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192||||192|178.56|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192||||192|115.2|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192||||192|96|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192||||192|11.12|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MULTIPLAN [1680]|HMA [168003]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MULTIPLAN [1680]|IHC HS [168011]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192||||192|11.96|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|Self-pay|Self-pay|192||||192|57.6|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192||||192|40.32|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|TRUSTMARK [2030]|STARMARK [203000]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192||||192|92.06|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|UMR [2035]|UMR OPTIONS [203501]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192||||192|10.59|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192||||192|172.8|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192||||192|6.94|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192||||192|12.92|178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192||||192||178.56|6.94
30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192||||192|96|178.56|6.94
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|AETNA [1015]|AETNA ACO WILCO [101532]|227||||227|6.25|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|227||||227|4.03|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|227||||227|4.28|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|227||||227|4.28|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|227||||227|113.73|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|227||||227|79.68|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|227||||227|4.88|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|227||||227|96.7|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|227||||227|113.5|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|227||||227|147.55|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|CORESOURCE [1315]|CORESOURCE [131500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|227||||227|10.57|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|227||||227|6.47|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|GEHA [1415]|GEHA [141500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|227||||227|8.89|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HEALTHNET [1495]|HEALTHNET [149500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|227||||227|4.88|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|227||||227|211.11|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|227||||227|136.2|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|227||||227|4.35|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|227||||227|113.5|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|227||||227|4.13|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|227||||227|5.33|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|227||||227|4.03|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MULTIPLAN [1680]|HMA [168003]|227||||227|5.93|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MULTIPLAN [1680]|IHC HS [168011]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|227||||227|4.45|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|227||||227|4.35|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|Self-pay|Self-pay|227||||227|68.1|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|227||||227|47.67|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|227||||227|3.87|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|227||||227|5.77|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|TRUSTMARK [2030]|STARMARK [203000]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|227||||227|108.85|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|UMR [2035]|UMR OPTIONS [203501]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|227||||227|3.93|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|227||||227|204.3|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|227||||227|2.63|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|227||||227|6.47|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|227||||227|3.95|211.11|2.63
30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|227||||227|113.5|211.11|2.63
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|155||||155|7.91|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|155||||155|5.67|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|155||||155|6.03|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|155||||155|6.03|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|155||||155|77.66|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|155||||155|54.41|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|155||||155|5.86|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|155||||155|66.03|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|155||||155|77.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|155||||155|100.75|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|155||||155|11.6|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|155||||155|7.1|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|GEHA [1415]|GEHA [141500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|155||||155|12.51|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|155||||155|5.86|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|155||||155|144.15|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|155||||155|93|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|155||||155|6.12|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|155||||155|77.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|155||||155|5.82|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|155||||155|7.51|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|155||||155|5.67|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MULTIPLAN [1680]|HMA [168003]|155||||155|8.34|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MULTIPLAN [1680]|IHC HS [168011]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|155||||155|6.27|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|155||||155|6.12|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|Self-pay|Self-pay|155||||155|46.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|155||||155|32.55|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|155||||155|5.45|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|155||||155|8.12|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|TRUSTMARK [2030]|STARMARK [203000]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|155||||155|74.32|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|UMR [2035]|UMR OPTIONS [203501]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|155||||155|5.54|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|155||||155|139.5|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|155||||155|3.34|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|155||||155|7.1|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|155||||155|5.56|144.15|3.34
30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|155||||155|77.5|144.15|3.34
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|AETNA [1015]|AETNA ACO WILCO [101532]|236||||236|7.15|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236||||236|4.61|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236||||236|4.9|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236||||236|4.9|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|236||||236|118.24|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236||||236|82.84|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236||||236|5.58|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|236||||236|100.54|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|236||||236|118|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236||||236|153.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|CORESOURCE [1315]|CORESOURCE [131500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|236||||236|10.22|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|236||||236|6.26|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|GEHA [1415]|GEHA [141500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|236||||236|10.17|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HEALTHNET [1495]|HEALTHNET [149500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236||||236|5.58|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|236||||236|219.48|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236||||236|141.6|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236||||236|4.97|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236||||236|118|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236||||236|4.74|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236||||236|6.1|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236||||236|4.61|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MULTIPLAN [1680]|HMA [168003]|236||||236|6.78|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MULTIPLAN [1680]|IHC HS [168011]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|236||||236|5.09|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236||||236|4.97|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|Self-pay|Self-pay|236||||236|70.8|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236||||236|49.56|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|236||||236|4.43|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236||||236|6.6|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|TRUSTMARK [2030]|STARMARK [203000]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236||||236|113.16|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|UMR [2035]|UMR OPTIONS [203501]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236||||236|4.51|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236||||236|212.4|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|236||||236|3.01|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|236||||236|6.26|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|236||||236|4.52|219.48|3.01
30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|236||||236|118|219.48|3.01
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|265||||265|7.49|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|265||||265|5.18|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|265||||265|5.51|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|265||||265|5.51|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|265||||265|132.77|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|265||||265|93.02|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|265||||265|5.86|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|265||||265|112.89|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|265||||265|132.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|265||||265|172.25|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|265||||265|9.33|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|265||||265|5.71|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|GEHA [1415]|GEHA [141500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|265||||265|11.43|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|265||||265|5.86|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|265||||265|246.45|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|265||||265|159|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|265||||265|5.59|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|265||||265|132.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|265||||265|5.33|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|265||||265|6.86|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|265||||265|5.18|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MULTIPLAN [1680]|HMA [168003]|265||||265|7.62|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|265||||265|5.73|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|265||||265|5.59|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|Self-pay|Self-pay|265||||265|79.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|265||||265|55.65|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|265||||265|4.98|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|265||||265|7.42|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|265||||265|127.07|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|265||||265|5.07|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|265||||265|238.5|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|265||||265|3.16|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|265||||265|5.71|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|265||||265|5.08|246.45|3.16
30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|265||||265|132.5|246.45|3.16
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|380||||380|24.49|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|380||||380|16.79|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|380||||380|16.79|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|380||||380|190.38|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|380||||380|133.38|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|380||||380|19.13|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|380||||380|161.88|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|380||||380|190|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|380||||380|247|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|CORESOURCE [1315]|CORESOURCE [131500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|380||||380|30.19|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|380||||380|18.49|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|GEHA [1415]|GEHA [141500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HEALTHNET [1495]|HEALTHNET [149500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|380||||380|19.13|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|380||||380|353.4|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|380||||380|228|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|380||||380|190|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|380||||380|16.22|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MULTIPLAN [1680]|HMA [168003]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MULTIPLAN [1680]|IHC HS [168011]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|380||||380|17.45|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|Self-pay|Self-pay|380||||380|114|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|380||||380|79.8|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|TRUSTMARK [2030]|STARMARK [203000]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|380||||380|182.21|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|UMR [2035]|UMR OPTIONS [203501]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|380||||380|15.45|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|380||||380|342|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|380||||380|10.33|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|380||||380|18.49|353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|380||||380||353.4|10.33
30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|380||||380|190|353.4|10.33
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|AETNA [1015]|AETNA ACO WILCO [101532]|462||||462|55.84|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|462||||462|38.28|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|462||||462|38.28|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|462||||462|231.46|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|462||||462|162.16|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|462||||462|43.62|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|462||||462|196.81|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|462||||462|231|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|462||||462|300.3|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|CORESOURCE [1315]|CORESOURCE [131500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|462||||462|54.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|462||||462|33.55|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|GEHA [1415]|GEHA [141500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HEALTHNET [1495]|HEALTHNET [149500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|462||||462|43.62|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|462||||462|429.66|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|462||||462|277.2|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|462||||462|231|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|462||||462|36.97|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MULTIPLAN [1680]|HMA [168003]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MULTIPLAN [1680]|IHC HS [168011]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|462||||462|39.79|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|Self-pay|Self-pay|462||||462|138.6|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|462||||462|97.02|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|TRUSTMARK [2030]|STARMARK [203000]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|462||||462|221.53|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|UMR [2035]|UMR OPTIONS [203501]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|462||||462|35.2|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|462||||462|415.8|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|462||||462|23.56|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|462||||462|33.55|429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|462||||462||429.66|23.56
30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|462||||462|231|429.66|23.56
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|AETNA [1015]|AETNA ACO WILCO [101532]|463||||463|53.64|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|463||||463|34.62|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|463||||463|36.77|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|463||||463|36.77|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|463||||463|231.96|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|463||||463|162.51|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|463||||463|41.9|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|463||||463|197.24|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|463||||463|231.5|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|463||||463|300.95|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|CORESOURCE [1315]|CORESOURCE [131500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|463||||463|55.88|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|463||||463|34.21|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|GEHA [1415]|GEHA [141500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|463||||463|76.37|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HEALTHNET [1495]|HEALTHNET [149500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|463||||463|41.9|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|463||||463|430.59|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|463||||463|277.8|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|463||||463|37.33|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|463||||463|231.5|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|463||||463|35.51|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|463||||463|45.82|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|463||||463|34.62|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MULTIPLAN [1680]|HMA [168003]|463||||463|50.91|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MULTIPLAN [1680]|IHC HS [168011]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|463||||463|38.22|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|463||||463|37.33|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|Self-pay|Self-pay|463||||463|138.9|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|463||||463|97.23|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|463||||463|33.26|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|463||||463|49.55|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|TRUSTMARK [2030]|STARMARK [203000]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|463||||463|222.01|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|UMR [2035]|UMR OPTIONS [203501]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|463||||463|33.82|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|463||||463|416.7|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|463||||463|22.63|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|463||||463|34.21|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|463||||463|33.94|430.59|22.63
30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|463||||463|231.5|430.59|22.63
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|AETNA [1015]|AETNA ACO WILCO [101532]|253||||253|18.35|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|253||||253|11.84|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|253||||253|12.57|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|253||||253|12.57|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|253||||253|126.75|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|253||||253|88.8|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|253||||253|14.33|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|253||||253|107.78|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|253||||253|126.5|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|253||||253|164.45|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|CORESOURCE [1315]|CORESOURCE [131500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|253||||253|27.93|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|253||||253|17.1|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|GEHA [1415]|GEHA [141500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|253||||253|26.12|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HEALTHNET [1495]|HEALTHNET [149500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|253||||253|14.33|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|253||||253|235.29|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|253||||253|151.8|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|253||||253|12.77|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|253||||253|126.5|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|253||||253|12.15|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|253||||253|15.67|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|253||||253|11.84|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MULTIPLAN [1680]|HMA [168003]|253||||253|17.42|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MULTIPLAN [1680]|IHC HS [168011]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|253||||253|13.06|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|253||||253|12.77|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|Self-pay|Self-pay|253||||253|75.9|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|253||||253|53.13|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|253||||253|11.38|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|253||||253|16.95|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|TRUSTMARK [2030]|STARMARK [203000]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|253||||253|121.31|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|UMR [2035]|UMR OPTIONS [203501]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|253||||253|11.57|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|253||||253|227.7|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|253||||253|7.74|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|253||||253|17.1|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|253||||253|11.61|235.29|7.74
30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|253||||253|126.5|235.29|7.74
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|210||||210|24.27|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|210||||210|17.4|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|210||||210|18.49|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|210||||210|18.49|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|210||||210|105.21|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|210||||210|73.71|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|210||||210|89.46|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|210||||210|105|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|210||||210|136.5|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|210||||210|22.49|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|210||||210|13.77|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|GEHA [1415]|GEHA [141500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|210||||210|38.39|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|210||||210|195.3|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|210||||210|126|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|210||||210|18.77|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|210||||210|105|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|210||||210|17.86|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|210||||210|23.03|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|210||||210|17.4|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MULTIPLAN [1680]|HMA [168003]|210||||210|25.59|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MULTIPLAN [1680]|IHC HS [168011]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|210||||210|19.22|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|210||||210|18.77|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|Self-pay|Self-pay|210||||210|63|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|210||||210|44.1|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|210||||210|16.72|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|210||||210|24.91|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|TRUSTMARK [2030]|STARMARK [203000]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|210||||210|100.7|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|UMR [2035]|UMR OPTIONS [203501]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|210||||210|17|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|210||||210|189|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|210||||210|10.24|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|210||||210|13.77|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|210||||210|17.06|195.3|10.24
30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|210||||210|105|195.3|10.24
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|AETNA [1015]|AETNA ACO WILCO [101532]|182||||182|21.67|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182||||182|13.99|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182||||182|14.87|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182||||182|14.87|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182||||182|91.18|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182||||182|63.88|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182||||182|16.94|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182||||182|77.53|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182||||182|91|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182||||182|118.3|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|CORESOURCE [1315]|CORESOURCE [131500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182||||182|31.68|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182||||182|19.39|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|GEHA [1415]|GEHA [141500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182||||182|30.87|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HEALTHNET [1495]|HEALTHNET [149500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182||||182|16.94|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182||||182|169.26|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182||||182|109.2|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182||||182|15.09|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182||||182|91|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182||||182|14.36|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182||||182|18.52|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182||||182|13.99|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MULTIPLAN [1680]|HMA [168003]|182||||182|20.58|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MULTIPLAN [1680]|IHC HS [168011]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182||||182|15.46|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182||||182|15.09|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|Self-pay|Self-pay|182||||182|54.6|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182||||182|38.22|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182||||182|13.45|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182||||182|20.03|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|TRUSTMARK [2030]|STARMARK [203000]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182||||182|87.27|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|UMR [2035]|UMR OPTIONS [203501]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182||||182|13.68|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182||||182|163.8|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182||||182|9.14|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182||||182|19.39|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182||||182|13.72|169.26|9.14
30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182||||182|91|169.26|9.14
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|AETNA [1015]|AETNA ACO WILCO [101532]|306||||306|25.41|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|306||||306|18.53|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|306||||306|18.53|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|306||||306|153.31|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|306||||306|107.41|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|306||||306|19.85|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|306||||306|130.36|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|306||||306|153|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|306||||306|198.9|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|CORESOURCE [1315]|CORESOURCE [131500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|306||||306|30.14|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|306||||306|18.45|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|GEHA [1415]|GEHA [141500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HEALTHNET [1495]|HEALTHNET [149500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|306||||306|19.85|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|306||||306|284.58|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|306||||306|183.6|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|306||||306|153|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|306||||306|17.9|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MULTIPLAN [1680]|HMA [168003]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MULTIPLAN [1680]|IHC HS [168011]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|306||||306|19.26|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|Self-pay|Self-pay|306||||306|91.8|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|306||||306|64.26|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|TRUSTMARK [2030]|STARMARK [203000]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|306||||306|146.73|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|UMR [2035]|UMR OPTIONS [203501]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|306||||306|17.05|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|306||||306|275.4|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|306||||306|10.72|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|306||||306|18.45|284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|306||||306||284.58|10.72
30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|306||||306|153|284.58|10.72
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|153||||153|18.72|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|153||||153|13.99|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|153||||153|13.99|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|153||||153|76.65|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|153||||153|53.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|153||||153|14.63|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|153||||153|65.18|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|153||||153|76.5|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|153||||153|99.45|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|CORESOURCE [1315]|CORESOURCE [131500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|153||||153|23.96|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|153||||153|14.67|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|GEHA [1415]|GEHA [141500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HEALTHNET [1495]|HEALTHNET [149500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153||||153|14.63|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|153||||153|142.29|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|153||||153|91.8|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|153||||153|76.5|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|153||||153|13.51|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MULTIPLAN [1680]|HMA [168003]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MULTIPLAN [1680]|IHC HS [168011]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|153||||153|14.54|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|Self-pay|Self-pay|153||||153|45.9|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|153||||153|32.13|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|TRUSTMARK [2030]|STARMARK [203000]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153||||153|73.36|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|UMR [2035]|UMR OPTIONS [203501]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|153||||153|12.87|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|153||||153|137.7|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|153||||153|7.9|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|153||||153|14.67|142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|153||||153||142.29|7.9
30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|153||||153|76.5|142.29|7.9
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|AETNA [1015]|AETNA ACO WILCO [101532]|244||||244|18|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244||||244|11.62|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244||||244|12.34|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244||||244|12.34|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|244||||244|122.24|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244||||244|85.64|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244||||244|14.06|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|244||||244|103.94|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|244||||244|122|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244||||244|158.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|CORESOURCE [1315]|CORESOURCE [131500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|244||||244|22.65|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|244||||244|13.87|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|GEHA [1415]|GEHA [141500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|244||||244|25.63|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HEALTHNET [1495]|HEALTHNET [149500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244||||244|14.06|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|244||||244|226.92|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244||||244|146.4|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244||||244|12.53|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244||||244|122|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244||||244|11.92|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244||||244|15.38|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244||||244|11.62|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MULTIPLAN [1680]|HMA [168003]|244||||244|17.09|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MULTIPLAN [1680]|IHC HS [168011]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|244||||244|12.83|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244||||244|12.53|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|Self-pay|Self-pay|244||||244|73.2|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244||||244|51.24|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|244||||244|11.16|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244||||244|16.63|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|TRUSTMARK [2030]|STARMARK [203000]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244||||244|117|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|UMR [2035]|UMR OPTIONS [203501]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244||||244|11.35|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244||||244|219.6|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|244||||244|7.59|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|244||||244|13.87|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|244||||244|11.39|226.92|7.59
30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|244||||244|122|226.92|7.59
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|281||||281|32.91|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281||||281|21.23|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281||||281|22.54|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281||||281|22.54|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|281||||281|140.78|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281||||281|98.63|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281||||281|25.7|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|281||||281|119.71|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|281||||281|140.5|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281||||281|182.65|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|281||||281|46.38|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|281||||281|28.39|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|GEHA [1415]|GEHA [141500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|281||||281|46.82|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281||||281|25.7|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|281||||281|261.33|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281||||281|168.6|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281||||281|22.89|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281||||281|140.5|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281||||281|21.77|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281||||281|28.09|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281||||281|21.23|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MULTIPLAN [1680]|HMA [168003]|281||||281|31.22|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MULTIPLAN [1680]|IHC HS [168011]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|281||||281|23.43|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281||||281|22.89|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|Self-pay|Self-pay|281||||281|84.3|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281||||281|59.01|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|281||||281|20.39|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281||||281|30.38|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|TRUSTMARK [2030]|STARMARK [203000]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281||||281|134.74|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|UMR [2035]|UMR OPTIONS [203501]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281||||281|20.74|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281||||281|252.9|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|281||||281|13.88|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|281||||281|28.39|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|281||||281|20.81|261.33|13.88
30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|281||||281|140.5|261.33|13.88
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|369||||369|23.8|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|369||||369|15.35|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|369||||369|16.31|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|369||||369|16.31|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|369||||369|184.87|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|369||||369|129.52|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|369||||369|18.59|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|369||||369|157.19|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|369||||369|184.5|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|369||||369|239.85|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|CORESOURCE [1315]|CORESOURCE [131500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|369||||369|30.16|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|369||||369|18.47|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|GEHA [1415]|GEHA [141500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|369||||369|33.86|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HEALTHNET [1495]|HEALTHNET [149500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|369||||369|18.59|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|369||||369|343.17|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|369||||369|221.4|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|369||||369|16.56|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|369||||369|184.5|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|369||||369|15.75|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|369||||369|20.32|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|369||||369|15.35|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MULTIPLAN [1680]|HMA [168003]|369||||369|22.58|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MULTIPLAN [1680]|IHC HS [168011]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|369||||369|16.95|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|369||||369|16.56|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|Self-pay|Self-pay|369||||369|110.7|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|369||||369|77.49|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|369||||369|14.75|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|369||||369|21.97|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|TRUSTMARK [2030]|STARMARK [203000]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|369||||369|176.94|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|UMR [2035]|UMR OPTIONS [203501]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|369||||369|15|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|369||||369|332.1|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|369||||369|10.04|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|369||||369|18.47|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|369||||369|15.05|343.17|10.04
30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|369||||369|184.5|343.17|10.04
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|297||||297|11.89|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297||||297|7.67|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297||||297|8.15|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297||||297|8.15|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|297||||297|148.8|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297||||297|104.25|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297||||297|9.29|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|297||||297|126.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|297||||297|148.5|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297||||297|193.05|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|CORESOURCE [1315]|CORESOURCE [131500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|297||||297|26.38|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|297||||297|16.15|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|GEHA [1415]|GEHA [141500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|297||||297|16.92|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HEALTHNET [1495]|HEALTHNET [149500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297||||297|9.29|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|297||||297|276.21|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297||||297|178.2|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297||||297|8.27|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297||||297|148.5|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297||||297|7.87|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297||||297|10.15|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297||||297|7.67|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MULTIPLAN [1680]|HMA [168003]|297||||297|11.28|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MULTIPLAN [1680]|IHC HS [168011]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|297||||297|8.47|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297||||297|8.27|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|Self-pay|Self-pay|297||||297|89.1|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297||||297|62.37|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|297||||297|7.37|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297||||297|10.98|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|TRUSTMARK [2030]|STARMARK [203000]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297||||297|142.41|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|UMR [2035]|UMR OPTIONS [203501]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297||||297|7.49|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297||||297|267.3|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|297||||297|5.02|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|297||||297|16.15|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|297||||297|7.52|276.21|5.02
30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|297||||297|148.5|276.21|5.02
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|AETNA [1015]|AETNA ACO WILCO [101532]|276||||276|28.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|276||||276|18.34|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|276||||276|19.48|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|276||||276|19.48|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|276||||276|138.28|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|276||||276|96.88|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|276||||276|22.19|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|276||||276|117.58|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|276||||276|138|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|276||||276|179.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|CORESOURCE [1315]|CORESOURCE [131500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|276||||276|25.7|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|276||||276|15.73|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|GEHA [1415]|GEHA [141500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|276||||276|40.46|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HEALTHNET [1495]|HEALTHNET [149500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|276||||276|22.19|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|276||||276|256.68|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|276||||276|165.6|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|276||||276|19.78|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|276||||276|138|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|276||||276|18.82|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|276||||276|24.27|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|276||||276|18.34|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MULTIPLAN [1680]|HMA [168003]|276||||276|26.97|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MULTIPLAN [1680]|IHC HS [168011]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|276||||276|20.25|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|276||||276|19.78|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|Self-pay|Self-pay|276||||276|82.8|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|276||||276|57.96|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|276||||276|17.62|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|276||||276|26.25|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|TRUSTMARK [2030]|STARMARK [203000]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|276||||276|132.34|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|UMR [2035]|UMR OPTIONS [203501]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|276||||276|17.92|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|276||||276|248.4|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|276||||276|11.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|276||||276|15.73|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|276||||276|17.98|256.68|11.98
30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|276||||276|138|256.68|11.98
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|99||||99|11.04|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99||||99|7.12|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99||||99|7.56|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99||||99|7.56|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|99||||99|49.6|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99||||99|34.75|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99||||99|8.62|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|99||||99|42.17|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|99||||99|49.5|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99||||99|64.35|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|99||||99|15.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|99||||99|9.24|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|GEHA [1415]|GEHA [141500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|99||||99|15.71|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99||||99|8.62|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|99||||99|92.07|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99||||99|59.4|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99||||99|7.68|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99||||99|49.5|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99||||99|7.3|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99||||99|9.42|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99||||99|7.12|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MULTIPLAN [1680]|HMA [168003]|99||||99|10.47|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MULTIPLAN [1680]|IHC HS [168011]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|99||||99|7.86|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99||||99|7.68|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|Self-pay|Self-pay|99||||99|29.7|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99||||99|20.79|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|99||||99|6.84|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99||||99|10.19|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|TRUSTMARK [2030]|STARMARK [203000]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99||||99|47.47|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|UMR [2035]|UMR OPTIONS [203501]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99||||99|6.95|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99||||99|89.1|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|99||||99|4.66|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|99||||99|9.24|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|99||||99|6.98|92.07|4.66
30186000|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AGGLUTININS FEBRILE EACH ANTIGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|99||||99|49.5|92.07|4.66
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|106||||106|11.12|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106||||106|7.98|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106||||106|8.47|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106||||106|8.47|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106||||106|53.11|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106||||106|37.21|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106||||106|45.16|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106||||106|53|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106||||106|68.9|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|CORESOURCE [1315]|CORESOURCE [131500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106||||106|10.58|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106||||106|6.48|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|GEHA [1415]|GEHA [141500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106||||106|17.6|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HEALTHNET [1495]|HEALTHNET [149500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106||||106|98.58|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106||||106|63.6|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106||||106|8.6|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106||||106|53|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106||||106|8.19|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106||||106|10.56|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106||||106|7.98|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MULTIPLAN [1680]|HMA [168003]|106||||106|11.73|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MULTIPLAN [1680]|IHC HS [168011]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106||||106|8.8|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106||||106|8.6|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|Self-pay|Self-pay|106||||106|31.8|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106||||106|22.26|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106||||106|7.66|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106||||106|11.42|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|TRUSTMARK [2030]|STARMARK [203000]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106||||106|50.83|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|UMR [2035]|UMR OPTIONS [203501]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106||||106|7.8|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106||||106|95.4|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106||||106|4.69|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106||||106|6.48|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106||||106|7.82|98.58|4.69
30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106||||106|53|98.58|4.69
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|86||||86|8.25|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86||||86|5.32|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86||||86|5.66|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86||||86|5.66|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86||||86|43.09|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86||||86|30.19|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86||||86|6.44|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86||||86|36.64|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86||||86|43|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86||||86|55.9|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86||||86|15.16|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86||||86|9.28|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|GEHA [1415]|GEHA [141500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86||||86|11.75|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86||||86|6.44|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86||||86|79.98|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86||||86|51.6|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86||||86|5.74|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86||||86|43|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86||||86|5.47|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86||||86|7.05|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86||||86|5.32|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MULTIPLAN [1680]|HMA [168003]|86||||86|7.83|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MULTIPLAN [1680]|IHC HS [168011]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86||||86|5.88|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86||||86|5.74|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|Self-pay|Self-pay|86||||86|25.8|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86||||86|18.06|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86||||86|5.12|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86||||86|7.62|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|TRUSTMARK [2030]|STARMARK [203000]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86||||86|41.24|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|UMR [2035]|UMR OPTIONS [203501]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86||||86|5.21|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86||||86|77.4|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86||||86|3.48|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86||||86|9.28|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86||||86|5.22|79.98|3.48
30186003|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86||||86|43|79.98|3.48
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|606||||606|23.8|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|606||||606|15.35|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|606||||606|16.31|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|606||||606|16.31|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|606||||606|303.61|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|606||||606|212.71|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|606||||606|18.59|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|606||||606|258.16|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|606||||606|303|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|606||||606|393.9|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|CORESOURCE [1315]|CORESOURCE [131500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|606||||606|34.23|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|606||||606|20.96|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|GEHA [1415]|GEHA [141500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|606||||606|33.86|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HEALTHNET [1495]|HEALTHNET [149500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|606||||606|18.59|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|606||||606|563.58|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|606||||606|363.6|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|606||||606|16.56|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|606||||606|303|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|606||||606|15.75|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|606||||606|20.32|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|606||||606|15.35|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MULTIPLAN [1680]|HMA [168003]|606||||606|22.58|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MULTIPLAN [1680]|IHC HS [168011]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|606||||606|16.95|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|606||||606|16.56|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|Self-pay|Self-pay|606||||606|181.8|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|606||||606|127.26|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|606||||606|14.75|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|606||||606|21.97|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|TRUSTMARK [2030]|STARMARK [203000]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|606||||606|290.58|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|UMR [2035]|UMR OPTIONS [203501]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|606||||606|15|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|606||||606|545.4|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|606||||606|10.04|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|606||||606|20.96|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|606||||606|15.05|563.58|10.04
30186021|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID LEUKOCYTE ANTIBODIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|606||||606|303|563.58|10.04
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|AETNA [1015]|AETNA ACO WILCO [101532]|532||||532|29.03|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|532||||532|18.74|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|532||||532|19.91|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|532||||532|19.91|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|532||||532|266.53|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|532||||532|186.73|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|532||||532|22.68|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|532||||532|226.63|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|532||||532|266|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|532||||532|345.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|CORESOURCE [1315]|CORESOURCE [131500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|532||||532|47.28|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|532||||532|28.95|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|GEHA [1415]|GEHA [141500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|532||||532|41.33|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HEALTHNET [1495]|HEALTHNET [149500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|532||||532|22.68|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|532||||532|494.76|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|532||||532|319.2|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|532||||532|20.21|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|532||||532|266|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|532||||532|19.23|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|532||||532|24.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|532||||532|18.74|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MULTIPLAN [1680]|HMA [168003]|532||||532|27.56|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MULTIPLAN [1680]|IHC HS [168011]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|532||||532|20.69|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|532||||532|20.21|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|Self-pay|Self-pay|532||||532|159.6|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|532||||532|111.72|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|532||||532|18|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|532||||532|26.82|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|TRUSTMARK [2030]|STARMARK [203000]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|532||||532|255.09|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|UMR [2035]|UMR OPTIONS [203501]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|532||||532|18.31|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|532||||532|478.8|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|532||||532|12.25|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|532||||532|28.95|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|532||||532|18.37|494.76|12.25
30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|532||||532|266|494.76|12.25
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|417||||417|19.69|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|417||||417|12.71|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|417||||417|13.5|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|417||||417|13.5|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|417||||417|208.92|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|417||||417|146.37|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|417||||417|15.38|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|417||||417|177.64|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|417||||417|208.5|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|417||||417|271.05|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|417||||417|27.73|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|417||||417|16.98|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|GEHA [1415]|GEHA [141500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|417||||417|28.04|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|417||||417|15.38|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|417||||417|387.81|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|417||||417|250.2|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|417||||417|13.71|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|417||||417|208.5|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|417||||417|13.03|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|417||||417|16.82|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|417||||417|12.71|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MULTIPLAN [1680]|HMA [168003]|417||||417|18.69|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|417||||417|14.03|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|417||||417|13.71|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|Self-pay|Self-pay|417||||417|125.1|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|417||||417|87.57|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|417||||417|12.21|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|417||||417|18.19|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|417||||417|199.95|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|417||||417|12.41|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|417||||417|375.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|417||||417|8.3|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|417||||417|16.98|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|417||||417|12.46|387.81|8.3
30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET IMMUNOGL ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|417||||417|208.5|387.81|8.3
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|250||||250|19.11|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250||||250|12.33|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250||||250|13.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250||||250|13.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|250||||250|125.25|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250||||250|87.75|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250||||250|14.92|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|250||||250|106.5|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|250||||250|125|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250||||250|162.5|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|CORESOURCE [1315]|CORESOURCE [131500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|250||||250|19.4|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|250||||250|11.88|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|GEHA [1415]|GEHA [141500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|250||||250|27.2|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HEALTHNET [1495]|HEALTHNET [149500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250||||250|14.92|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|250||||250|232.5|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250||||250|150|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250||||250|13.3|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250||||250|125|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250||||250|12.65|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250||||250|16.32|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250||||250|12.33|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MULTIPLAN [1680]|HMA [168003]|250||||250|18.14|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MULTIPLAN [1680]|IHC HS [168011]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|250||||250|13.61|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250||||250|13.3|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|Self-pay|Self-pay|250||||250|75|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250||||250|52.5|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|250||||250|11.85|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250||||250|17.65|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|TRUSTMARK [2030]|STARMARK [203000]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250||||250|119.88|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|UMR [2035]|UMR OPTIONS [203501]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250||||250|12.05|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250||||250|225|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|250||||250|8.06|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|250||||250|11.88|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|250||||250|12.09|232.5|8.06
30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|250||||250|125|232.5|8.06
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|218||||218|135.5|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218||||218|144.16|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218||||218|144.16|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|218||||218|109.22|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218||||218|76.52|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218||||218|93.74|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|218||||218|92.87|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|218||||218|109|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218||||218|141.7|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|218||||218|99.5|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|218||||218|66.44|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|GEHA [1415]|GEHA [141500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218||||218|93.74|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|218||||218|202.74|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218||||218|130.8|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218||||218|218|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218||||218|159.37|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MULTIPLAN [1680]|HMA [168003]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MULTIPLAN [1680]|IHC HS [168011]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|218||||218|149.84|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|Self-pay|Self-pay|218||||218|65.4|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218||||218|45.78|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|TRUSTMARK [2030]|STARMARK [203000]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218||||218|104.53|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|UMR [2035]|UMR OPTIONS [203501]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218||||218|151.77|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218||||218|196.2|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|218||||218|86.84|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|218||||218|66.44|218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|218||||218||218|45.78
30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|218||||218|109|218|45.78
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|AETNA [1015]|AETNA ACO WILCO [101532]|150||||150|0|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150||||150|87.64|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150||||150|87.64|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|150||||150|75.15|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150||||150|52.65|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150||||150|64.5|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|150||||150|63.9|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|150||||150|75|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150||||150|97.5|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|CORESOURCE [1315]|CORESOURCE [131500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|150||||150|0|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|150||||150|0|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|GEHA [1415]|GEHA [141500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HEALTHNET [1495]|HEALTHNET [149500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150||||150|64.5|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|150||||150|139.5|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150||||150|90|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150||||150|41.04|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150||||150|96.89|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MULTIPLAN [1680]|HMA [168003]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MULTIPLAN [1680]|IHC HS [168011]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|150||||150|91.09|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|Self-pay|Self-pay|150||||150|45|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150||||150|31.5|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|TRUSTMARK [2030]|STARMARK [203000]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150||||150|71.93|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|UMR [2035]|UMR OPTIONS [203501]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150||||150|92.28|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150||||150|135|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|150||||150|10.3|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|150||||150|0|139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|150||||150||139.5|10.3
30186999|EAP|0309 - LABORATORY-OTHER LABORATORY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|150||||150|75|139.5|10.3
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|AETNA [1015]|AETNA ACO WILCO [101532]|88||||88|7.47|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88||||88|4.81|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88||||88|5.12|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88||||88|5.12|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|88||||88|44.09|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88||||88|30.89|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88||||88|5.83|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|88||||88|37.49|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|88||||88|44|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88||||88|57.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|CORESOURCE [1315]|CORESOURCE [131500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|88||||88|9.16|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|88||||88|5.61|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|GEHA [1415]|GEHA [141500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|88||||88|10.62|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HEALTHNET [1495]|HEALTHNET [149500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88||||88|5.83|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|88||||88|81.84|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88||||88|52.8|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88||||88|5.19|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88||||88|44|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88||||88|4.94|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88||||88|6.37|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88||||88|4.81|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MULTIPLAN [1680]|HMA [168003]|88||||88|7.08|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MULTIPLAN [1680]|IHC HS [168011]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|88||||88|5.32|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88||||88|5.19|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|Self-pay|Self-pay|88||||88|26.4|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88||||88|18.48|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|88||||88|4.63|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88||||88|6.89|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|TRUSTMARK [2030]|STARMARK [203000]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88||||88|42.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|UMR [2035]|UMR OPTIONS [203501]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88||||88|4.71|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88||||88|79.2|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|88||||88|3.15|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|88||||88|5.61|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|88||||88|4.72|81.84|3.15
30189050|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|88||||88|44|81.84|3.15
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|AETNA [1015]|AETNA ACO WILCO [101532]|196||||196|8.7|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|196||||196|5.71|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|196||||196|6.06|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|196||||196|6.06|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|196||||196|98.2|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|196||||196|68.8|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|196||||196|6.8|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|196||||196|83.5|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|196||||196|98|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|196||||196|127.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|CORESOURCE [1315]|CORESOURCE [131500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|196||||196|11.81|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|196||||196|7.23|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|GEHA [1415]|GEHA [141500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|196||||196|12.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HEALTHNET [1495]|HEALTHNET [149500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|196||||196|6.8|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|196||||196|182.28|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|196||||196|117.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|196||||196|6.16|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|196||||196|98|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|196||||196|5.86|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|196||||196|7.56|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|196||||196|5.71|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MULTIPLAN [1680]|HMA [168003]|196||||196|8.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MULTIPLAN [1680]|IHC HS [168011]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|196||||196|6.3|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|196||||196|6.16|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|Self-pay|Self-pay|196||||196|58.8|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|196||||196|41.16|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|196||||196|5.49|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|196||||196|8.18|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|TRUSTMARK [2030]|STARMARK [203000]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|196||||196|93.98|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|UMR [2035]|UMR OPTIONS [203501]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|196||||196|5.58|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|196||||196|176.4|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|196||||196|3.67|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|196||||196|7.23|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|196||||196|5.6|182.28|3.67
30189051|EAP|0309 - LABORATORY-OTHER LABORATORY|HC CELL CNT BODY FLUID W/DIFF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|196||||196|98|182.28|3.67
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|110||||110|6.75|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110||||110|4.36|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110||||110|4.62|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110||||110|4.62|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110||||110|55.11|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110||||110|38.61|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110||||110|5.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110||||110|46.86|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110||||110|55|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110||||110|71.5|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|CORESOURCE [1315]|CORESOURCE [131500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110||||110|9.83|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110||||110|6.02|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|GEHA [1415]|GEHA [141500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110||||110|9.61|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HEALTHNET [1495]|HEALTHNET [149500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110||||110|5.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110||||110|102.3|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110||||110|66|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110||||110|4.7|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110||||110|55|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110||||110|4.46|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110||||110|5.76|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110||||110|4.36|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MULTIPLAN [1680]|HMA [168003]|110||||110|6.41|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MULTIPLAN [1680]|IHC HS [168011]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110||||110|4.8|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110||||110|4.7|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|Self-pay|Self-pay|110||||110|33|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110||||110|23.1|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110||||110|4.18|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110||||110|6.23|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|TRUSTMARK [2030]|STARMARK [203000]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110||||110|52.75|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|UMR [2035]|UMR OPTIONS [203501]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110||||110|4.25|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110||||110|99|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110||||110|2.85|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110||||110|6.02|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110||||110|4.27|102.3|2.85
30189055|EAP|0309 - LABORATORY-OTHER LABORATORY|HC LEUKOCYT ASSESS WBC FECAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110||||110|55|102.3|2.85
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|AETNA [1015]|AETNA ACO WILCO [101532]|129||||129|11.31|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|129||||129|7.48|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|129||||129|7.94|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|129||||129|7.94|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|129||||129|64.63|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|129||||129|45.28|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|129||||129|8.83|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|129||||129|54.95|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|129||||129|64.5|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|129||||129|83.85|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|CORESOURCE [1315]|CORESOURCE [131500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|129||||129|26.46|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|129||||129|16.2|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|GEHA [1415]|GEHA [141500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|129||||129|16.49|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HEALTHNET [1495]|HEALTHNET [149500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|129||||129|8.83|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|129||||129|119.97|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|129||||129|77.4|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|129||||129|8.06|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|129||||129|64.5|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|129||||129|7.67|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|129||||129|9.9|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|129||||129|7.48|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MULTIPLAN [1680]|HMA [168003]|129||||129|11|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MULTIPLAN [1680]|IHC HS [168011]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|129||||129|8.25|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|129||||129|8.06|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|Self-pay|Self-pay|129||||129|38.7|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|129||||129|27.09|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|129||||129|7.18|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|129||||129|10.7|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|TRUSTMARK [2030]|STARMARK [203000]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|129||||129|61.86|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|UMR [2035]|UMR OPTIONS [203501]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|129||||129|7.31|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|129||||129|116.1|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|129||||129|4.77|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|129||||129|16.2|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|129||||129|7.33|119.97|4.77
30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|129||||129|64.5|119.97|4.77
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|AETNA [1015]|AETNA ACO WILCO [101532]|55||||55|8.23|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55||||55|6.27|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55||||55|6.27|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55||||55|27.56|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55||||55|19.31|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55||||55|5.86|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55||||55|23.43|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55||||55|27.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55||||55|35.75|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|CORESOURCE [1315]|CORESOURCE [131500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55||||55|9.81|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55||||55|6|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|GEHA [1415]|GEHA [141500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HEALTHNET [1495]|HEALTHNET [149500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55||||55|5.86|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55||||55|51.15|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55||||55|33|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55||||55|27.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55||||55|6.06|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MULTIPLAN [1680]|HMA [168003]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MULTIPLAN [1680]|IHC HS [168011]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55||||55|6.52|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|Self-pay|Self-pay|55||||55|16.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55||||55|11.55|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|TRUSTMARK [2030]|STARMARK [203000]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55||||55|26.37|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|UMR [2035]|UMR OPTIONS [203501]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55||||55|5.77|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55||||55|49.5|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55||||55|3.47|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55||||55|6|51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55||||55||51.15|3.47
30189190|EAP|0309 - LABORATORY-OTHER LABORATORY|HC SMEAR NASAL EOSINOPHILS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55||||55|27.5|51.15|3.47
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|167||||167|28.35|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167||||167|18.29|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167||||167|19.42|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167||||167|19.42|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|167||||167|83.67|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167||||167|58.62|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167||||167|22.14|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|167||||167|71.14|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|167||||167|83.5|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167||||167|108.55|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|CORESOURCE [1315]|CORESOURCE [131500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|167||||167|0|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|167||||167|14.29|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|GEHA [1415]|GEHA [141500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|167||||167|40.34|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HEALTHNET [1495]|HEALTHNET [149500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167||||167|22.14|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|167||||167|155.31|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167||||167|100.2|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167||||167|19.72|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167||||167|83.5|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167||||167|18.76|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167||||167|24.21|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167||||167|18.29|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MULTIPLAN [1680]|HMA [168003]|167||||167|26.9|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MULTIPLAN [1680]|IHC HS [168011]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|167||||167|20.18|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167||||167|19.72|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|Self-pay|Self-pay|167||||167|50.1|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167||||167|35.07|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|167||||167|17.57|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167||||167|26.18|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|TRUSTMARK [2030]|STARMARK [203000]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167||||167|80.08|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|UMR [2035]|UMR OPTIONS [203501]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167||||167|0|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167||||167|150.3|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|167||||167|11.96|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|167||||167|14.29|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|167||||167|17.93|155.31|11.96
30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|167||||167|83.5|155.31|11.96
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|AETNA [1015]|AETNA ACO WILCO [101532]|268||||268|17.64|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|268||||268|11.38|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|268||||268|12.09|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|268||||268|12.09|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|268||||268|134.27|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|268||||268|94.07|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|268||||268|13.78|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|268||||268|114.17|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|268||||268|134|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|268||||268|174.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|CORESOURCE [1315]|CORESOURCE [131500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|268||||268|17.14|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|268||||268|10.49|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|GEHA [1415]|GEHA [141500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|268||||268|25.11|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HEALTHNET [1495]|HEALTHNET [149500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|268||||268|13.78|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|268||||268|249.24|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268||||268|160.8|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|268||||268|12.28|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|268||||268|134|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|268||||268|11.68|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|268||||268|15.07|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|268||||268|11.38|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MULTIPLAN [1680]|HMA [168003]|268||||268|16.74|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MULTIPLAN [1680]|IHC HS [168011]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|268||||268|12.57|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|268||||268|12.28|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|Self-pay|Self-pay|268||||268|80.4|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|268||||268|56.28|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|268||||268|10.94|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|268||||268|16.29|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|TRUSTMARK [2030]|STARMARK [203000]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268||||268|128.51|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|UMR [2035]|UMR OPTIONS [203501]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|268||||268|11.12|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|268||||268|241.2|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|268||||268|7.44|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|268||||268|10.49|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|268||||268|11.16|249.24|7.44
30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|268||||268|134|249.24|7.44
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|AETNA [1015]|AETNA ACO WILCO [101532]|182||||182|11.54|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182||||182|7.45|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182||||182|7.91|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182||||182|7.91|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182||||182|91.18|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182||||182|63.88|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182||||182|9.01|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182||||182|77.53|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182||||182|91|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182||||182|118.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|CORESOURCE [1315]|CORESOURCE [131500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182||||182|11.71|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182||||182|7.17|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|GEHA [1415]|GEHA [141500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182||||182|16.43|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HEALTHNET [1495]|HEALTHNET [149500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182||||182|9.01|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182||||182|169.26|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182||||182|109.2|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182||||182|8.03|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182||||182|91|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182||||182|7.64|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182||||182|9.86|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182||||182|7.45|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MULTIPLAN [1680]|HMA [168003]|182||||182|10.95|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MULTIPLAN [1680]|IHC HS [168011]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182||||182|8.22|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182||||182|8.03|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|Self-pay|Self-pay|182||||182|54.6|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182||||182|38.22|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182||||182|7.15|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182||||182|10.66|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|TRUSTMARK [2030]|STARMARK [203000]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182||||182|87.27|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|UMR [2035]|UMR OPTIONS [203501]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182||||182|7.28|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182||||182|163.8|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182||||182|4.87|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182||||182|7.17|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182||||182|7.3|169.26|4.87
30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182||||182|91|169.26|4.87
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|169||||169|9.12|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169||||169|6.25|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169||||169|6.25|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169||||169|84.67|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169||||169|59.32|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169||||169|7.12|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169||||169|71.99|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169||||169|84.5|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169||||169|109.85|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169||||169|15.88|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169||||169|9.72|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|GEHA [1415]|GEHA [141500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169||||169|7.12|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169||||169|157.17|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169||||169|101.4|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169||||169|84.5|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169||||169|6.04|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MULTIPLAN [1680]|HMA [168003]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169||||169|6.5|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|Self-pay|Self-pay|169||||169|50.7|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169||||169|35.49|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169||||169|81.04|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169||||169|5.75|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169||||169|152.1|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169||||169|3.85|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169||||169|9.72|157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169||||169||157.17|3.85
30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169||||169|84.5|157.17|3.85
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|153||||153|8.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153||||153|5.28|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|153||||153|5.61|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|153||||153|5.61|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|153||||153|76.65|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|153||||153|53.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|153||||153|6.39|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|153||||153|65.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|153||||153|76.5|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|153||||153|99.45|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|CORESOURCE [1315]|CORESOURCE [131500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|153||||153|13.76|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|153||||153|8.42|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|GEHA [1415]|GEHA [141500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|153||||153|11.66|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HEALTHNET [1495]|HEALTHNET [149500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153||||153|6.39|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|153||||153|142.29|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|153||||153|91.8|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|153||||153|5.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|153||||153|76.5|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|153||||153|5.42|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|153||||153|6.99|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153||||153|5.28|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MULTIPLAN [1680]|HMA [168003]|153||||153|7.77|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MULTIPLAN [1680]|IHC HS [168011]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|153||||153|5.83|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|153||||153|5.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|Self-pay|Self-pay|153||||153|45.9|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|153||||153|32.13|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|153||||153|5.08|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|153||||153|7.56|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|TRUSTMARK [2030]|STARMARK [203000]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153||||153|73.36|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|UMR [2035]|UMR OPTIONS [203501]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|153||||153|5.17|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|153||||153|137.7|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|153||||153|3.45|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|153||||153|8.42|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|153||||153|5.18|142.29|3.45
30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|153||||153|76.5|142.29|3.45
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|AETNA [1015]|AETNA ACO WILCO [101532]|170||||170|20.47|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170||||170|13.21|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170||||170|14.03|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170||||170|14.03|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170||||170|85.17|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170||||170|59.67|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170||||170|15.98|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170||||170|72.42|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170||||170|85|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170||||170|110.5|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|CORESOURCE [1315]|CORESOURCE [131500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170||||170|84.85|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170||||170|51.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|GEHA [1415]|GEHA [141500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170||||170|29.14|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HEALTHNET [1495]|HEALTHNET [149500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170||||170|15.98|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170||||170|158.1|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170||||170|102|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170||||170|14.25|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170||||170|85|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170||||170|13.54|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170||||170|17.48|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170||||170|13.21|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MULTIPLAN [1680]|HMA [168003]|170||||170|19.43|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MULTIPLAN [1680]|IHC HS [168011]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170||||170|14.58|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170||||170|14.25|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|Self-pay|Self-pay|170||||170|51|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170||||170|35.7|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170||||170|12.69|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170||||170|18.91|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|TRUSTMARK [2030]|STARMARK [203000]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170||||170|81.52|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|UMR [2035]|UMR OPTIONS [203501]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170||||170|12.9|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170||||170|153|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170||||170|8.63|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170||||170|51.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170||||170|12.95|158.1|8.63
30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170||||170|85|158.1|8.63
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|350||||350|40.23|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350||||350|25.96|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350||||350|27.57|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350||||350|27.57|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|350||||350|175.35|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350||||350|122.85|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350||||350|31.42|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|350||||350|149.1|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|350||||350|175|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350||||350|227.5|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|CORESOURCE [1315]|CORESOURCE [131500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|350||||350|46.68|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|350||||350|28.58|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|GEHA [1415]|GEHA [141500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|350||||350|57.26|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HEALTHNET [1495]|HEALTHNET [149500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350||||350|31.42|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|350||||350|325.5|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350||||350|210|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350||||350|28|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350||||350|175|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350||||350|26.63|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350||||350|34.36|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350||||350|25.96|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MULTIPLAN [1680]|HMA [168003]|350||||350|38.18|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MULTIPLAN [1680]|IHC HS [168011]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|350||||350|28.66|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350||||350|28|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|Self-pay|Self-pay|350||||350|105|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350||||350|73.5|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|350||||350|24.94|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350||||350|37.16|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|TRUSTMARK [2030]|STARMARK [203000]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350||||350|167.83|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|UMR [2035]|UMR OPTIONS [203501]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350||||350|25.36|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350||||350|315|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|350||||350|16.97|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|350||||350|28.58|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|350||||350|25.45|325.5|16.97
30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|350||||350|175|325.5|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|405||||405|40.23|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|405||||405|25.96|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|405||||405|27.57|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|405||||405|27.57|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|405||||405|202.91|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|405||||405|142.16|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|405||||405|31.42|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|405||||405|172.53|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|405||||405|202.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|405||||405|263.25|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|CORESOURCE [1315]|CORESOURCE [131500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|405||||405|50.07|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|405||||405|30.65|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|GEHA [1415]|GEHA [141500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|405||||405|57.26|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HEALTHNET [1495]|HEALTHNET [149500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|405||||405|31.42|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|405||||405|376.65|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|405||||405|243|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|405||||405|28|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|405||||405|202.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|405||||405|26.63|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|405||||405|34.36|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|405||||405|25.96|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MULTIPLAN [1680]|HMA [168003]|405||||405|38.18|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MULTIPLAN [1680]|IHC HS [168011]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|405||||405|28.66|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|405||||405|28|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|Self-pay|Self-pay|405||||405|121.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|405||||405|85.05|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|405||||405|24.94|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|405||||405|37.16|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|TRUSTMARK [2030]|STARMARK [203000]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|405||||405|194.2|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|UMR [2035]|UMR OPTIONS [203501]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|405||||405|25.36|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|405||||405|364.5|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|405||||405|16.97|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|405||||405|30.65|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|405||||405|25.45|376.65|16.97
30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|405||||405|202.5|376.65|16.97
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|281||||281|25.39|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281||||281|17.42|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281||||281|17.42|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|281||||281|140.78|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281||||281|98.63|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281||||281|19.84|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|281||||281|119.71|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|281||||281|140.5|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281||||281|182.65|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|CORESOURCE [1315]|CORESOURCE [131500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|281||||281|47.68|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|281||||281|29.19|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|GEHA [1415]|GEHA [141500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HEALTHNET [1495]|HEALTHNET [149500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281||||281|19.84|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|281||||281|261.33|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281||||281|168.6|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281||||281|140.5|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281||||281|16.82|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MULTIPLAN [1680]|HMA [168003]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MULTIPLAN [1680]|IHC HS [168011]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|281||||281|18.11|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|Self-pay|Self-pay|281||||281|84.3|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281||||281|59.01|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|TRUSTMARK [2030]|STARMARK [203000]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281||||281|134.74|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|UMR [2035]|UMR OPTIONS [203501]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281||||281|16.02|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281||||281|252.9|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|281||||281|10.71|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|281||||281|29.19|261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|281||||281||261.33|10.71
30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTI-PHOSPHATIDYLSERINE ANTIBODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|281||||281|140.5|261.33|10.71
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|AETNA [1015]|AETNA ACO WILCO [101532]|100||||100|12.75|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100||||100|8.74|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100||||100|8.74|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100||||100|50.1|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100||||100|35.1|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100||||100|9.95|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100||||100|42.6|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100||||100|50|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100||||100|65|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|CORESOURCE [1315]|CORESOURCE [131500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100||||100|12.26|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100||||100|7.51|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|GEHA [1415]|GEHA [141500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HEALTHNET [1495]|HEALTHNET [149500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100||||100|9.95|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100||||100|93|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100||||100|60|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100||||100|50|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100||||100|8.44|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MULTIPLAN [1680]|HMA [168003]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MULTIPLAN [1680]|IHC HS [168011]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100||||100|9.08|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|Self-pay|Self-pay|100||||100|30|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100||||100|21|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|TRUSTMARK [2030]|STARMARK [203000]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100||||100|47.95|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|UMR [2035]|UMR OPTIONS [203501]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100||||100|8.03|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100||||100|90|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100||||100|5.38|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100||||100|7.51|93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100||||100||93|5.38
30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100||||100|50|93|5.38
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|323||||323|18.96|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|323||||323|12.24|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|323||||323|13|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|323||||323|13|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|323||||323|161.82|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|323||||323|113.37|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|323||||323|14.81|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|323||||323|137.6|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|323||||323|161.5|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|323||||323|209.95|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|CORESOURCE [1315]|CORESOURCE [131500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|323||||323|19.89|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|323||||323|12.18|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|GEHA [1415]|GEHA [141500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|323||||323|27|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HEALTHNET [1495]|HEALTHNET [149500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|323||||323|14.81|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|323||||323|300.39|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|323||||323|193.8|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|323||||323|13.2|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|323||||323|161.5|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|323||||323|12.56|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|323||||323|16.2|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|323||||323|12.24|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MULTIPLAN [1680]|HMA [168003]|323||||323|18|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MULTIPLAN [1680]|IHC HS [168011]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|323||||323|13.51|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|323||||323|13.2|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|Self-pay|Self-pay|323||||323|96.9|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|323||||323|67.83|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|323||||323|11.76|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|323||||323|17.52|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|TRUSTMARK [2030]|STARMARK [203000]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|323||||323|154.88|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|UMR [2035]|UMR OPTIONS [203501]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|323||||323|11.96|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|323||||323|290.7|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|323||||323|8|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|323||||323|12.18|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|323||||323|12|300.39|8
30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|323||||323|161.5|300.39|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|252||||252|18.96|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|252||||252|12.24|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|252||||252|13|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|252||||252|13|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|252||||252|126.25|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|252||||252|88.45|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|252||||252|14.81|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|252||||252|107.35|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|252||||252|126|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|252||||252|163.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|CORESOURCE [1315]|CORESOURCE [131500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|252||||252|19.89|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|252||||252|12.18|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|GEHA [1415]|GEHA [141500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|252||||252|27|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HEALTHNET [1495]|HEALTHNET [149500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|252||||252|14.81|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|252||||252|234.36|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|252||||252|151.2|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|252||||252|13.2|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|252||||252|126|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|252||||252|12.56|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|252||||252|16.2|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|252||||252|12.24|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MULTIPLAN [1680]|HMA [168003]|252||||252|18|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MULTIPLAN [1680]|IHC HS [168011]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|252||||252|13.51|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|252||||252|13.2|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|Self-pay|Self-pay|252||||252|75.6|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|252||||252|52.92|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|252||||252|11.76|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|252||||252|17.52|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|TRUSTMARK [2030]|STARMARK [203000]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|252||||252|120.83|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|UMR [2035]|UMR OPTIONS [203501]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|252||||252|11.96|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|252||||252|226.8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|252||||252|8|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|252||||252|12.18|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|252||||252|12|234.36|8
30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|252||||252|126|234.36|8
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|AETNA [1015]|AETNA ACO WILCO [101532]|341||||341|32.12|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|341||||341|20.73|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|341||||341|22.01|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|341||||341|22.01|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|341||||341|170.84|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|341||||341|119.69|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|341||||341|25.09|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|341||||341|145.27|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|341||||341|170.5|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|341||||341|221.65|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|CORESOURCE [1315]|CORESOURCE [131500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|CORVEL CORP [2235]|CORVEL CORP [223500]|341||||341|46.4|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|341||||341|28.41|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|GEHA [1415]|GEHA [141500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|341||||341|45.72|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HEALTHNET [1495]|HEALTHNET [149500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|341||||341|25.09|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HEALTHSMART [1505]|HEALTHSMART [150501]|341||||341|317.13|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|341||||341|204.6|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|341||||341|22.35|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|341||||341|170.5|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|341||||341|21.26|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|341||||341|27.43|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|341||||341|20.73|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MULTIPLAN [1680]|HMA [168003]|341||||341|30.48|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MULTIPLAN [1680]|IHC HS [168011]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|341||||341|22.88|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|341||||341|22.35|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|Self-pay|Self-pay|341||||341|102.3|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|341||||341|71.61|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|341||||341|19.91|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|341||||341|29.67|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|TRUSTMARK [2030]|STARMARK [203000]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|341||||341|163.51|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|UMR [2035]|UMR OPTIONS [203501]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|341||||341|20.25|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|341||||341|306.9|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|341||||341|13.55|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|341||||341|28.41|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|341||||341|20.32|317.13|13.55
30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|341||||341|170.5|317.13|13.55
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|272||||272|20.47|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|272||||272|13.21|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|272||||272|14.03|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|272||||272|14.03|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|272||||272|136.27|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|272||||272|95.47|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|272||||272|15.98|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|272||||272|115.87|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|272||||272|136|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|272||||272|176.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|CORESOURCE [1315]|CORESOURCE [131500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|272||||272|25.9|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|272||||272|15.85|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|GEHA [1415]|GEHA [141500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|272||||272|29.14|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HEALTHNET [1495]|HEALTHNET [149500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|272||||272|15.98|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|272||||272|252.96|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|272||||272|163.2|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|272||||272|14.25|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|272||||272|136|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|272||||272|13.54|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|272||||272|17.48|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|272||||272|13.21|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MULTIPLAN [1680]|HMA [168003]|272||||272|19.43|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MULTIPLAN [1680]|IHC HS [168011]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|272||||272|14.58|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|272||||272|14.25|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|Self-pay|Self-pay|272||||272|81.6|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|272||||272|57.12|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|272||||272|12.69|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|272||||272|18.91|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|TRUSTMARK [2030]|STARMARK [203000]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|272||||272|130.42|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|UMR [2035]|UMR OPTIONS [203501]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|272||||272|12.9|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|272||||272|244.8|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|272||||272|8.63|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|272||||272|15.85|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|272||||272|12.95|252.96|8.63
30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|272||||272|136|252.96|8.63
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|187||||187|20.93|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|187||||187|14.36|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|187||||187|14.36|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|187||||187|93.69|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|187||||187|65.64|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|187||||187|16.35|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|187||||187|79.66|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|187||||187|93.5|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|187||||187|121.55|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|CORESOURCE [1315]|CORESOURCE [131500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|187||||187|29.21|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|187||||187|17.88|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|GEHA [1415]|GEHA [141500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HEALTHNET [1495]|HEALTHNET [149500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|187||||187|16.35|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|187||||187|173.91|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|187||||187|112.2|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|187||||187|93.5|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|187||||187|13.87|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MULTIPLAN [1680]|HMA [168003]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MULTIPLAN [1680]|IHC HS [168011]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|187||||187|14.93|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|Self-pay|Self-pay|187||||187|56.1|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|187||||187|39.27|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|TRUSTMARK [2030]|STARMARK [203000]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|187||||187|89.67|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|UMR [2035]|UMR OPTIONS [203501]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|187||||187|13.21|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|187||||187|168.3|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|187||||187|8.83|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|187||||187|17.88|173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|187||||187||173.91|8.83
30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|187||||187|93.5|173.91|8.83
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|AETNA [1015]|AETNA ACO WILCO [101532]|286||||286|21.72|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|286||||286|14.01|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|286||||286|14.89|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|286||||286|14.89|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|286||||286|143.29|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|286||||286|100.39|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|286||||286|16.97|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|286||||286|121.84|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|286||||286|143|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|286||||286|185.9|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|CORESOURCE [1315]|CORESOURCE [131500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|CORVEL CORP [2235]|CORVEL CORP [223500]|286||||286|31.76|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|286||||286|19.44|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|GEHA [1415]|GEHA [141500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|286||||286|30.92|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HEALTHNET [1495]|HEALTHNET [149500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|286||||286|16.97|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HEALTHSMART [1505]|HEALTHSMART [150501]|286||||286|265.98|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|286||||286|171.6|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|286||||286|15.11|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|286||||286|143|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|286||||286|14.38|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|286||||286|18.55|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|286||||286|14.01|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MULTIPLAN [1680]|HMA [168003]|286||||286|20.61|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MULTIPLAN [1680]|IHC HS [168011]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|286||||286|15.48|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|286||||286|15.11|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|Self-pay|Self-pay|286||||286|85.8|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|286||||286|60.06|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|286||||286|13.47|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|286||||286|20.06|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|TRUSTMARK [2030]|STARMARK [203000]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|286||||286|137.14|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|UMR [2035]|UMR OPTIONS [203501]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|286||||286|13.7|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|286||||286|257.4|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|286||||286|9.16|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|286||||286|19.44|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|286||||286|13.74|265.98|9.16
30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|286||||286|143|265.98|9.16
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|AETNA [1015]|AETNA ACO WILCO [101532]|170||||170|19.13|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170||||170|13.12|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170||||170|13.12|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170||||170|85.17|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170||||170|59.67|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170||||170|14.95|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170||||170|72.42|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170||||170|85|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170||||170|110.5|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|CORESOURCE [1315]|CORESOURCE [131500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170||||170|21.03|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170||||170|12.88|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|GEHA [1415]|GEHA [141500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HEALTHNET [1495]|HEALTHNET [149500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170||||170|14.95|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170||||170|158.1|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170||||170|102|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170||||170|85|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170||||170|12.67|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MULTIPLAN [1680]|HMA [168003]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MULTIPLAN [1680]|IHC HS [168011]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170||||170|13.64|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|Self-pay|Self-pay|170||||170|51|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170||||170|35.7|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|TRUSTMARK [2030]|STARMARK [203000]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170||||170|81.52|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|UMR [2035]|UMR OPTIONS [203501]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170||||170|12.07|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170||||170|153|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170||||170|8.07|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170||||170|12.88|158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170||||170||158.1|8.07
30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170||||170|85|158.1|8.07
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|AETNA [1015]|AETNA ACO WILCO [101532]|419||||419|28.35|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|419||||419|18.29|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|419||||419|19.42|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|419||||419|19.42|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|419||||419|209.92|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|419||||419|147.07|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|419||||419|22.14|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|419||||419|178.49|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|419||||419|209.5|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|419||||419|272.35|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|CORESOURCE [1315]|CORESOURCE [131500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|419||||419|29.01|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|419||||419|17.76|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|GEHA [1415]|GEHA [141500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|419||||419|40.34|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HEALTHNET [1495]|HEALTHNET [149500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|419||||419|22.14|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|419||||419|389.67|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|419||||419|251.4|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|419||||419|19.72|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|419||||419|209.5|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|419||||419|18.76|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|419||||419|24.21|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|419||||419|18.29|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MULTIPLAN [1680]|HMA [168003]|419||||419|26.9|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MULTIPLAN [1680]|IHC HS [168011]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|419||||419|20.18|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|419||||419|19.72|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|Self-pay|Self-pay|419||||419|125.7|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|419||||419|87.99|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|419||||419|17.57|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|419||||419|26.18|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|TRUSTMARK [2030]|STARMARK [203000]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|419||||419|200.91|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|UMR [2035]|UMR OPTIONS [203501]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|419||||419|17.87|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|419||||419|377.1|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|419||||419|11.96|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|419||||419|17.76|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|419||||419|17.93|389.67|11.96
30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|419||||419|209.5|389.67|11.96
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|308||||308|19.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|308||||308|12.29|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|308||||308|13.06|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|308||||308|13.06|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|308||||308|154.31|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|308||||308|108.11|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|308||||308|14.88|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|308||||308|131.21|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|308||||308|154|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|308||||308|200.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|308||||308|35.3|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|308||||308|21.61|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|GEHA [1415]|GEHA [141500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|308||||308|27.11|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|308||||308|14.88|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|308||||308|286.44|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|308||||308|184.8|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|308||||308|13.26|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|308||||308|154|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|308||||308|12.62|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|308||||308|16.27|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|308||||308|12.29|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MULTIPLAN [1680]|HMA [168003]|308||||308|18.08|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|308||||308|13.57|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|308||||308|13.26|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|Self-pay|Self-pay|308||||308|92.4|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|308||||308|64.68|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|308||||308|11.81|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|308||||308|17.59|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|308||||308|147.69|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|308||||308|12.02|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|308||||308|277.2|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|308||||308|8.03|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|308||||308|21.61|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|308||||308|12.05|286.44|8.03
30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|308||||308|154|286.44|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|AETNA [1015]|AETNA ACO WILCO [101532]|267||||267|19.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267||||267|12.29|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267||||267|13.06|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267||||267|13.06|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267||||267|133.77|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267||||267|93.72|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267||||267|14.88|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267||||267|113.74|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267||||267|133.5|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267||||267|173.55|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|CORESOURCE [1315]|CORESOURCE [131500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267||||267|35.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267||||267|21.61|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|GEHA [1415]|GEHA [141500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267||||267|27.11|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HEALTHNET [1495]|HEALTHNET [149500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267||||267|14.88|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267||||267|248.31|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267||||267|160.2|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267||||267|13.26|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267||||267|133.5|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267||||267|12.62|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267||||267|16.27|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267||||267|12.29|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MULTIPLAN [1680]|HMA [168003]|267||||267|18.08|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MULTIPLAN [1680]|IHC HS [168011]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267||||267|13.57|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267||||267|13.26|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|Self-pay|Self-pay|267||||267|80.1|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267||||267|56.07|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267||||267|11.81|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267||||267|17.59|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|TRUSTMARK [2030]|STARMARK [203000]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267||||267|128.03|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|UMR [2035]|UMR OPTIONS [203501]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267||||267|12.02|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267||||267|240.3|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267||||267|8.03|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267||||267|21.61|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267||||267|12.05|248.31|8.03
30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267||||267|133.5|248.31|8.03
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|AETNA [1015]|AETNA ACO WILCO [101532]|379||||379|32.91|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|379||||379|21.23|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|379||||379|22.54|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|379||||379|22.54|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|379||||379|189.88|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|379||||379|133.03|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|379||||379|25.7|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|379||||379|161.45|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|379||||379|189.5|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|379||||379|246.35|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|CORESOURCE [1315]|CORESOURCE [131500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|CORVEL CORP [2235]|CORVEL CORP [223500]|379||||379|38.72|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|379||||379|23.71|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|GEHA [1415]|GEHA [141500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|379||||379|46.82|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HEALTHNET [1495]|HEALTHNET [149500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|379||||379|25.7|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HEALTHSMART [1505]|HEALTHSMART [150501]|379||||379|352.47|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|379||||379|227.4|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|379||||379|22.89|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|379||||379|189.5|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|379||||379|21.77|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|379||||379|28.09|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|379||||379|21.23|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MULTIPLAN [1680]|HMA [168003]|379||||379|31.22|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MULTIPLAN [1680]|IHC HS [168011]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|379||||379|23.43|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|379||||379|22.89|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|Self-pay|Self-pay|379||||379|113.7|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|379||||379|79.59|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|379||||379|20.39|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|379||||379|30.38|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|TRUSTMARK [2030]|STARMARK [203000]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|379||||379|181.73|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|UMR [2035]|UMR OPTIONS [203501]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|379||||379|20.74|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|379||||379|341.1|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|379||||379|13.88|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|379||||379|23.71|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|379||||379|20.81|352.47|13.88
30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|379||||379|189.5|352.47|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|AETNA [1015]|AETNA ACO WILCO [101532]|401||||401|32.91|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|401||||401|21.23|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|401||||401|22.54|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|401||||401|22.54|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|401||||401|200.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|401||||401|140.75|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|401||||401|25.7|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|401||||401|170.83|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|401||||401|200.5|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|401||||401|260.65|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|CORESOURCE [1315]|CORESOURCE [131500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|CORVEL CORP [2235]|CORVEL CORP [223500]|401||||401|38.72|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|401||||401|23.71|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|GEHA [1415]|GEHA [141500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|401||||401|46.82|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HEALTHNET [1495]|HEALTHNET [149500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|401||||401|25.7|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HEALTHSMART [1505]|HEALTHSMART [150501]|401||||401|372.93|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|401||||401|240.6|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|401||||401|22.89|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|401||||401|200.5|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|401||||401|21.77|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|401||||401|28.09|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|401||||401|21.23|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MULTIPLAN [1680]|HMA [168003]|401||||401|31.22|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MULTIPLAN [1680]|IHC HS [168011]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|401||||401|23.43|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|401||||401|22.89|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|Self-pay|Self-pay|401||||401|120.3|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|401||||401|84.21|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|401||||401|20.39|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|401||||401|30.38|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|TRUSTMARK [2030]|STARMARK [203000]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|401||||401|192.28|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|UMR [2035]|UMR OPTIONS [203501]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|401||||401|20.74|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|401||||401|360.9|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|401||||401|13.88|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|401||||401|23.71|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|401||||401|20.81|372.93|13.88
30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|401||||401|200.5|372.93|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|AETNA [1015]|AETNA ACO WILCO [101532]|385||||385|32.91|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|385||||385|21.23|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|385||||385|22.54|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|385||||385|22.54|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|385||||385|192.89|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|385||||385|135.14|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|385||||385|25.7|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|385||||385|164.01|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|385||||385|192.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|385||||385|250.25|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|CORESOURCE [1315]|CORESOURCE [131500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|CORVEL CORP [2235]|CORVEL CORP [223500]|385||||385|38.72|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|385||||385|23.71|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|GEHA [1415]|GEHA [141500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|385||||385|46.82|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HEALTHNET [1495]|HEALTHNET [149500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|385||||385|25.7|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HEALTHSMART [1505]|HEALTHSMART [150501]|385||||385|358.05|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|385||||385|231|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|385||||385|22.89|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|385||||385|192.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|385||||385|21.77|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|385||||385|28.09|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|385||||385|21.23|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MULTIPLAN [1680]|HMA [168003]|385||||385|31.22|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MULTIPLAN [1680]|IHC HS [168011]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|385||||385|23.43|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|385||||385|22.89|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|Self-pay|Self-pay|385||||385|115.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|385||||385|80.85|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|385||||385|20.39|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|385||||385|30.38|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|TRUSTMARK [2030]|STARMARK [203000]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|385||||385|184.61|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|UMR [2035]|UMR OPTIONS [203501]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|385||||385|20.74|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|385||||385|346.5|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|385||||385|13.88|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|385||||385|23.71|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|385||||385|20.81|358.05|13.88
30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|385||||385|192.5|358.05|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|AETNA [1015]|AETNA ACO WILCO [101532]|411||||411|32.91|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|411||||411|22.54|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|411||||411|22.54|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|411||||411|205.91|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|411||||411|144.26|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|411||||411|25.7|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|411||||411|175.09|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|411||||411|205.5|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|411||||411|267.15|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|CORESOURCE [1315]|CORESOURCE [131500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|411||||411|28.72|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|411||||411|16.89|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|GEHA [1415]|GEHA [141500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HEALTHNET [1495]|HEALTHNET [149500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|411||||411|25.7|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|411||||411|382.23|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|411||||411|246.6|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|411||||411|205.5|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|411||||411|21.77|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MULTIPLAN [1680]|HMA [168003]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MULTIPLAN [1680]|IHC HS [168011]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|411||||411|23.43|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|Self-pay|Self-pay|411||||411|123.3|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|411||||411|86.31|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|TRUSTMARK [2030]|STARMARK [203000]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|411||||411|197.07|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|UMR [2035]|UMR OPTIONS [203501]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|411||||411|20.74|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|411||||411|369.9|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|411||||411|13.88|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|411||||411|16.89|382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|411||||411||382.23|13.88
30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|411||||411|205.5|382.23|13.88
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|286||||286|8.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|286||||286|5.28|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|286||||286|5.61|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|286||||286|5.61|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|286||||286|143.29|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|286||||286|100.39|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|286||||286|6.39|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|286||||286|121.84|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|286||||286|143|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|286||||286|185.9|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|286||||286|8.09|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|286||||286|4.95|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|GEHA [1415]|GEHA [141500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|286||||286|11.66|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|286||||286|6.39|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|286||||286|265.98|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|286||||286|171.6|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|286||||286|5.7|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|286||||286|143|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|286||||286|5.42|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|286||||286|6.99|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|286||||286|5.28|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MULTIPLAN [1680]|HMA [168003]|286||||286|7.77|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|286||||286|5.83|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|286||||286|5.7|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|Self-pay|Self-pay|286||||286|85.8|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|286||||286|60.06|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|286||||286|5.08|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|286||||286|7.56|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|286||||286|137.14|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|286||||286|5.17|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|286||||286|257.4|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|286||||286|3.45|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|286||||286|4.95|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|286||||286|5.18|265.98|3.45
30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|286||||286|143|265.98|3.45
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|AETNA [1015]|AETNA ACO WILCO [101532]|131||||131|10.21|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131||||131|7.01|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131||||131|7.01|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131||||131|65.63|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131||||131|45.98|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131||||131|7.98|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131||||131|55.81|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131||||131|65.5|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131||||131|85.15|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|CORESOURCE [1315]|CORESOURCE [131500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|131||||131|10.84|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131||||131|6.63|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|GEHA [1415]|GEHA [141500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HEALTHNET [1495]|HEALTHNET [149500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131||||131|7.98|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|131||||131|121.83|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131||||131|78.6|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131||||131|65.5|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131||||131|6.77|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MULTIPLAN [1680]|HMA [168003]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MULTIPLAN [1680]|IHC HS [168011]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|131||||131|7.29|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|Self-pay|Self-pay|131||||131|39.3|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131||||131|27.51|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|TRUSTMARK [2030]|STARMARK [203000]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131||||131|62.81|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|UMR [2035]|UMR OPTIONS [203501]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131||||131|6.44|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131||||131|117.9|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131||||131|4.31|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131||||131|6.63|121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131||||131||121.83|4.31
30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131||||131|65.5|121.83|4.31
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|485||||485|32.91|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|485||||485|21.23|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|485||||485|22.54|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|485||||485|22.54|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|485||||485|242.99|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|485||||485|170.24|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|485||||485|25.7|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|485||||485|206.61|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|485||||485|242.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|485||||485|315.25|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|485||||485|33.26|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|485||||485|20.37|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|GEHA [1415]|GEHA [141500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|485||||485|46.82|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|485||||485|25.7|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|485||||485|451.05|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|485||||485|291|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|485||||485|22.89|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|485||||485|242.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|485||||485|21.77|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|485||||485|28.09|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|485||||485|21.23|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MULTIPLAN [1680]|HMA [168003]|485||||485|31.22|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MULTIPLAN [1680]|IHC HS [168011]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|485||||485|23.43|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|485||||485|22.89|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|Self-pay|Self-pay|485||||485|145.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|485||||485|101.85|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|485||||485|20.39|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|485||||485|30.38|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|TRUSTMARK [2030]|STARMARK [203000]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|485||||485|232.56|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|UMR [2035]|UMR OPTIONS [203501]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|485||||485|20.74|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|485||||485|436.5|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|485||||485|13.88|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|485||||485|20.37|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|485||||485|20.81|451.05|13.88
30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER QN EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|485||||485|242.5|451.05|13.88
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|197||||197|23.69|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|197||||197|15.29|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|197||||197|16.24|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|197||||197|16.24|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|197||||197|98.7|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|197||||197|69.15|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|197||||197|18.5|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|197||||197|83.92|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|197||||197|98.5|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|197||||197|128.05|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|CORESOURCE [1315]|CORESOURCE [131500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|197||||197|27.17|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|197||||197|16.63|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|GEHA [1415]|GEHA [141500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|197||||197|33.73|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HEALTHNET [1495]|HEALTHNET [149500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|197||||197|18.5|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|197||||197|183.21|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|197||||197|118.2|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|197||||197|16.49|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|197||||197|98.5|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|197||||197|15.68|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|197||||197|20.24|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|197||||197|15.29|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MULTIPLAN [1680]|HMA [168003]|197||||197|22.49|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MULTIPLAN [1680]|IHC HS [168011]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|197||||197|16.88|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|197||||197|16.49|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|Self-pay|Self-pay|197||||197|59.1|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|197||||197|41.37|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|197||||197|14.69|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|197||||197|21.89|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|TRUSTMARK [2030]|STARMARK [203000]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|197||||197|94.46|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|UMR [2035]|UMR OPTIONS [203501]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|197||||197|14.94|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|197||||197|177.3|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|197||||197|9.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|197||||197|16.63|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|197||||197|14.99|183.21|9.99
30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|197||||197|98.5|183.21|9.99
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|316||||316|42.56|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|316||||316|32.41|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|316||||316|32.41|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|316||||316|158.32|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|316||||316|110.92|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|316||||316|29.92|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|316||||316|134.62|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|316||||316|158|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|316||||316|205.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|CORESOURCE [1315]|CORESOURCE [131500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|316||||316|54.5|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|316||||316|33.36|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|GEHA [1415]|GEHA [141500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HEALTHNET [1495]|HEALTHNET [149500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|316||||316|29.92|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|316||||316|293.88|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|316||||316|189.6|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|316||||316|158|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|316||||316|31.3|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MULTIPLAN [1680]|HMA [168003]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MULTIPLAN [1680]|IHC HS [168011]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|316||||316|33.69|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|Self-pay|Self-pay|316||||316|94.8|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|316||||316|66.36|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|TRUSTMARK [2030]|STARMARK [203000]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|316||||316|151.52|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|UMR [2035]|UMR OPTIONS [203501]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|316||||316|29.81|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|316||||316|284.4|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|316||||316|17.95|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|316||||316|33.36|293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|316||||316||293.88|17.95
30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|316||||316|158|293.88|17.95
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|AETNA [1015]|AETNA ACO WILCO [101532]|316||||316|35.35|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|316||||316|25.06|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|316||||316|25.06|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|316||||316|158.32|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|316||||316|110.92|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|316||||316|27.61|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|316||||316|134.62|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|316||||316|158|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|316||||316|205.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|CORESOURCE [1315]|CORESOURCE [131500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|316||||316|54.17|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|316||||316|33.17|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|GEHA [1415]|GEHA [141500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HEALTHNET [1495]|HEALTHNET [149500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|316||||316|27.61|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|316||||316|293.88|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|316||||316|189.6|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|316||||316|158|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|316||||316|24.2|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MULTIPLAN [1680]|HMA [168003]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MULTIPLAN [1680]|IHC HS [168011]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|316||||316|26.05|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|Self-pay|Self-pay|316||||316|94.8|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|316||||316|66.36|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|TRUSTMARK [2030]|STARMARK [203000]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|316||||316|151.52|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|UMR [2035]|UMR OPTIONS [203501]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|316||||316|23.04|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|316||||316|284.4|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|316||||316|14.91|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|316||||316|33.17|293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|316||||316||293.88|14.91
30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|316||||316|158|293.88|14.91
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|AETNA [1015]|AETNA ACO WILCO [101532]|198||||198|22.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198||||198|14.33|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198||||198|15.23|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198||||198|15.23|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198||||198|99.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198||||198|69.5|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198||||198|17.34|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198||||198|84.35|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198||||198|99|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198||||198|128.7|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|CORESOURCE [1315]|CORESOURCE [131500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198||||198|32.82|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198||||198|20.09|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|GEHA [1415]|GEHA [141500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198||||198|31.61|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HEALTHNET [1495]|HEALTHNET [149500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198||||198|17.34|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198||||198|184.14|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198||||198|118.8|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198||||198|15.46|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198||||198|99|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198||||198|14.7|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198||||198|18.97|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198||||198|14.33|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MULTIPLAN [1680]|HMA [168003]|198||||198|21.08|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MULTIPLAN [1680]|IHC HS [168011]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198||||198|15.83|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198||||198|15.46|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|Self-pay|Self-pay|198||||198|59.4|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198||||198|41.58|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198||||198|13.77|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198||||198|20.51|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|TRUSTMARK [2030]|STARMARK [203000]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198||||198|94.94|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|UMR [2035]|UMR OPTIONS [203501]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198||||198|14|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198||||198|178.2|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198||||198|9.37|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198||||198|20.09|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198||||198|14.05|184.14|9.37
30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198||||198|99|184.14|9.37
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|AETNA [1015]|AETNA ACO WILCO [101532]|158||||158|18.93|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158||||158|12.22|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158||||158|12.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158||||158|12.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158||||158|79.16|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158||||158|55.46|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158||||158|14.79|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158||||158|67.31|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158||||158|79|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158||||158|102.7|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|CORESOURCE [1315]|CORESOURCE [131500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158||||158|28.94|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158||||158|17.72|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|GEHA [1415]|GEHA [141500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158||||158|26.96|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HEALTHNET [1495]|HEALTHNET [149500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158||||158|14.79|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158||||158|146.94|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158||||158|94.8|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158||||158|13.18|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158||||158|79|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158||||158|12.54|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158||||158|16.17|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158||||158|12.22|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MULTIPLAN [1680]|HMA [168003]|158||||158|17.97|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MULTIPLAN [1680]|IHC HS [168011]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158||||158|13.49|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158||||158|13.18|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|Self-pay|Self-pay|158||||158|47.4|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158||||158|33.18|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158||||158|11.74|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158||||158|17.49|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|TRUSTMARK [2030]|STARMARK [203000]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158||||158|75.76|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|UMR [2035]|UMR OPTIONS [203501]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158||||158|11.94|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158||||158|142.2|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158||||158|7.99|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158||||158|17.72|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158||||158|11.98|146.94|7.99
30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION GEL QUAL EA AG/ANTBDY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158||||158|79|146.94|7.99
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|464||||464|38.52|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464||||464|26.41|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464||||464|26.41|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|464||||464|232.46|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464||||464|162.86|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464||||464|30.09|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|464||||464|197.66|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|464||||464|232|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464||||464|301.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|464||||464|43.34|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|464||||464|26.54|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|GEHA [1415]|GEHA [141500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464||||464|30.09|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|464||||464|431.52|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464||||464|278.4|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464||||464|232|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464||||464|25.51|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MULTIPLAN [1680]|HMA [168003]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|464||||464|27.45|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|Self-pay|Self-pay|464||||464|139.2|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464||||464|97.44|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464||||464|222.49|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464||||464|24.29|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|464||||464|417.6|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|464||||464|16.25|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|464||||464|26.54|431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|464||||464||431.52|16.25
30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|464||||464|232|431.52|16.25
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|483||||483|35.31|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|483||||483|22.79|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|483||||483|24.2|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|483||||483|24.2|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|483||||483|241.98|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|483||||483|169.53|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|483||||483|27.59|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|483||||483|205.76|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|483||||483|241.5|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|483||||483|313.95|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|CORESOURCE [1315]|CORESOURCE [131500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|483||||483|54.44|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|483||||483|33.33|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|GEHA [1415]|GEHA [141500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|483||||483|50.27|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HEALTHNET [1495]|HEALTHNET [149500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|483||||483|27.59|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|483||||483|449.19|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|483||||483|289.8|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|483||||483|24.57|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|483||||483|241.5|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|483||||483|23.38|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|483||||483|30.16|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|483||||483|22.79|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MULTIPLAN [1680]|HMA [168003]|483||||483|33.51|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MULTIPLAN [1680]|IHC HS [168011]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|483||||483|25.15|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|483||||483|24.57|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|Self-pay|Self-pay|483||||483|144.9|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|483||||483|101.43|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|483||||483|21.89|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|483||||483|32.62|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|TRUSTMARK [2030]|STARMARK [203000]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|483||||483|231.6|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|UMR [2035]|UMR OPTIONS [203501]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|483||||483|22.26|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|483||||483|434.7|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|483||||483|14.9|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|483||||483|33.33|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|483||||483|22.34|449.19|14.9
30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|483||||483|241.5|449.19|14.9
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|AETNA [1015]|AETNA ACO WILCO [101532]|654||||654|46.38|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|654||||654|29.94|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|654||||654|31.8|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|654||||654|31.8|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|654||||654|327.65|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|654||||654|229.55|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|654||||654|36.23|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|654||||654|278.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|654||||654|327|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|654||||654|425.1|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|CORESOURCE [1315]|CORESOURCE [131500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|654||||654|64.85|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|654||||654|39.7|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|GEHA [1415]|GEHA [141500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|654||||654|66.04|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HEALTHNET [1495]|HEALTHNET [149500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|654||||654|36.23|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|654||||654|608.22|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|654||||654|392.4|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|654||||654|32.29|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|654||||654|327|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|654||||654|30.71|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|654||||654|39.62|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|654||||654|29.94|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MULTIPLAN [1680]|HMA [168003]|654||||654|44.03|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MULTIPLAN [1680]|IHC HS [168011]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|654||||654|33.05|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|654||||654|32.29|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|Self-pay|Self-pay|654||||654|196.2|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|654||||654|137.34|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|654||||654|28.76|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|654||||654|42.85|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|TRUSTMARK [2030]|STARMARK [203000]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|654||||654|313.59|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|UMR [2035]|UMR OPTIONS [203501]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|654||||654|29.25|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|654||||654|588.6|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|654||||654|19.57|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|654||||654|39.7|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|654||||654|29.35|608.22|19.57
30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|654||||654|327|608.22|19.57
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|AETNA [1015]|AETNA ACO WILCO [101532]|350||||350|24.64|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350||||350|15.9|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350||||350|16.89|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350||||350|16.89|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|350||||350|175.35|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350||||350|122.85|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350||||350|19.24|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|350||||350|149.1|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|350||||350|175|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350||||350|227.5|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|CORESOURCE [1315]|CORESOURCE [131500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|350||||350|88.16|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|350||||350|53.98|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|GEHA [1415]|GEHA [141500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|350||||350|35.08|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HEALTHNET [1495]|HEALTHNET [149500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350||||350|19.24|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|350||||350|325.5|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350||||350|210|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350||||350|17.15|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350||||350|175|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350||||350|16.31|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350||||350|21.05|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350||||350|15.9|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MULTIPLAN [1680]|HMA [168003]|350||||350|23.39|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MULTIPLAN [1680]|IHC HS [168011]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|350||||350|17.56|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350||||350|17.15|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|Self-pay|Self-pay|350||||350|105|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350||||350|73.5|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|350||||350|15.28|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350||||350|22.76|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|TRUSTMARK [2030]|STARMARK [203000]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350||||350|167.83|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|UMR [2035]|UMR OPTIONS [203501]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350||||350|15.53|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350||||350|315|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|350||||350|10.39|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|350||||350|53.98|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|350||||350|15.59|325.5|10.39
30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|350||||350|175|325.5|10.39
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|337||||337|33.84|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|337||||337|21.84|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|337||||337|23.2|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|337||||337|23.2|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|337||||337|168.84|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|337||||337|118.29|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|337||||337|26.43|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|337||||337|143.56|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|337||||337|168.5|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|337||||337|219.05|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|337||||337|43.34|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|337||||337|26.54|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|GEHA [1415]|GEHA [141500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|337||||337|48.17|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|337||||337|26.43|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|337||||337|313.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|337||||337|202.2|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|337||||337|23.55|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|337||||337|168.5|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|337||||337|22.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|337||||337|28.9|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|337||||337|21.84|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MULTIPLAN [1680]|HMA [168003]|337||||337|32.12|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MULTIPLAN [1680]|IHC HS [168011]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|337||||337|24.11|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|337||||337|23.55|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|Self-pay|Self-pay|337||||337|101.1|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|337||||337|70.77|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|337||||337|20.98|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|337||||337|31.26|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|TRUSTMARK [2030]|STARMARK [203000]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|337||||337|161.59|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|UMR [2035]|UMR OPTIONS [203501]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|337||||337|21.34|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|337||||337|303.3|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|337||||337|14.27|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|337||||337|26.54|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|337||||337|21.41|313.41|14.27
30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|337||||337|168.5|313.41|14.27
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|370||||370|23.82|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370||||370|15.38|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370||||370|16.34|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370||||370|16.34|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|370||||370|185.37|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370||||370|129.87|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370||||370|18.61|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|370||||370|157.62|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|370||||370|185|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370||||370|240.5|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|CORESOURCE [1315]|CORESOURCE [131500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|370||||370|34.42|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|370||||370|21.07|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|GEHA [1415]|GEHA [141500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|370||||370|33.93|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HEALTHNET [1495]|HEALTHNET [149500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370||||370|18.61|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|370||||370|344.1|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370||||370|222|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370||||370|16.59|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370||||370|185|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370||||370|15.78|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370||||370|20.36|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370||||370|15.38|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MULTIPLAN [1680]|HMA [168003]|370||||370|22.62|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MULTIPLAN [1680]|IHC HS [168011]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|370||||370|16.98|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370||||370|16.59|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|Self-pay|Self-pay|370||||370|111|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370||||370|77.7|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|370||||370|14.78|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370||||370|22.02|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|TRUSTMARK [2030]|STARMARK [203000]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370||||370|177.42|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|UMR [2035]|UMR OPTIONS [203501]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370||||370|15.03|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370||||370|333|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|370||||370|10.05|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|370||||370|21.07|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|370||||370|15.08|344.1|10.05
30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INTRINSIC FACTOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|370||||370|185|344.1|10.05
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|AETNA [1015]|AETNA ACO WILCO [101532]|279||||279|33.52|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279||||279|24.04|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279||||279|25.54|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279||||279|25.54|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279||||279|139.78|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279||||279|97.93|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279||||279|24.43|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279||||279|118.85|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279||||279|139.5|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279||||279|181.35|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|CORESOURCE [1315]|CORESOURCE [131500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|279||||279|30.86|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279||||279|18.89|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|GEHA [1415]|GEHA [141500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279||||279|53.03|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HEALTHNET [1495]|HEALTHNET [149500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279||||279|24.43|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|279||||279|259.47|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279||||279|167.4|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279||||279|25.93|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279||||279|139.5|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279||||279|24.67|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279||||279|31.82|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279||||279|24.04|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MULTIPLAN [1680]|HMA [168003]|279||||279|35.36|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MULTIPLAN [1680]|IHC HS [168011]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|279||||279|26.55|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279||||279|25.93|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|Self-pay|Self-pay|279||||279|83.7|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279||||279|58.59|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279||||279|23.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279||||279|34.41|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|TRUSTMARK [2030]|STARMARK [203000]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279||||279|133.78|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|UMR [2035]|UMR OPTIONS [203501]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279||||279|23.49|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279||||279|251.1|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|279||||279|14.14|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279||||279|18.89|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279||||279|23.57|259.47|14.14
30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279||||279|139.5|259.47|14.14
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|AETNA [1015]|AETNA ACO WILCO [101532]|234||||234|19.69|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234||||234|13.5|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234||||234|13.5|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|234||||234|117.23|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234||||234|82.13|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234||||234|15.38|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|234||||234|99.68|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|234||||234|117|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234||||234|152.1|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|CORESOURCE [1315]|CORESOURCE [131500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|234||||234|25.99|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|234||||234|15.91|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|GEHA [1415]|GEHA [141500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HEALTHNET [1495]|HEALTHNET [149500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234||||234|15.38|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|234||||234|217.62|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234||||234|140.4|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234||||234|117|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234||||234|13.03|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MULTIPLAN [1680]|HMA [168003]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MULTIPLAN [1680]|IHC HS [168011]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|234||||234|14.03|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|Self-pay|Self-pay|234||||234|70.2|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234||||234|49.14|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|TRUSTMARK [2030]|STARMARK [203000]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234||||234|112.2|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|UMR [2035]|UMR OPTIONS [203501]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234||||234|12.41|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234||||234|210.6|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|234||||234|8.3|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|234||||234|15.91|217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|234||||234||217.62|8.3
30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|234||||234|117|217.62|8.3
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|AETNA [1015]|AETNA ACO WILCO [101532]|782||||782|214.73|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|782||||782|138.58|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|782||||782|147.2|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|782||||782|147.2|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|782||||782|391.78|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|782||||782|274.48|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|782||||782|167.73|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|782||||782|333.13|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|782||||782|391|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|782||||782|508.3|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|CORESOURCE [1315]|CORESOURCE [131500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|782||||782|188.24|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|782||||782|110.44|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|GEHA [1415]|GEHA [141500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|782||||782|305.69|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HEALTHNET [1495]|HEALTHNET [149500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|782||||782|167.73|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|782||||782|727.26|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|782||||782|469.2|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|782||||782|149.45|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|782||||782|391|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|782||||782|142.17|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|782||||782|183.41|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|782||||782|138.58|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MULTIPLAN [1680]|HMA [168003]|782||||782|203.79|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MULTIPLAN [1680]|IHC HS [168011]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|782||||782|153|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|782||||782|149.45|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|Self-pay|Self-pay|782||||782|234.6|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|782||||782|164.22|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|782||||782|133.14|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|782||||782|198.36|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|TRUSTMARK [2030]|STARMARK [203000]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|782||||782|374.97|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|UMR [2035]|UMR OPTIONS [203501]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|782||||782|135.39|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|782||||782|703.8|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|782||||782|90.58|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|782||||782|110.44|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|782||||782|135.86|727.26|90.58
30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|782||||782|391|727.26|90.58
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|1465||||1465|77.48|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1465||||1465|53.12|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1465||||1465|53.12|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1465||||1465|733.97|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1465||||1465|514.22|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1465||||1465|60.53|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1465||||1465|624.09|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1465||||1465|732.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1465||||1465|952.25|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|CORESOURCE [1315]|CORESOURCE [131500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1465||||1465|89.99|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1465||||1465|55.09|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|GEHA [1415]|GEHA [141500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HEALTHNET [1495]|HEALTHNET [149500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1465||||1465|60.53|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1465||||1465|1362.45|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1465||||1465|879|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1465||||1465|732.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1465||||1465|51.31|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MULTIPLAN [1680]|HMA [168003]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MULTIPLAN [1680]|IHC HS [168011]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1465||||1465|55.21|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|Self-pay|Self-pay|1465||||1465|439.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1465||||1465|307.65|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|TRUSTMARK [2030]|STARMARK [203000]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1465||||1465|702.47|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|UMR [2035]|UMR OPTIONS [203501]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1465||||1465|48.86|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1465||||1465|1318.5|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1465||||1465|32.68|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1465||||1465|55.09|1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1465||||1465||1362.45|32.68
30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1465||||1465|732.5|1362.45|32.68
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|132||||132|59.63|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132||||132|38.48|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132||||132|40.88|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132||||132|40.88|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|132||||132|66.13|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132||||132|46.33|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132||||132|46.58|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|132||||132|56.23|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|132||||132|66|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132||||132|85.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|CORESOURCE [1315]|CORESOURCE [131500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|132||||132|56.94|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|132||||132|34.86|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|GEHA [1415]|GEHA [141500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|132||||132|84.89|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HEALTHNET [1495]|HEALTHNET [149500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132||||132|46.58|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|132||||132|122.76|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132||||132|79.2|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132||||132|41.5|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132||||132|66|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132||||132|39.49|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132||||132|50.94|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132||||132|38.48|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MULTIPLAN [1680]|HMA [168003]|132||||132|56.6|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MULTIPLAN [1680]|IHC HS [168011]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|132||||132|42.49|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132||||132|41.5|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|Self-pay|Self-pay|132||||132|39.6|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132||||132|27.72|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|132||||132|36.98|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132||||132|55.09|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|TRUSTMARK [2030]|STARMARK [203000]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132||||132|63.29|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|UMR [2035]|UMR OPTIONS [203501]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132||||132|37.61|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132||||132|118.8|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|132||||132|25.15|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|132||||132|34.86|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|132||||132|37.73|122.76|25.15
30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|132||||132|66|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|132||||132|59.63|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132||||132|38.48|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132||||132|40.88|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132||||132|40.88|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|132||||132|66.13|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132||||132|46.33|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132||||132|46.58|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|132||||132|56.23|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|132||||132|66|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132||||132|85.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|CORESOURCE [1315]|CORESOURCE [131500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|132||||132|56.94|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|132||||132|34.86|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|GEHA [1415]|GEHA [141500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|132||||132|84.89|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HEALTHNET [1495]|HEALTHNET [149500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132||||132|46.58|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|132||||132|122.76|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132||||132|79.2|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132||||132|41.5|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132||||132|66|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132||||132|39.49|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132||||132|50.94|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132||||132|38.48|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MULTIPLAN [1680]|HMA [168003]|132||||132|56.6|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MULTIPLAN [1680]|IHC HS [168011]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|132||||132|42.49|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132||||132|41.5|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|Self-pay|Self-pay|132||||132|39.6|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132||||132|27.72|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|132||||132|36.98|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132||||132|55.09|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|TRUSTMARK [2030]|STARMARK [203000]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132||||132|63.29|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|UMR [2035]|UMR OPTIONS [203501]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132||||132|37.61|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132||||132|118.8|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|132||||132|25.15|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|132||||132|34.86|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|132||||132|37.73|122.76|25.15
30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|132||||132|66|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|132||||132|59.63|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132||||132|38.48|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132||||132|40.88|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132||||132|40.88|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|132||||132|66.13|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132||||132|46.33|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132||||132|46.58|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|132||||132|56.23|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|132||||132|66|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132||||132|85.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|132||||132|61.23|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|132||||132|37.49|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|GEHA [1415]|GEHA [141500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|132||||132|84.89|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132||||132|46.58|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|132||||132|122.76|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132||||132|79.2|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132||||132|41.5|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132||||132|66|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132||||132|39.49|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132||||132|50.94|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132||||132|38.48|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MULTIPLAN [1680]|HMA [168003]|132||||132|56.6|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|132||||132|42.49|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132||||132|41.5|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|Self-pay|Self-pay|132||||132|39.6|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132||||132|27.72|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|132||||132|36.98|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132||||132|55.09|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132||||132|63.29|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132||||132|37.61|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132||||132|118.8|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|132||||132|25.15|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|132||||132|37.49|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|132||||132|37.73|122.76|25.15
30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|132||||132|66|122.76|25.15
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|AETNA [1015]|AETNA ACO WILCO [101532]|620||||620|74.24|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|620||||620|47.92|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|620||||620|50.9|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|620||||620|50.9|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|620||||620|310.62|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|620||||620|217.62|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|620||||620|58.01|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|620||||620|264.12|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|620||||620|310|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|620||||620|403|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|CORESOURCE [1315]|CORESOURCE [131500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|620||||620|78.66|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|620||||620|48.16|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|GEHA [1415]|GEHA [141500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|620||||620|105.71|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HEALTHNET [1495]|HEALTHNET [149500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|620||||620|58.01|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|620||||620|576.6|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|620||||620|372|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|620||||620|51.68|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|620||||620|310|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|620||||620|49.16|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|620||||620|63.42|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|620||||620|47.92|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MULTIPLAN [1680]|HMA [168003]|620||||620|70.47|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MULTIPLAN [1680]|IHC HS [168011]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|620||||620|52.9|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|620||||620|51.68|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|Self-pay|Self-pay|620||||620|186|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|620||||620|130.2|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|620||||620|46.04|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|620||||620|68.59|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|TRUSTMARK [2030]|STARMARK [203000]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|620||||620|297.29|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|UMR [2035]|UMR OPTIONS [203501]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|620||||620|46.81|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|620||||620|558|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|620||||620|31.32|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|620||||620|48.16|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|620||||620|46.98|576.6|31.32
30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|620||||620|310|576.6|31.32
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|459||||459|42.31|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|459||||459|27.32|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|459||||459|29.01|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|459||||459|29.01|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|459||||459|229.96|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|459||||459|161.11|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|459||||459|33.06|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|459||||459|195.53|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|459||||459|229.5|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|459||||459|298.35|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|CORESOURCE [1315]|CORESOURCE [131500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|459||||459|52.36|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|459||||459|32.06|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|GEHA [1415]|GEHA [141500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|459||||459|60.26|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HEALTHNET [1495]|HEALTHNET [149500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|459||||459|33.06|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|459||||459|426.87|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|459||||459|275.4|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|459||||459|29.46|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|459||||459|229.5|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|459||||459|28.02|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|459||||459|36.15|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|459||||459|27.32|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MULTIPLAN [1680]|HMA [168003]|459||||459|40.17|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MULTIPLAN [1680]|IHC HS [168011]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|459||||459|30.15|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|459||||459|29.46|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|Self-pay|Self-pay|459||||459|137.7|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|459||||459|96.39|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|459||||459|26.24|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|459||||459|39.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|TRUSTMARK [2030]|STARMARK [203000]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|459||||459|220.09|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|UMR [2035]|UMR OPTIONS [203501]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|459||||459|26.68|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|459||||459|413.1|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|459||||459|17.85|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|459||||459|32.06|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|459||||459|26.78|426.87|17.85
30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|459||||459|229.5|426.87|17.85
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|215||||215|23|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215||||215|14.84|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215||||215|15.77|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215||||215|15.77|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|215||||215|107.72|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215||||215|75.47|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215||||215|17.96|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|215||||215|91.59|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|215||||215|107.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215||||215|139.75|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|CORESOURCE [1315]|CORESOURCE [131500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|215||||215|29.78|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|215||||215|18.23|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|GEHA [1415]|GEHA [141500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|215||||215|32.74|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HEALTHNET [1495]|HEALTHNET [149500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215||||215|17.96|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|215||||215|199.95|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215||||215|129|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215||||215|16.01|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215||||215|107.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215||||215|15.23|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215||||215|19.64|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215||||215|14.84|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MULTIPLAN [1680]|HMA [168003]|215||||215|21.83|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MULTIPLAN [1680]|IHC HS [168011]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|215||||215|16.39|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215||||215|16.01|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|Self-pay|Self-pay|215||||215|64.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215||||215|45.15|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|215||||215|14.26|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215||||215|21.24|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|TRUSTMARK [2030]|STARMARK [203000]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215||||215|103.09|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|UMR [2035]|UMR OPTIONS [203501]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215||||215|14.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215||||215|193.5|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|215||||215|9.7|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|215||||215|18.23|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|215||||215|14.55|199.95|9.7
30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|215||||215|107.5|199.95|9.7
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|98||||98|26.72|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98||||98|18.33|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98||||98|18.33|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|98||||98|49.1|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98||||98|34.4|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98||||98|20.88|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|98||||98|41.75|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|98||||98|49|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98||||98|63.7|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|CORESOURCE [1315]|CORESOURCE [131500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|98||||98|40.58|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|98||||98|24.84|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|GEHA [1415]|GEHA [141500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HEALTHNET [1495]|HEALTHNET [149500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98||||98|20.88|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|98||||98|91.14|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98||||98|58.8|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98||||98|49|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98||||98|17.7|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MULTIPLAN [1680]|HMA [168003]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MULTIPLAN [1680]|IHC HS [168011]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|98||||98|19.05|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|Self-pay|Self-pay|98||||98|29.4|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98||||98|20.58|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|TRUSTMARK [2030]|STARMARK [203000]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98||||98|46.99|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|UMR [2035]|UMR OPTIONS [203501]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98||||98|16.86|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98||||98|88.2|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|98||||98|11.27|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|98||||98|24.84|91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|98||||98||91.14|11.27
30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|98||||98|49|91.14|11.27
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|AETNA [1015]|AETNA ACO WILCO [101532]|186||||186|19.35|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186||||186|14.74|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186||||186|14.74|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186||||186|93.19|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186||||186|65.29|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186||||186|14.06|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186||||186|79.24|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186||||186|93|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186||||186|120.9|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|CORESOURCE [1315]|CORESOURCE [131500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|186||||186|22.23|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186||||186|13.61|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|GEHA [1415]|GEHA [141500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HEALTHNET [1495]|HEALTHNET [149500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186||||186|14.06|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|186||||186|172.98|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186||||186|111.6|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186||||186|93|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186||||186|14.24|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MULTIPLAN [1680]|HMA [168003]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MULTIPLAN [1680]|IHC HS [168011]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|186||||186|15.32|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|Self-pay|Self-pay|186||||186|55.8|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186||||186|39.06|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|TRUSTMARK [2030]|STARMARK [203000]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186||||186|89.19|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|UMR [2035]|UMR OPTIONS [203501]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186||||186|13.56|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186||||186|167.4|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186||||186|8.17|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186||||186|13.61|172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186||||186||172.98|8.17
30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186||||186|93|172.98|8.17
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|175||||175|16.42|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|175||||175|11.77|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|175||||175|12.51|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|175||||175|12.51|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|175||||175|87.68|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|175||||175|61.43|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|175||||175|12.58|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|175||||175|74.55|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|175||||175|87.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|175||||175|113.75|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|175||||175|18.36|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|175||||175|11.24|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|GEHA [1415]|GEHA [141500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|175||||175|25.97|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|175||||175|12.58|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|175||||175|162.75|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|175||||175|105|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|175||||175|12.69|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|175||||175|87.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|175||||175|12.08|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|175||||175|15.58|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|175||||175|11.77|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MULTIPLAN [1680]|HMA [168003]|175||||175|17.31|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|175||||175|13|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|175||||175|12.69|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|Self-pay|Self-pay|175||||175|52.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|175||||175|36.75|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|175||||175|11.31|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|175||||175|16.85|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|175||||175|83.91|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|175||||175|11.51|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|175||||175|157.5|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|175||||175|6.92|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|175||||175|11.24|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|175||||175|11.54|162.75|6.92
30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|175||||175|87.5|162.75|6.92
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|151||||151|16.81|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151||||151|11.53|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151||||151|11.53|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|151||||151|75.65|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151||||151|53|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151||||151|13.13|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|151||||151|64.33|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|151||||151|75.5|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151||||151|98.15|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|CORESOURCE [1315]|CORESOURCE [131500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|151||||151|17.48|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|151||||151|10.7|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|GEHA [1415]|GEHA [141500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HEALTHNET [1495]|HEALTHNET [149500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151||||151|13.13|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|151||||151|140.43|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151||||151|90.6|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151||||151|75.5|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151||||151|11.13|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MULTIPLAN [1680]|HMA [168003]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MULTIPLAN [1680]|IHC HS [168011]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|151||||151|11.98|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|Self-pay|Self-pay|151||||151|45.3|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151||||151|31.71|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|TRUSTMARK [2030]|STARMARK [203000]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151||||151|72.4|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|UMR [2035]|UMR OPTIONS [203501]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151||||151|10.6|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151||||151|135.9|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|151||||151|7.09|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|151||||151|10.7|140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|151||||151||140.43|7.09
30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|151||||151|75.5|140.43|7.09
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|153||||153|8.96|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|153||||153|6.65|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|153||||153|6.65|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|153||||153|76.65|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|153||||153|53.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|153||||153|7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|153||||153|65.18|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|153||||153|76.5|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|153||||153|99.45|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|CORESOURCE [1315]|CORESOURCE [131500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|153||||153|12.8|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|153||||153|7.84|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|GEHA [1415]|GEHA [141500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HEALTHNET [1495]|HEALTHNET [149500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153||||153|7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|153||||153|142.29|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|153||||153|91.8|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|153||||153|76.5|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|153||||153|6.43|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MULTIPLAN [1680]|HMA [168003]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MULTIPLAN [1680]|IHC HS [168011]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|153||||153|6.91|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|Self-pay|Self-pay|153||||153|45.9|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|153||||153|32.13|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|TRUSTMARK [2030]|STARMARK [203000]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153||||153|73.36|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|UMR [2035]|UMR OPTIONS [203501]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|153||||153|6.12|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|153||||153|137.7|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|153||||153|3.78|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|153||||153|7.84|142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|153||||153||142.29|3.78
30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|153||||153|76.5|142.29|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|169||||169|8.96|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169||||169|5.78|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169||||169|6.14|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169||||169|6.14|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169||||169|84.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169||||169|59.32|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169||||169|7|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169||||169|71.99|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169||||169|84.5|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169||||169|109.85|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|CORESOURCE [1315]|CORESOURCE [131500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169||||169|13.66|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169||||169|8.36|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|GEHA [1415]|GEHA [141500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169||||169|12.76|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HEALTHNET [1495]|HEALTHNET [149500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169||||169|7|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169||||169|157.17|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169||||169|101.4|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169||||169|6.24|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169||||169|84.5|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169||||169|5.94|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169||||169|7.65|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169||||169|5.78|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MULTIPLAN [1680]|HMA [168003]|169||||169|8.51|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MULTIPLAN [1680]|IHC HS [168011]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169||||169|6.38|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169||||169|6.24|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|Self-pay|Self-pay|169||||169|50.7|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169||||169|35.49|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169||||169|5.56|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169||||169|8.28|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|TRUSTMARK [2030]|STARMARK [203000]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169||||169|81.04|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|UMR [2035]|UMR OPTIONS [203501]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169||||169|5.65|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169||||169|152.1|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169||||169|3.78|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169||||169|8.36|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169||||169|5.67|157.17|3.78
30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169||||169|84.5|157.17|3.78
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|AETNA [1015]|AETNA ACO WILCO [101532]|975||||975|97.96|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|975||||975|63.22|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|975||||975|67.15|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|975||||975|67.15|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|975||||975|488.48|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|975||||975|342.23|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|975||||975|76.52|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|975||||975|415.35|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|975||||975|487.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|975||||975|633.75|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|CORESOURCE [1315]|CORESOURCE [131500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|975||||975|135.74|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|975||||975|83.11|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|GEHA [1415]|GEHA [141500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|975||||975|139.46|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HEALTHNET [1495]|HEALTHNET [149500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|975||||975|76.52|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|975||||975|906.75|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|975||||975|585|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|975||||975|68.18|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|975||||975|487.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|975||||975|64.86|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|975||||975|83.67|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|975||||975|63.22|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MULTIPLAN [1680]|HMA [168003]|975||||975|92.97|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MULTIPLAN [1680]|IHC HS [168011]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|975||||975|69.79|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|975||||975|68.18|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|Self-pay|Self-pay|975||||975|292.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|975||||975|204.75|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|975||||975|60.74|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|975||||975|90.49|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|TRUSTMARK [2030]|STARMARK [203000]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|975||||975|467.51|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|UMR [2035]|UMR OPTIONS [203501]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|975||||975|61.77|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|975||||975|877.5|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|975||||975|41.32|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|975||||975|83.11|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|975||||975|61.98|906.75|41.32
30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|975||||975|487.5|906.75|41.32
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|86||||86|11.5|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86||||86|9.84|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86||||86|9.84|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86||||86|43.09|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86||||86|30.19|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86||||86|36.98|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86||||86|36.64|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86||||86|43|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86||||86|55.9|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|CORESOURCE [1315]|CORESOURCE [131500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86||||86|10.03|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86||||86|6.14|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|GEHA [1415]|GEHA [141500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HEALTHNET [1495]|HEALTHNET [149500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86||||86|36.98|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86||||86|79.98|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86||||86|51.6|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86||||86|41.04|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86||||86|9.03|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MULTIPLAN [1680]|HMA [168003]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MULTIPLAN [1680]|IHC HS [168011]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86||||86|10.23|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|Self-pay|Self-pay|86||||86|25.8|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86||||86|18.06|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|TRUSTMARK [2030]|STARMARK [203000]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86||||86|41.24|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|UMR [2035]|UMR OPTIONS [203501]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86||||86|8.6|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86||||86|77.4|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86||||86|10.3|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86||||86|6.14|79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86||||86||79.98|6.14
30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86||||86|43|79.98|6.14
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|225||||225|6.75|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225||||225|4.36|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225||||225|4.62|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225||||225|4.62|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|225||||225|112.73|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225||||225|78.98|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225||||225|5.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|225||||225|95.85|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|225||||225|112.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225||||225|146.25|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|CORESOURCE [1315]|CORESOURCE [131500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|225||||225|7.77|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|225||||225|4.76|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|GEHA [1415]|GEHA [141500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|225||||225|9.61|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HEALTHNET [1495]|HEALTHNET [149500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225||||225|5.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|225||||225|209.25|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225||||225|135|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225||||225|4.7|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225||||225|112.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225||||225|4.46|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225||||225|5.76|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225||||225|4.36|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MULTIPLAN [1680]|HMA [168003]|225||||225|6.41|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MULTIPLAN [1680]|IHC HS [168011]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|225||||225|4.8|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225||||225|4.7|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|Self-pay|Self-pay|225||||225|67.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225||||225|47.25|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|225||||225|4.18|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225||||225|6.23|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|TRUSTMARK [2030]|STARMARK [203000]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225||||225|107.89|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|UMR [2035]|UMR OPTIONS [203501]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225||||225|4.25|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225||||225|202.5|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|225||||225|2.85|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|225||||225|4.76|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|225||||225|4.27|209.25|2.85
30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|225||||225|112.5|209.25|2.85
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|263||||263|6.96|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263||||263|4.49|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263||||263|4.77|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263||||263|4.77|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|263||||263|131.76|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263||||263|92.31|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263||||263|5.44|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|263||||263|112.04|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|263||||263|131.5|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263||||263|170.95|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|CORESOURCE [1315]|CORESOURCE [131500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|263||||263|9.53|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|263||||263|5.83|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|GEHA [1415]|GEHA [141500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|263||||263|9.9|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HEALTHNET [1495]|HEALTHNET [149500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263||||263|5.44|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|263||||263|244.59|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263||||263|157.8|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263||||263|4.84|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263||||263|131.5|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263||||263|4.61|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263||||263|5.94|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263||||263|4.49|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MULTIPLAN [1680]|HMA [168003]|263||||263|6.6|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MULTIPLAN [1680]|IHC HS [168011]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|263||||263|4.96|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263||||263|4.84|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|Self-pay|Self-pay|263||||263|78.9|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263||||263|55.23|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|263||||263|4.31|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263||||263|6.42|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|TRUSTMARK [2030]|STARMARK [203000]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263||||263|126.11|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|UMR [2035]|UMR OPTIONS [203501]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263||||263|4.39|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263||||263|236.7|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|263||||263|2.93|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|263||||263|5.83|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|263||||263|4.4|244.59|2.93
30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|263||||263|131.5|244.59|2.93
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|AETNA [1015]|AETNA ACO WILCO [101532]|211||||211|16.08|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211||||211|11.03|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211||||211|11.03|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|211||||211|105.71|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211||||211|74.06|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211||||211|12.56|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|211||||211|89.89|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|211||||211|105.5|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211||||211|137.15|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|CORESOURCE [1315]|CORESOURCE [131500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|211||||211|16.93|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|211||||211|10.37|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|GEHA [1415]|GEHA [141500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HEALTHNET [1495]|HEALTHNET [149500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211||||211|12.56|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|211||||211|196.23|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211||||211|126.6|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211||||211|105.5|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211||||211|10.65|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MULTIPLAN [1680]|HMA [168003]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MULTIPLAN [1680]|IHC HS [168011]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|211||||211|11.46|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|Self-pay|Self-pay|211||||211|63.3|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211||||211|44.31|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|TRUSTMARK [2030]|STARMARK [203000]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211||||211|101.17|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|UMR [2035]|UMR OPTIONS [203501]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211||||211|10.14|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211||||211|189.9|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|211||||211|6.79|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|211||||211|10.37|196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|211||||211||196.23|6.79
30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|211||||211|105.5|196.23|6.79
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|20.34|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|13.95|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|13.95|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|15.89|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|19.56|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|11.97|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|15.89|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|13.47|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|14.5|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|Self-pay|Self-pay|202||||202|60.6|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|12.83|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|8.58|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|11.97|187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|8.58
30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|8.58
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|AETNA [1015]|AETNA ACO WILCO [101532]|248||||248|23.8|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248||||248|15.35|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248||||248|16.31|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248||||248|16.31|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|248||||248|124.25|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248||||248|87.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248||||248|18.59|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|248||||248|105.65|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|248||||248|124|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248||||248|161.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|CORESOURCE [1315]|CORESOURCE [131500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|248||||248|22.86|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|248||||248|14|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|GEHA [1415]|GEHA [141500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|248||||248|33.86|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HEALTHNET [1495]|HEALTHNET [149500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248||||248|18.59|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|248||||248|230.64|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248||||248|148.8|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248||||248|16.56|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248||||248|124|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248||||248|15.75|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248||||248|20.32|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248||||248|15.35|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MULTIPLAN [1680]|HMA [168003]|248||||248|22.58|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MULTIPLAN [1680]|IHC HS [168011]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|248||||248|16.95|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248||||248|16.56|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|Self-pay|Self-pay|248||||248|74.4|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248||||248|52.08|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|248||||248|14.75|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248||||248|21.97|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|TRUSTMARK [2030]|STARMARK [203000]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248||||248|118.92|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|UMR [2035]|UMR OPTIONS [203501]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248||||248|15|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248||||248|223.2|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|248||||248|10.04|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|248||||248|14|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|248||||248|15.05|230.64|10.04
30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|248||||248|124|230.64|10.04
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|AETNA [1015]|AETNA ACO WILCO [101532]|139||||139|20.35|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139||||139|13.96|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139||||139|13.96|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139||||139|69.64|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139||||139|48.79|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139||||139|15.9|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139||||139|59.21|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139||||139|69.5|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139||||139|90.35|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|CORESOURCE [1315]|CORESOURCE [131500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139||||139|19.37|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139||||139|11.86|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|GEHA [1415]|GEHA [141500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HEALTHNET [1495]|HEALTHNET [149500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139||||139|15.9|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139||||139|129.27|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139||||139|83.4|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139||||139|69.5|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139||||139|13.48|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MULTIPLAN [1680]|HMA [168003]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MULTIPLAN [1680]|IHC HS [168011]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139||||139|14.51|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|Self-pay|Self-pay|139||||139|41.7|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139||||139|29.19|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|TRUSTMARK [2030]|STARMARK [203000]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139||||139|66.65|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|UMR [2035]|UMR OPTIONS [203501]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139||||139|12.84|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139||||139|125.1|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139||||139|8.59|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139||||139|11.86|129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139||||139||129.27|8.59
30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139||||139|69.5|129.27|8.59
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|AETNA [1015]|AETNA ACO WILCO [101532]|122||||122|16.08|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122||||122|10.38|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122||||122|11.03|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122||||122|11.03|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|122||||122|61.12|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122||||122|42.82|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122||||122|12.56|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|122||||122|51.97|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|122||||122|61|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122||||122|79.3|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|CORESOURCE [1315]|CORESOURCE [131500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|122||||122|19.05|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|122||||122|11.66|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|GEHA [1415]|GEHA [141500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|122||||122|22.91|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HEALTHNET [1495]|HEALTHNET [149500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122||||122|12.56|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|122||||122|113.46|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122||||122|73.2|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122||||122|11.2|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122||||122|61|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122||||122|10.65|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122||||122|13.74|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122||||122|10.38|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MULTIPLAN [1680]|HMA [168003]|122||||122|15.27|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MULTIPLAN [1680]|IHC HS [168011]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|122||||122|11.46|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122||||122|11.2|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|Self-pay|Self-pay|122||||122|36.6|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122||||122|25.62|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|122||||122|9.98|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122||||122|14.86|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|TRUSTMARK [2030]|STARMARK [203000]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122||||122|58.5|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|UMR [2035]|UMR OPTIONS [203501]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122||||122|10.14|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122||||122|109.8|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|122||||122|6.79|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|122||||122|11.66|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|122||||122|10.18|113.46|6.79
30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|122||||122|61|113.46|6.79
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|AETNA [1015]|AETNA ACO WILCO [101532]|182||||182|20.4|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182||||182|13.98|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182||||182|13.98|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182||||182|91.18|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182||||182|63.88|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182||||182|15.93|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182||||182|77.53|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182||||182|91|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182||||182|118.3|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|CORESOURCE [1315]|CORESOURCE [131500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182||||182|20.55|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182||||182|12.58|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|GEHA [1415]|GEHA [141500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HEALTHNET [1495]|HEALTHNET [149500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182||||182|15.93|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182||||182|169.26|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182||||182|109.2|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182||||182|91|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182||||182|13.5|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MULTIPLAN [1680]|HMA [168003]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MULTIPLAN [1680]|IHC HS [168011]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182||||182|14.53|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|Self-pay|Self-pay|182||||182|54.6|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182||||182|38.22|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|TRUSTMARK [2030]|STARMARK [203000]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182||||182|87.27|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|UMR [2035]|UMR OPTIONS [203501]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182||||182|12.86|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182||||182|163.8|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182||||182|8.6|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182||||182|12.58|169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182||||182||169.26|8.6
30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182||||182|91|169.26|8.6
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|547||||547|20.84|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|547||||547|13.45|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|547||||547|14.29|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|547||||547|14.29|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|547||||547|274.05|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|547||||547|192|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|547||||547|16.28|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|547||||547|233.02|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|547||||547|273.5|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|547||||547|355.55|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|547||||547|21.46|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|547||||547|13.14|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|GEHA [1415]|GEHA [141500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|547||||547|29.68|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|547||||547|16.28|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|547||||547|508.71|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|547||||547|328.2|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|547||||547|14.51|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|547||||547|273.5|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|547||||547|13.81|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|547||||547|17.81|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|547||||547|13.45|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MULTIPLAN [1680]|HMA [168003]|547||||547|19.79|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MULTIPLAN [1680]|IHC HS [168011]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|547||||547|14.85|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|547||||547|14.51|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|Self-pay|Self-pay|547||||547|164.1|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|547||||547|114.87|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|547||||547|12.93|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|547||||547|19.26|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|TRUSTMARK [2030]|STARMARK [203000]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|547||||547|262.29|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|UMR [2035]|UMR OPTIONS [203501]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|547||||547|13.15|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|547||||547|492.3|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|547||||547|8.79|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|547||||547|13.14|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|547||||547|13.19|508.71|8.79
30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|547||||547|273.5|508.71|8.79
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|AETNA [1015]|AETNA ACO WILCO [101532]|205||||205|24.48|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205||||205|16.78|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205||||205|16.78|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|205||||205|102.71|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205||||205|71.96|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205||||205|19.13|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|205||||205|87.33|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|205||||205|102.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205||||205|133.25|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|CORESOURCE [1315]|CORESOURCE [131500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|205||||205|25.28|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|205||||205|15.48|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|GEHA [1415]|GEHA [141500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HEALTHNET [1495]|HEALTHNET [149500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205||||205|19.13|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|205||||205|190.65|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205||||205|123|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205||||205|102.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205||||205|16.21|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MULTIPLAN [1680]|HMA [168003]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MULTIPLAN [1680]|IHC HS [168011]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|205||||205|17.44|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|Self-pay|Self-pay|205||||205|61.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205||||205|43.05|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|TRUSTMARK [2030]|STARMARK [203000]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205||||205|98.3|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|UMR [2035]|UMR OPTIONS [203501]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205||||205|15.44|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205||||205|184.5|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|205||||205|10.33|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|205||||205|15.48|190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|205||||205||190.65|10.33
30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|205||||205|102.5|190.65|10.33
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|307||||307|26.91|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|307||||307|17.37|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|307||||307|18.45|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|307||||307|18.45|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|307||||307|153.81|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|307||||307|107.76|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|307||||307|21.02|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|307||||307|130.78|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|307||||307|153.5|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|307||||307|199.55|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|CORESOURCE [1315]|CORESOURCE [131500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|307||||307|25.7|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|307||||307|15.74|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|GEHA [1415]|GEHA [141500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|307||||307|38.32|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HEALTHNET [1495]|HEALTHNET [149500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|307||||307|21.02|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|307||||307|285.51|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|307||||307|184.2|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|307||||307|18.73|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|307||||307|153.5|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|307||||307|17.82|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|307||||307|22.99|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|307||||307|17.37|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MULTIPLAN [1680]|HMA [168003]|307||||307|25.55|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MULTIPLAN [1680]|IHC HS [168011]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|307||||307|19.18|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|307||||307|18.73|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|Self-pay|Self-pay|307||||307|92.1|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|307||||307|64.47|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|307||||307|16.69|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|307||||307|24.86|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|TRUSTMARK [2030]|STARMARK [203000]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|307||||307|147.21|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|UMR [2035]|UMR OPTIONS [203501]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|307||||307|16.97|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|307||||307|276.3|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|307||||307|11.35|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|307||||307|15.74|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|307||||307|17.03|285.51|11.35
30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|307||||307|153.5|285.51|11.35
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|78||||78|21.13|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78||||78|14.5|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78||||78|14.5|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|78||||78|39.08|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78||||78|27.38|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78||||78|16.52|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|78||||78|33.23|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|78||||78|39|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78||||78|50.7|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|CORESOURCE [1315]|CORESOURCE [131500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|78||||78|20.17|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|78||||78|12.35|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|GEHA [1415]|GEHA [141500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HEALTHNET [1495]|HEALTHNET [149500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78||||78|16.52|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|78||||78|72.54|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78||||78|46.8|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78||||78|39|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78||||78|14|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MULTIPLAN [1680]|HMA [168003]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MULTIPLAN [1680]|IHC HS [168011]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|78||||78|15.07|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|Self-pay|Self-pay|78||||78|23.4|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78||||78|16.38|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|TRUSTMARK [2030]|STARMARK [203000]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78||||78|37.4|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|UMR [2035]|UMR OPTIONS [203501]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78||||78|13.34|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78||||78|70.2|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|78||||78|8.92|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|78||||78|12.35|72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|78||||78||72.54|8.92
30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|78||||78|39|72.54|8.92
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|134||||134|14.11|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134||||134|9.67|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134||||134|9.67|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|134||||134|67.13|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134||||134|47.03|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134||||134|11.03|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|134||||134|57.08|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|134||||134|67|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134||||134|87.1|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|134||||134|14.19|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|134||||134|8.69|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|GEHA [1415]|GEHA [141500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134||||134|11.03|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|134||||134|124.62|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134||||134|80.4|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134||||134|67|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134||||134|9.34|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MULTIPLAN [1680]|HMA [168003]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MULTIPLAN [1680]|IHC HS [168011]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|134||||134|10.05|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|Self-pay|Self-pay|134||||134|40.2|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134||||134|28.14|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|TRUSTMARK [2030]|STARMARK [203000]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134||||134|64.25|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|UMR [2035]|UMR OPTIONS [203501]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134||||134|8.9|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134||||134|120.6|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|134||||134|5.95|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|134||||134|8.69|124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|134||||134||124.62|5.95
30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|134||||134|67|124.62|5.95
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|AETNA [1015]|AETNA ACO WILCO [101532]|393||||393|20.74|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|393||||393|13.38|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|393||||393|14.21|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|393||||393|14.21|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|393||||393|196.89|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|393||||393|137.94|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|393||||393|16.2|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|393||||393|167.42|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|393||||393|196.5|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|393||||393|255.45|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|CORESOURCE [1315]|CORESOURCE [131500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|393||||393|19.82|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|393||||393|12.14|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|GEHA [1415]|GEHA [141500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|393||||393|29.52|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HEALTHNET [1495]|HEALTHNET [149500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|393||||393|16.2|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|393||||393|365.49|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|393||||393|235.8|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|393||||393|14.43|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|393||||393|196.5|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|393||||393|13.73|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|393||||393|17.71|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|393||||393|13.38|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MULTIPLAN [1680]|HMA [168003]|393||||393|19.68|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MULTIPLAN [1680]|IHC HS [168011]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|393||||393|14.77|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|393||||393|14.43|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|Self-pay|Self-pay|393||||393|117.9|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|393||||393|82.53|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|393||||393|12.86|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|393||||393|19.16|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|TRUSTMARK [2030]|STARMARK [203000]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|393||||393|188.44|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|UMR [2035]|UMR OPTIONS [203501]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|393||||393|13.08|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|393||||393|353.7|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|393||||393|8.75|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|393||||393|12.14|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|393||||393|13.12|365.49|8.75
30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|393||||393|196.5|365.49|8.75
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|AETNA [1015]|AETNA ACO WILCO [101532]|191||||191|18.97|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191||||191|13.01|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191||||191|13.01|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191||||191|95.69|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191||||191|67.04|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191||||191|14.82|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191||||191|81.37|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191||||191|95.5|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191||||191|124.15|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|CORESOURCE [1315]|CORESOURCE [131500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191||||191|20|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191||||191|12.24|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|GEHA [1415]|GEHA [141500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HEALTHNET [1495]|HEALTHNET [149500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191||||191|14.82|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191||||191|177.63|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191||||191|114.6|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191||||191|95.5|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191||||191|12.57|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MULTIPLAN [1680]|HMA [168003]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MULTIPLAN [1680]|IHC HS [168011]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191||||191|13.52|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|Self-pay|Self-pay|191||||191|57.3|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191||||191|40.11|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|TRUSTMARK [2030]|STARMARK [203000]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191||||191|91.58|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|UMR [2035]|UMR OPTIONS [203501]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191||||191|11.97|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191||||191|171.9|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|191||||191|8|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191||||191|12.24|177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191||||191||177.63|8
30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191||||191|95.5|177.63|8
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|167||||167|18.69|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167||||167|12.06|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167||||167|12.81|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167||||167|12.81|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|167||||167|83.67|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167||||167|58.62|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167||||167|14.6|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|167||||167|71.14|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|167||||167|83.5|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167||||167|108.55|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|CORESOURCE [1315]|CORESOURCE [131500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|167||||167|17.89|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|167||||167|10.95|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|GEHA [1415]|GEHA [141500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|167||||167|26.6|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HEALTHNET [1495]|HEALTHNET [149500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167||||167|14.6|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|167||||167|155.31|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167||||167|100.2|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167||||167|13|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167||||167|83.5|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167||||167|12.37|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167||||167|15.96|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167||||167|12.06|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MULTIPLAN [1680]|HMA [168003]|167||||167|17.73|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MULTIPLAN [1680]|IHC HS [168011]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|167||||167|13.31|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167||||167|13|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|Self-pay|Self-pay|167||||167|50.1|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167||||167|35.07|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|167||||167|11.58|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167||||167|17.26|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|TRUSTMARK [2030]|STARMARK [203000]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167||||167|80.08|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|UMR [2035]|UMR OPTIONS [203501]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167||||167|11.78|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167||||167|150.3|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|167||||167|7.88|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|167||||167|10.95|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|167||||167|11.82|155.31|7.88
30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|167||||167|83.5|155.31|7.88
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|180||||180|20.04|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180||||180|12.93|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180||||180|13.74|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180||||180|13.74|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|180||||180|90.18|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180||||180|63.18|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180||||180|15.66|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|180||||180|76.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|180||||180|90|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180||||180|117|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|180||||180|19.13|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|180||||180|11.71|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|GEHA [1415]|GEHA [141500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|180||||180|28.53|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180||||180|15.66|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|180||||180|167.4|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180||||180|108|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180||||180|13.95|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180||||180|90|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180||||180|13.27|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180||||180|17.12|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180||||180|12.93|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MULTIPLAN [1680]|HMA [168003]|180||||180|19.02|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MULTIPLAN [1680]|IHC HS [168011]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|180||||180|14.28|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180||||180|13.95|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|Self-pay|Self-pay|180||||180|54|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180||||180|37.8|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|180||||180|12.43|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180||||180|18.51|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|TRUSTMARK [2030]|STARMARK [203000]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180||||180|86.31|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|UMR [2035]|UMR OPTIONS [203501]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180||||180|12.64|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180||||180|162|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|180||||180|8.45|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|180||||180|11.71|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|180||||180|12.68|167.4|8.45
30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|180||||180|90|167.4|8.45
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|AETNA [1015]|AETNA ACO WILCO [101532]|412||||412|18.13|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|412||||412|11.7|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|412||||412|12.43|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|412||||412|12.43|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|412||||412|206.41|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|412||||412|144.61|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|412||||412|14.17|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|412||||412|175.51|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|412||||412|206|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|412||||412|267.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|CORESOURCE [1315]|CORESOURCE [131500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|412||||412|18.4|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|412||||412|11.27|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|GEHA [1415]|GEHA [141500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|412||||412|25.81|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HEALTHNET [1495]|HEALTHNET [149500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|412||||412|14.17|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|412||||412|383.16|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|412||||412|247.2|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|412||||412|12.62|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|412||||412|206|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|412||||412|12.01|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|412||||412|15.48|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|412||||412|11.7|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MULTIPLAN [1680]|HMA [168003]|412||||412|17.21|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MULTIPLAN [1680]|IHC HS [168011]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|412||||412|12.92|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|412||||412|12.62|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|Self-pay|Self-pay|412||||412|123.6|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|412||||412|86.52|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|412||||412|11.24|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|412||||412|16.75|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|TRUSTMARK [2030]|STARMARK [203000]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|412||||412|197.55|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|UMR [2035]|UMR OPTIONS [203501]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|412||||412|11.43|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|412||||412|370.8|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|412||||412|7.65|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|412||||412|11.27|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|412||||412|11.47|383.16|7.65
30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|412||||412|206|383.16|7.65
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|AETNA [1015]|AETNA ACO WILCO [101532]|173||||173|19.16|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173||||173|13.13|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173||||173|13.13|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|173||||173|86.67|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173||||173|60.72|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173||||173|14.97|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|173||||173|73.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|173||||173|86.5|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173||||173|112.45|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|CORESOURCE [1315]|CORESOURCE [131500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|173||||173|19.08|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|173||||173|11.68|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|GEHA [1415]|GEHA [141500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HEALTHNET [1495]|HEALTHNET [149500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173||||173|14.97|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|173||||173|160.89|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173||||173|103.8|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173||||173|86.5|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173||||173|12.68|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MULTIPLAN [1680]|HMA [168003]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MULTIPLAN [1680]|IHC HS [168011]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|173||||173|13.65|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|Self-pay|Self-pay|173||||173|51.9|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173||||173|36.33|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|TRUSTMARK [2030]|STARMARK [203000]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173||||173|82.95|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|UMR [2035]|UMR OPTIONS [203501]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173||||173|12.08|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173||||173|155.7|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|173||||173|8.08|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|173||||173|11.68|160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|173||||173||160.89|8.08
30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|173||||173|86.5|160.89|8.08
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|284||||284|22.77|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|284||||284|15.62|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|284||||284|15.62|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|284||||284|142.28|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|284||||284|99.68|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|284||||284|17.79|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|284||||284|120.98|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|284||||284|142|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|284||||284|184.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|CORESOURCE [1315]|CORESOURCE [131500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|284||||284|21.75|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|284||||284|13.32|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|GEHA [1415]|GEHA [141500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HEALTHNET [1495]|HEALTHNET [149500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|284||||284|17.79|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|284||||284|264.12|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|284||||284|170.4|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|284||||284|142|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|284||||284|15.08|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MULTIPLAN [1680]|HMA [168003]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MULTIPLAN [1680]|IHC HS [168011]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|284||||284|16.24|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|Self-pay|Self-pay|284||||284|85.2|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|284||||284|59.64|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|TRUSTMARK [2030]|STARMARK [203000]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|284||||284|136.18|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|UMR [2035]|UMR OPTIONS [203501]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|284||||284|14.36|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|284||||284|255.6|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|284||||284|9.61|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|284||||284|13.32|264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|284||||284||264.12|9.61
30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|284||||284|142|264.12|9.61
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|AETNA [1015]|AETNA ACO WILCO [101532]|191||||191|22.75|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191||||191|14.68|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191||||191|15.59|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191||||191|15.59|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191||||191|95.69|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191||||191|67.04|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191||||191|17.77|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191||||191|81.37|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191||||191|95.5|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191||||191|124.15|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|CORESOURCE [1315]|CORESOURCE [131500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191||||191|22.13|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191||||191|13.55|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|GEHA [1415]|GEHA [141500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191||||191|32.38|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HEALTHNET [1495]|HEALTHNET [149500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191||||191|17.77|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191||||191|177.63|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191||||191|114.6|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191||||191|15.83|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191||||191|95.5|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191||||191|15.06|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191||||191|19.43|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191||||191|14.68|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MULTIPLAN [1680]|HMA [168003]|191||||191|21.59|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MULTIPLAN [1680]|IHC HS [168011]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191||||191|16.2|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191||||191|15.83|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|Self-pay|Self-pay|191||||191|57.3|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191||||191|40.11|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191||||191|14.1|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191||||191|21.01|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|TRUSTMARK [2030]|STARMARK [203000]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191||||191|91.58|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|UMR [2035]|UMR OPTIONS [203501]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191||||191|14.34|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191||||191|171.9|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|191||||191|9.59|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191||||191|13.55|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191||||191|14.39|177.63|9.59
30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191||||191|95.5|177.63|9.59
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|356||||356|26.62|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356||||356|17.19|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356||||356|18.26|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356||||356|18.26|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|356||||356|178.36|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356||||356|124.96|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356||||356|20.8|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|356||||356|151.66|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|356||||356|178|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356||||356|231.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|356||||356|25.34|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|356||||356|15.52|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|GEHA [1415]|GEHA [141500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|356||||356|37.91|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356||||356|20.8|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|356||||356|331.08|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356||||356|213.6|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356||||356|18.54|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356||||356|178|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356||||356|17.64|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356||||356|22.75|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356||||356|17.19|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MULTIPLAN [1680]|HMA [168003]|356||||356|25.28|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MULTIPLAN [1680]|IHC HS [168011]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|356||||356|18.98|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356||||356|18.54|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|Self-pay|Self-pay|356||||356|106.8|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356||||356|74.76|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|356||||356|16.51|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356||||356|24.6|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|TRUSTMARK [2030]|STARMARK [203000]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356||||356|170.7|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|UMR [2035]|UMR OPTIONS [203501]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356||||356|16.8|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356||||356|320.4|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|356||||356|11.23|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|356||||356|15.52|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|356||||356|16.85|331.08|11.23
30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|356||||356|178|331.08|11.23
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|215||||215|24.04|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215||||215|16.48|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215||||215|16.48|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|215||||215|107.72|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215||||215|75.47|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215||||215|18.77|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|215||||215|91.59|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|215||||215|107.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215||||215|139.75|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|CORESOURCE [1315]|CORESOURCE [131500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|215||||215|22.93|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|215||||215|14.04|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|GEHA [1415]|GEHA [141500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HEALTHNET [1495]|HEALTHNET [149500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215||||215|18.77|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|215||||215|199.95|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215||||215|129|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215||||215|107.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215||||215|15.92|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MULTIPLAN [1680]|HMA [168003]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MULTIPLAN [1680]|IHC HS [168011]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|215||||215|17.13|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|Self-pay|Self-pay|215||||215|64.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215||||215|45.15|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|TRUSTMARK [2030]|STARMARK [203000]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215||||215|103.09|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|UMR [2035]|UMR OPTIONS [203501]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215||||215|15.16|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215||||215|193.5|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|215||||215|10.14|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|215||||215|14.04|199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|215||||215||199.95|10.14
30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|215||||215|107.5|199.95|10.14
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|20.84|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|14.29|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|14.29|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|16.28|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|19.83|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|12.14|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|16.28|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|13.81|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|14.85|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|Self-pay|Self-pay|202||||202|60.6|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|13.15|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|8.79|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|12.14|187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|8.79
30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|20.84|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|14.29|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|14.29|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|16.28|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|19.83|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|12.14|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|16.28|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|13.81|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|14.85|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|Self-pay|Self-pay|202||||202|60.6|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|13.15|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|8.79|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|12.14|187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|8.79
30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|20.84|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|14.29|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|14.29|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|16.28|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|19.83|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|12.14|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|16.28|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|13.81|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|14.85|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|Self-pay|Self-pay|202||||202|60.6|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|13.15|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|8.79|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|12.14|187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|8.79
30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|20.84|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|14.29|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|14.29|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|16.28|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|19.83|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|12.14|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|16.28|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|13.81|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|14.85|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|Self-pay|Self-pay|202||||202|60.6|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|13.15|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|8.79|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|12.14|187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|8.79
30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|8.79
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|172||||172|20.59|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172||||172|14.12|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172||||172|14.12|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|172||||172|86.17|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172||||172|60.37|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172||||172|16.08|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|172||||172|73.27|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|172||||172|86|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172||||172|111.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|172||||172|19.82|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|172||||172|12.13|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|GEHA [1415]|GEHA [141500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172||||172|16.08|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|172||||172|159.96|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172||||172|103.2|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172||||172|86|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172||||172|13.64|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MULTIPLAN [1680]|HMA [168003]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|172||||172|14.68|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|Self-pay|Self-pay|172||||172|51.6|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172||||172|36.12|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172||||172|82.47|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|UMR [2035]|UMR OPTIONS [203501]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172||||172|12.99|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172||||172|154.8|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|172||||172|8.68|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|172||||172|12.13|159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|172||||172||159.96|8.68
30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|172||||172|86|159.96|8.68
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|287||||287|20.74|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|287||||287|13.38|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|287||||287|14.21|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|287||||287|14.21|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|287||||287|143.79|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|287||||287|100.74|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|287||||287|16.2|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|287||||287|122.26|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|287||||287|143.5|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|287||||287|186.55|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|CORESOURCE [1315]|CORESOURCE [131500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|287||||287|21.44|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|287||||287|13.13|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|GEHA [1415]|GEHA [141500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|287||||287|29.52|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HEALTHNET [1495]|HEALTHNET [149500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|287||||287|16.2|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|287||||287|266.91|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|287||||287|172.2|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|287||||287|14.43|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|287||||287|143.5|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|287||||287|13.73|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|287||||287|17.71|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|287||||287|13.38|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MULTIPLAN [1680]|HMA [168003]|287||||287|19.68|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MULTIPLAN [1680]|IHC HS [168011]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|287||||287|14.77|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|287||||287|14.43|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|Self-pay|Self-pay|287||||287|86.1|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|287||||287|60.27|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|287||||287|12.86|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|287||||287|19.16|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|TRUSTMARK [2030]|STARMARK [203000]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|287||||287|137.62|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|UMR [2035]|UMR OPTIONS [203501]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|287||||287|13.08|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|287||||287|258.3|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|287||||287|8.75|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|287||||287|13.13|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|287||||287|13.12|266.91|8.75
30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|287||||287|143.5|266.91|8.75
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|AETNA [1015]|AETNA ACO WILCO [101532]|259||||259|24.17|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|259||||259|15.6|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|259||||259|16.56|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|259||||259|16.56|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|259||||259|129.76|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|259||||259|90.91|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|259||||259|18.88|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|259||||259|110.33|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|259||||259|129.5|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|259||||259|168.35|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|CORESOURCE [1315]|CORESOURCE [131500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|259||||259|23.43|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|259||||259|14.35|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|GEHA [1415]|GEHA [141500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|259||||259|34.4|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HEALTHNET [1495]|HEALTHNET [149500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|259||||259|18.88|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|259||||259|240.87|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|259||||259|155.4|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|259||||259|16.82|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|259||||259|129.5|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|259||||259|16|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|259||||259|20.64|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|259||||259|15.6|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MULTIPLAN [1680]|HMA [168003]|259||||259|22.94|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MULTIPLAN [1680]|IHC HS [168011]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|259||||259|17.21|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|259||||259|16.82|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|Self-pay|Self-pay|259||||259|77.7|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|259||||259|54.39|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|259||||259|14.98|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|259||||259|22.32|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|TRUSTMARK [2030]|STARMARK [203000]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|259||||259|124.19|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|UMR [2035]|UMR OPTIONS [203501]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|259||||259|15.24|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|259||||259|233.1|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|259||||259|10.19|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|259||||259|14.35|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|259||||259|15.29|240.87|10.19
30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|259||||259|129.5|240.87|10.19
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|AETNA [1015]|AETNA ACO WILCO [101532]|289||||289|28.67|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289||||289|18.5|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|289||||289|19.65|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|289||||289|19.65|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|289||||289|144.79|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|289||||289|101.44|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|289||||289|22.4|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|289||||289|123.11|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|289||||289|144.5|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|289||||289|187.85|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|CORESOURCE [1315]|CORESOURCE [131500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|289||||289|27.28|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|289||||289|16.7|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|GEHA [1415]|GEHA [141500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|289||||289|40.82|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HEALTHNET [1495]|HEALTHNET [149500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289||||289|22.4|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|289||||289|268.77|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|289||||289|173.4|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|289||||289|19.95|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|289||||289|144.5|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|289||||289|18.98|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|289||||289|24.49|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289||||289|18.5|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MULTIPLAN [1680]|HMA [168003]|289||||289|27.21|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MULTIPLAN [1680]|IHC HS [168011]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|289||||289|20.42|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|289||||289|19.95|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|Self-pay|Self-pay|289||||289|86.7|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|289||||289|60.69|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|289||||289|17.78|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|289||||289|26.48|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|TRUSTMARK [2030]|STARMARK [203000]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289||||289|138.58|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|UMR [2035]|UMR OPTIONS [203501]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|289||||289|18.08|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|289||||289|260.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|289||||289|12.1|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|289||||289|16.7|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|289||||289|18.14|268.77|12.1
30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|289||||289|144.5|268.77|12.1
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|147||||147|16.08|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147||||147|11.03|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147||||147|11.03|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|147||||147|73.65|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147||||147|51.6|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147||||147|12.56|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|147||||147|62.62|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|147||||147|73.5|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147||||147|95.55|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|CORESOURCE [1315]|CORESOURCE [131500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|147||||147|19.05|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|147||||147|11.66|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|GEHA [1415]|GEHA [141500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HEALTHNET [1495]|HEALTHNET [149500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147||||147|12.56|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|147||||147|136.71|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147||||147|88.2|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147||||147|73.5|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147||||147|10.65|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MULTIPLAN [1680]|HMA [168003]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MULTIPLAN [1680]|IHC HS [168011]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|147||||147|11.46|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|Self-pay|Self-pay|147||||147|44.1|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147||||147|30.87|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|TRUSTMARK [2030]|STARMARK [203000]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147||||147|70.49|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|UMR [2035]|UMR OPTIONS [203501]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147||||147|10.14|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147||||147|132.3|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|147||||147|6.79|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|147||||147|11.66|136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|147||||147||136.71|6.79
30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|147||||147|73.5|136.71|6.79
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|158||||158|20.14|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158||||158|14.44|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158||||158|15.34|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158||||158|15.34|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158||||158|79.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158||||158|55.46|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158||||158|67.31|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158||||158|79|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158||||158|102.7|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|CORESOURCE [1315]|CORESOURCE [131500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158||||158|15.82|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158||||158|9.68|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|GEHA [1415]|GEHA [141500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158||||158|31.86|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HEALTHNET [1495]|HEALTHNET [149500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158||||158|146.94|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158||||158|94.8|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158||||158|15.58|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158||||158|79|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158||||158|14.82|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158||||158|19.12|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158||||158|14.44|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MULTIPLAN [1680]|HMA [168003]|158||||158|21.24|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MULTIPLAN [1680]|IHC HS [168011]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158||||158|15.94|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158||||158|15.58|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|Self-pay|Self-pay|158||||158|47.4|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158||||158|33.18|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158||||158|13.88|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158||||158|20.67|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|TRUSTMARK [2030]|STARMARK [203000]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158||||158|75.76|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|UMR [2035]|UMR OPTIONS [203501]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158||||158|14.12|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158||||158|142.2|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158||||158|8.5|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158||||158|9.68|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158||||158|14.16|146.94|8.5
30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158||||158|79|146.94|8.5
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|AETNA [1015]|AETNA ACO WILCO [101532]|162||||162|19.38|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162||||162|12.5|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162||||162|13.28|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162||||162|13.28|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|162||||162|81.16|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162||||162|56.86|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162||||162|15.13|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|162||||162|69.01|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|162||||162|81|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162||||162|105.3|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|CORESOURCE [1315]|CORESOURCE [131500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|162||||162|19.23|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|162||||162|11.77|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|GEHA [1415]|GEHA [141500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|162||||162|27.56|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HEALTHNET [1495]|HEALTHNET [149500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162||||162|15.13|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|162||||162|150.66|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162||||162|97.2|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162||||162|13.48|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162||||162|81|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162||||162|12.82|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162||||162|16.54|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162||||162|12.5|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MULTIPLAN [1680]|HMA [168003]|162||||162|18.38|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MULTIPLAN [1680]|IHC HS [168011]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|162||||162|13.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162||||162|13.48|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|Self-pay|Self-pay|162||||162|48.6|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162||||162|34.02|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|162||||162|12.01|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162||||162|17.89|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|TRUSTMARK [2030]|STARMARK [203000]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162||||162|77.68|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|UMR [2035]|UMR OPTIONS [203501]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162||||162|12.21|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162||||162|145.8|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|162||||162|8.17|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|162||||162|11.77|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|162||||162|12.25|150.66|8.17
30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|162||||162|81|150.66|8.17
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|219||||219|23.25|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219||||219|15.95|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219||||219|15.95|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|219||||219|109.72|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219||||219|76.87|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219||||219|18.17|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|219||||219|93.29|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|219||||219|109.5|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219||||219|142.35|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|CORESOURCE [1315]|CORESOURCE [131500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|219||||219|22.14|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|219||||219|13.56|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|GEHA [1415]|GEHA [141500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HEALTHNET [1495]|HEALTHNET [149500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219||||219|18.17|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|219||||219|203.67|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219||||219|131.4|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219||||219|109.5|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219||||219|15.41|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MULTIPLAN [1680]|HMA [168003]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MULTIPLAN [1680]|IHC HS [168011]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|219||||219|16.58|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|Self-pay|Self-pay|219||||219|65.7|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219||||219|45.99|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|TRUSTMARK [2030]|STARMARK [203000]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219||||219|105.01|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|UMR [2035]|UMR OPTIONS [203501]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219||||219|14.68|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219||||219|197.1|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|219||||219|9.81|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|219||||219|13.56|203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|219||||219||203.67|9.81
30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|219||||219|109.5|203.67|9.81
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|AETNA [1015]|AETNA ACO WILCO [101532]|406||||406|23.97|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406||||406|17.19|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|406||||406|18.26|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|406||||406|18.26|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|406||||406|203.41|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|406||||406|142.51|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|406||||406|17.91|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|406||||406|172.96|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|406||||406|203|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|406||||406|263.9|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|CORESOURCE [1315]|CORESOURCE [131500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|406||||406|24.32|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|406||||406|14.89|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|GEHA [1415]|GEHA [141500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|406||||406|37.91|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HEALTHNET [1495]|HEALTHNET [149500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406||||406|17.91|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|406||||406|377.58|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406||||406|243.6|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|406||||406|18.54|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406||||406|203|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|406||||406|17.64|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|406||||406|22.75|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|406||||406|17.19|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MULTIPLAN [1680]|HMA [168003]|406||||406|25.28|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MULTIPLAN [1680]|IHC HS [168011]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|406||||406|18.98|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|406||||406|18.54|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|Self-pay|Self-pay|406||||406|121.8|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|406||||406|85.26|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|406||||406|16.51|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|406||||406|24.6|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|TRUSTMARK [2030]|STARMARK [203000]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406||||406|194.68|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|UMR [2035]|UMR OPTIONS [203501]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|406||||406|16.8|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|406||||406|365.4|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406||||406|10.11|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|406||||406|14.89|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|406||||406|16.85|377.58|10.11
30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|406||||406|203|377.58|10.11
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|AETNA [1015]|AETNA ACO WILCO [101532]|231||||231|20.55|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231||||231|13.27|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231||||231|14.1|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231||||231|14.1|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|231||||231|115.73|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231||||231|81.08|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231||||231|16.06|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|231||||231|98.41|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|231||||231|115.5|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231||||231|150.15|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|CORESOURCE [1315]|CORESOURCE [131500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|231||||231|21.44|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|231||||231|13.13|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|GEHA [1415]|GEHA [141500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|231||||231|29.27|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HEALTHNET [1495]|HEALTHNET [149500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231||||231|16.06|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|231||||231|214.83|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231||||231|138.6|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231||||231|14.31|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231||||231|115.5|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231||||231|13.61|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231||||231|17.56|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231||||231|13.27|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MULTIPLAN [1680]|HMA [168003]|231||||231|19.52|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MULTIPLAN [1680]|IHC HS [168011]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|231||||231|14.66|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231||||231|14.31|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|Self-pay|Self-pay|231||||231|69.3|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231||||231|48.51|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|231||||231|12.75|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231||||231|18.99|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|TRUSTMARK [2030]|STARMARK [203000]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231||||231|110.76|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|UMR [2035]|UMR OPTIONS [203501]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231||||231|12.96|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231||||231|207.9|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|231||||231|8.67|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|231||||231|13.13|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|231||||231|13.01|214.83|8.67
30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|231||||231|115.5|214.83|8.67
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|AETNA [1015]|AETNA ACO WILCO [101532]|225||||225|25.03|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225||||225|17.16|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225||||225|17.16|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|225||||225|112.73|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225||||225|78.98|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225||||225|19.56|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|225||||225|95.85|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|225||||225|112.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225||||225|146.25|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|CORESOURCE [1315]|CORESOURCE [131500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|225||||225|24.1|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|225||||225|14.75|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|GEHA [1415]|GEHA [141500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HEALTHNET [1495]|HEALTHNET [149500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225||||225|19.56|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|225||||225|209.25|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225||||225|135|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225||||225|112.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225||||225|16.58|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MULTIPLAN [1680]|HMA [168003]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MULTIPLAN [1680]|IHC HS [168011]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|225||||225|17.84|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|Self-pay|Self-pay|225||||225|67.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225||||225|47.25|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|TRUSTMARK [2030]|STARMARK [203000]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225||||225|107.89|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|UMR [2035]|UMR OPTIONS [203501]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225||||225|15.79|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225||||225|202.5|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|225||||225|10.56|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|225||||225|14.75|209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|225||||225||209.25|10.56
30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|225||||225|112.5|209.25|10.56
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|AETNA [1015]|AETNA ACO WILCO [101532]|141||||141|13.26|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141||||141|9.84|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141||||141|9.84|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|141||||141|70.64|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141||||141|49.49|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141||||141|10.36|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|141||||141|60.07|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|141||||141|70.5|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141||||141|91.65|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|CORESOURCE [1315]|CORESOURCE [131500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|141||||141|13.12|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|141||||141|7.83|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|GEHA [1415]|GEHA [141500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HEALTHNET [1495]|HEALTHNET [149500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141||||141|10.36|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|141||||141|131.13|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141||||141|84.6|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141||||141|70.5|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141||||141|9.51|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MULTIPLAN [1680]|HMA [168003]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MULTIPLAN [1680]|IHC HS [168011]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|141||||141|10.23|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|Self-pay|Self-pay|141||||141|42.3|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141||||141|29.61|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|TRUSTMARK [2030]|STARMARK [203000]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141||||141|67.61|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|UMR [2035]|UMR OPTIONS [203501]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141||||141|9.05|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141||||141|126.9|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|141||||141|5.59|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|141||||141|7.83|131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|141||||141||131.13|5.59
30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|141||||141|70.5|131.13|5.59
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|AETNA [1015]|AETNA ACO WILCO [101532]|255||||255|30.6|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|255||||255|19.74|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|255||||255|20.97|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|255||||255|20.97|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|255||||255|127.76|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|255||||255|89.51|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|255||||255|23.9|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|255||||255|108.63|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|255||||255|127.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|255||||255|165.75|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|CORESOURCE [1315]|CORESOURCE [131500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|255||||255|29.26|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|255||||255|17.91|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|GEHA [1415]|GEHA [141500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|255||||255|43.54|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HEALTHNET [1495]|HEALTHNET [149500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|255||||255|23.9|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|255||||255|237.15|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|255||||255|153|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|255||||255|21.29|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|255||||255|127.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|255||||255|20.25|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|255||||255|26.12|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|255||||255|19.74|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MULTIPLAN [1680]|HMA [168003]|255||||255|29.03|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MULTIPLAN [1680]|IHC HS [168011]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|255||||255|21.8|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|255||||255|21.29|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|Self-pay|Self-pay|255||||255|76.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|255||||255|53.55|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|255||||255|18.96|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|255||||255|28.25|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|TRUSTMARK [2030]|STARMARK [203000]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|255||||255|122.27|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|UMR [2035]|UMR OPTIONS [203501]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|255||||255|19.28|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|255||||255|229.5|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|255||||255|12.91|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|255||||255|17.91|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|255||||255|19.35|237.15|12.91
30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|255||||255|127.5|237.15|12.91
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|273||||273|27.13|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273||||273|17.5|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273||||273|18.59|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273||||273|18.59|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|273||||273|136.77|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273||||273|95.82|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273||||273|21.19|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|273||||273|116.3|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|273||||273|136.5|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273||||273|177.45|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|CORESOURCE [1315]|CORESOURCE [131500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|273||||273|26.02|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|273||||273|15.93|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|GEHA [1415]|GEHA [141500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|273||||273|38.61|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HEALTHNET [1495]|HEALTHNET [149500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273||||273|21.19|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|273||||273|253.89|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273||||273|163.8|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273||||273|18.88|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273||||273|136.5|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273||||273|17.95|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273||||273|23.17|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273||||273|17.5|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MULTIPLAN [1680]|HMA [168003]|273||||273|25.74|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MULTIPLAN [1680]|IHC HS [168011]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|273||||273|19.32|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273||||273|18.88|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|Self-pay|Self-pay|273||||273|81.9|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273||||273|57.33|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|273||||273|16.82|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273||||273|25.05|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|TRUSTMARK [2030]|STARMARK [203000]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273||||273|130.9|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|UMR [2035]|UMR OPTIONS [203501]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273||||273|17.1|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273||||273|245.7|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|273||||273|11.44|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|273||||273|15.93|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|273||||273|17.16|253.89|11.44
30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|273||||273|136.5|253.89|11.44
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|AETNA [1015]|AETNA ACO WILCO [101532]|534||||534|22.75|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|534||||534|14.68|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|534||||534|15.59|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|534||||534|15.59|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|534||||534|267.53|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|534||||534|187.43|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|534||||534|17.77|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|534||||534|227.48|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|534||||534|267|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|534||||534|347.1|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|CORESOURCE [1315]|CORESOURCE [131500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|534||||534|21.75|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|534||||534|13.32|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|GEHA [1415]|GEHA [141500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|534||||534|32.38|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HEALTHNET [1495]|HEALTHNET [149500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|534||||534|17.77|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|534||||534|496.62|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|534||||534|320.4|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|534||||534|15.83|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|534||||534|267|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|534||||534|15.06|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|534||||534|19.43|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|534||||534|14.68|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MULTIPLAN [1680]|HMA [168003]|534||||534|21.59|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MULTIPLAN [1680]|IHC HS [168011]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|534||||534|16.2|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|534||||534|15.83|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|Self-pay|Self-pay|534||||534|160.2|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|534||||534|112.14|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|534||||534|14.1|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|534||||534|21.01|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|TRUSTMARK [2030]|STARMARK [203000]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|534||||534|256.05|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|UMR [2035]|UMR OPTIONS [203501]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|534||||534|14.34|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|534||||534|480.6|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|534||||534|9.59|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|534||||534|13.32|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|534||||534|14.39|496.62|9.59
30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|534||||534|267|496.62|9.59
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|AETNA [1015]|AETNA ACO WILCO [101532]|174||||174|20.84|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|174||||174|13.45|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|174||||174|14.29|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|174||||174|14.29|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|174||||174|87.17|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|174||||174|61.07|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|174||||174|16.28|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|174||||174|74.12|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|174||||174|87|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|174||||174|113.1|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|CORESOURCE [1315]|CORESOURCE [131500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|174||||174|20.72|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|174||||174|12.68|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|GEHA [1415]|GEHA [141500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|174||||174|29.68|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HEALTHNET [1495]|HEALTHNET [149500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|174||||174|16.28|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|174||||174|161.82|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|174||||174|104.4|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|174||||174|14.51|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|174||||174|87|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|174||||174|13.81|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|174||||174|17.81|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|174||||174|13.45|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MULTIPLAN [1680]|HMA [168003]|174||||174|19.79|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MULTIPLAN [1680]|IHC HS [168011]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|174||||174|14.85|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|174||||174|14.51|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|Self-pay|Self-pay|174||||174|52.2|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|174||||174|36.54|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|174||||174|12.93|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|174||||174|19.26|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|TRUSTMARK [2030]|STARMARK [203000]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|174||||174|83.43|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|UMR [2035]|UMR OPTIONS [203501]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|174||||174|13.15|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|174||||174|156.6|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|174||||174|8.79|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|174||||174|12.68|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|174||||174|13.19|161.82|8.79
30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|174||||174|87|161.82|8.79
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|AETNA [1015]|AETNA ACO WILCO [101532]|255||||255|30.6|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|255||||255|19.74|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|255||||255|20.97|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|255||||255|20.97|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|255||||255|127.76|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|255||||255|89.51|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|255||||255|23.9|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|255||||255|108.63|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|255||||255|127.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|255||||255|165.75|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|CORESOURCE [1315]|CORESOURCE [131500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|CORVEL CORP [2235]|CORVEL CORP [223500]|255||||255|35.16|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|255||||255|21.53|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|GEHA [1415]|GEHA [141500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|255||||255|43.54|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HEALTHNET [1495]|HEALTHNET [149500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|255||||255|23.9|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HEALTHSMART [1505]|HEALTHSMART [150501]|255||||255|237.15|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|255||||255|153|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|255||||255|21.29|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|255||||255|127.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|255||||255|20.25|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|255||||255|26.12|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|255||||255|19.74|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MULTIPLAN [1680]|HMA [168003]|255||||255|29.03|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MULTIPLAN [1680]|IHC HS [168011]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|255||||255|21.8|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|255||||255|21.29|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|Self-pay|Self-pay|255||||255|76.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|255||||255|53.55|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|255||||255|18.96|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|255||||255|28.25|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|TRUSTMARK [2030]|STARMARK [203000]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|255||||255|122.27|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|UMR [2035]|UMR OPTIONS [203501]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|255||||255|19.28|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|255||||255|229.5|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|255||||255|12.91|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|255||||255|21.53|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|255||||255|19.35|237.15|12.91
30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|255||||255|127.5|237.15|12.91
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|AETNA [1015]|AETNA ACO WILCO [101532]|208||||208|19.75|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208||||208|14.07|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208||||208|14.94|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208||||208|14.94|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|208||||208|104.21|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208||||208|73.01|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208||||208|15.43|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|208||||208|88.61|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|208||||208|104|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208||||208|135.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|CORESOURCE [1315]|CORESOURCE [131500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|208||||208|19.25|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|208||||208|11.78|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|GEHA [1415]|GEHA [141500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|208||||208|31.03|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HEALTHNET [1495]|HEALTHNET [149500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208||||208|15.43|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|208||||208|193.44|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208||||208|124.8|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208||||208|15.17|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208||||208|104|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208||||208|14.43|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208||||208|18.62|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208||||208|14.07|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MULTIPLAN [1680]|HMA [168003]|208||||208|20.69|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MULTIPLAN [1680]|IHC HS [168011]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|208||||208|15.53|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208||||208|15.17|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|Self-pay|Self-pay|208||||208|62.4|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208||||208|43.68|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|208||||208|13.51|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208||||208|20.13|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|TRUSTMARK [2030]|STARMARK [203000]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208||||208|99.74|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|UMR [2035]|UMR OPTIONS [203501]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208||||208|13.74|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208||||208|187.2|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|208||||208|8.33|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|208||||208|11.78|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|208||||208|13.79|193.44|8.33
30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|208||||208|104|193.44|8.33
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|AETNA [1015]|AETNA ACO WILCO [101532]|158||||158|14.03|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158||||158|9.64|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158||||158|9.64|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158||||158|79.16|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158||||158|55.46|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158||||158|10.97|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158||||158|67.31|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158||||158|79|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158||||158|102.7|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|CORESOURCE [1315]|CORESOURCE [131500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158||||158|13.45|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158||||158|8.23|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|GEHA [1415]|GEHA [141500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HEALTHNET [1495]|HEALTHNET [149500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158||||158|10.97|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158||||158|146.94|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158||||158|94.8|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158||||158|79|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158||||158|9.31|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MULTIPLAN [1680]|HMA [168003]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MULTIPLAN [1680]|IHC HS [168011]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158||||158|10.02|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|Self-pay|Self-pay|158||||158|47.4|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158||||158|33.18|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|TRUSTMARK [2030]|STARMARK [203000]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158||||158|75.76|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|UMR [2035]|UMR OPTIONS [203501]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158||||158|8.87|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158||||158|142.2|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158||||158|5.92|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158||||158|8.23|146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158||||158||146.94|5.92
30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158||||158|79|146.94|5.92
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|AETNA [1015]|AETNA ACO WILCO [101532]|191||||191|21.37|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191||||191|13.79|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191||||191|14.65|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191||||191|14.65|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191||||191|95.69|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191||||191|67.04|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191||||191|16.69|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191||||191|81.37|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191||||191|95.5|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191||||191|124.15|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|CORESOURCE [1315]|CORESOURCE [131500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191||||191|21.81|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191||||191|13.35|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|GEHA [1415]|GEHA [141500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191||||191|30.42|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HEALTHNET [1495]|HEALTHNET [149500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191||||191|16.69|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191||||191|177.63|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191||||191|114.6|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191||||191|14.87|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191||||191|95.5|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191||||191|14.14|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191||||191|18.25|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191||||191|13.79|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MULTIPLAN [1680]|HMA [168003]|191||||191|20.28|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MULTIPLAN [1680]|IHC HS [168011]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191||||191|15.23|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191||||191|14.87|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|Self-pay|Self-pay|191||||191|57.3|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191||||191|40.11|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191||||191|13.25|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191||||191|19.74|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|TRUSTMARK [2030]|STARMARK [203000]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191||||191|91.58|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|UMR [2035]|UMR OPTIONS [203501]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191||||191|13.47|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191||||191|171.9|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|191||||191|9.01|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191||||191|13.35|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191||||191|13.52|177.63|9.01
30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191||||191|95.5|177.63|9.01
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|244||||244|21.66|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244||||244|13.98|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244||||244|14.86|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244||||244|14.86|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|244||||244|122.24|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244||||244|85.64|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244||||244|16.92|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|244||||244|103.94|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|244||||244|122|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244||||244|158.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|244||||244|20.56|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|244||||244|12.59|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|GEHA [1415]|GEHA [141500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|244||||244|30.85|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244||||244|16.92|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|244||||244|226.92|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244||||244|146.4|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244||||244|15.08|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244||||244|122|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244||||244|14.35|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244||||244|18.51|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244||||244|13.98|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MULTIPLAN [1680]|HMA [168003]|244||||244|20.57|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|244||||244|15.45|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244||||244|15.08|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|Self-pay|Self-pay|244||||244|73.2|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244||||244|51.24|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|244||||244|13.44|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244||||244|20.02|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244||||244|117|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244||||244|13.67|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244||||244|219.6|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|244||||244|9.14|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|244||||244|12.59|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|244||||244|13.71|226.92|9.14
30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|244||||244|122|226.92|9.14
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|166||||166|19.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166||||166|12.29|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166||||166|13.06|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166||||166|13.06|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|166||||166|83.17|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166||||166|58.27|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166||||166|14.88|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|166||||166|70.72|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|166||||166|83|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166||||166|107.9|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|166||||166|25.46|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|166||||166|15.59|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|GEHA [1415]|GEHA [141500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|166||||166|27.11|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166||||166|14.88|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|166||||166|154.38|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166||||166|99.6|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166||||166|13.26|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166||||166|83|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166||||166|12.62|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166||||166|16.27|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166||||166|12.29|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MULTIPLAN [1680]|HMA [168003]|166||||166|18.08|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|166||||166|13.57|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166||||166|13.26|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|Self-pay|Self-pay|166||||166|49.8|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166||||166|34.86|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|166||||166|11.81|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166||||166|17.59|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166||||166|79.6|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166||||166|12.02|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166||||166|149.4|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|166||||166|8.03|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|166||||166|15.59|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|166||||166|12.05|154.38|8.03
30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|166||||166|83|154.38|8.03
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|267||||267|18.6|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267||||267|12.01|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267||||267|12.75|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267||||267|12.75|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267||||267|133.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267||||267|93.72|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267||||267|14.54|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267||||267|113.74|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267||||267|133.5|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267||||267|173.55|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267||||267|29.64|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267||||267|18.15|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|GEHA [1415]|GEHA [141500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267||||267|26.48|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267||||267|14.54|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267||||267|248.31|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267||||267|160.2|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267||||267|12.95|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267||||267|133.5|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267||||267|12.31|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267||||267|15.89|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267||||267|12.01|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MULTIPLAN [1680]|HMA [168003]|267||||267|17.66|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MULTIPLAN [1680]|IHC HS [168011]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267||||267|13.25|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267||||267|12.95|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|Self-pay|Self-pay|267||||267|80.1|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267||||267|56.07|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267||||267|11.53|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267||||267|17.18|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|TRUSTMARK [2030]|STARMARK [203000]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267||||267|128.03|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|UMR [2035]|UMR OPTIONS [203501]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267||||267|11.72|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267||||267|240.3|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267||||267|7.85|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267||||267|18.15|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267||||267|11.77|248.31|7.85
30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267||||267|133.5|248.31|7.85
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|AETNA [1015]|AETNA ACO WILCO [101532]|428||||428|16.97|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|428||||428|10.95|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|428||||428|11.64|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|428||||428|11.64|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|428||||428|214.43|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|428||||428|150.23|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|428||||428|13.26|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|428||||428|182.33|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|428||||428|214|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|428||||428|278.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|CORESOURCE [1315]|CORESOURCE [131500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|428||||428|21.52|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|428||||428|13.18|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|GEHA [1415]|GEHA [141500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|428||||428|24.17|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HEALTHNET [1495]|HEALTHNET [149500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|428||||428|13.26|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|428||||428|398.04|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|428||||428|256.8|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|428||||428|11.81|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|428||||428|214|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|428||||428|11.24|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|428||||428|14.5|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|428||||428|10.95|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MULTIPLAN [1680]|HMA [168003]|428||||428|16.11|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MULTIPLAN [1680]|IHC HS [168011]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|428||||428|12.1|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|428||||428|11.81|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|Self-pay|Self-pay|428||||428|128.4|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|428||||428|89.88|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|428||||428|10.53|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|428||||428|15.68|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|TRUSTMARK [2030]|STARMARK [203000]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|428||||428|205.23|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|UMR [2035]|UMR OPTIONS [203501]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|428||||428|10.71|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|428||||428|385.2|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|428||||428|7.16|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|428||||428|13.18|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|428||||428|10.74|398.04|7.16
30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|428||||428|214|398.04|7.16
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|AETNA [1015]|AETNA ACO WILCO [101532]|173||||173|18.28|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173||||173|11.8|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173||||173|12.54|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173||||173|12.54|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|173||||173|86.67|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173||||173|60.72|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173||||173|14.28|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|173||||173|73.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|173||||173|86.5|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173||||173|112.45|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|CORESOURCE [1315]|CORESOURCE [131500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|173||||173|22.23|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|173||||173|13.61|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|GEHA [1415]|GEHA [141500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|173||||173|26.03|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HEALTHNET [1495]|HEALTHNET [149500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173||||173|14.28|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|173||||173|160.89|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173||||173|103.8|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173||||173|12.73|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173||||173|86.5|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173||||173|12.11|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173||||173|15.62|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173||||173|11.8|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MULTIPLAN [1680]|HMA [168003]|173||||173|17.36|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MULTIPLAN [1680]|IHC HS [168011]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|173||||173|13.03|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173||||173|12.73|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|Self-pay|Self-pay|173||||173|51.9|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173||||173|36.33|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|173||||173|11.34|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173||||173|16.89|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|TRUSTMARK [2030]|STARMARK [203000]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173||||173|82.95|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|UMR [2035]|UMR OPTIONS [203501]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173||||173|11.54|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173||||173|155.7|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|173||||173|7.71|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|173||||173|13.61|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|173||||173|11.57|160.89|7.71
30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|173||||173|86.5|160.89|7.71
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|AETNA [1015]|AETNA ACO WILCO [101532]|182||||182|19.58|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182||||182|12.64|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182||||182|13.43|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182||||182|13.43|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182||||182|91.18|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182||||182|63.88|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182||||182|15.29|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182||||182|77.53|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182||||182|91|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182||||182|118.3|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|CORESOURCE [1315]|CORESOURCE [131500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182||||182|25.47|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182||||182|15.59|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|GEHA [1415]|GEHA [141500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182||||182|27.88|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HEALTHNET [1495]|HEALTHNET [149500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182||||182|15.29|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182||||182|169.26|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182||||182|109.2|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182||||182|13.63|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182||||182|91|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182||||182|12.97|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182||||182|16.73|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182||||182|12.64|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MULTIPLAN [1680]|HMA [168003]|182||||182|18.59|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MULTIPLAN [1680]|IHC HS [168011]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182||||182|13.96|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182||||182|13.63|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|Self-pay|Self-pay|182||||182|54.6|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182||||182|38.22|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182||||182|12.14|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182||||182|18.09|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|TRUSTMARK [2030]|STARMARK [203000]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182||||182|87.27|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|UMR [2035]|UMR OPTIONS [203501]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182||||182|12.35|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182||||182|163.8|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182||||182|8.26|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182||||182|15.59|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182||||182|12.39|169.26|8.26
30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182||||182|91|169.26|8.26
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|263||||263|17.8|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263||||263|11.49|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263||||263|12.19|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263||||263|12.19|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|263||||263|131.76|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263||||263|92.31|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263||||263|13.9|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|263||||263|112.04|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|263||||263|131.5|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263||||263|170.95|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|263||||263|23.23|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|263||||263|14.22|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|GEHA [1415]|GEHA [141500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|263||||263|25.34|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263||||263|13.9|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|263||||263|244.59|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263||||263|157.8|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263||||263|12.39|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263||||263|131.5|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263||||263|11.78|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263||||263|15.2|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263||||263|11.49|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MULTIPLAN [1680]|HMA [168003]|263||||263|16.89|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MULTIPLAN [1680]|IHC HS [168011]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|263||||263|12.67|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263||||263|12.39|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|Self-pay|Self-pay|263||||263|78.9|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263||||263|55.23|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|263||||263|11.03|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263||||263|16.44|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|TRUSTMARK [2030]|STARMARK [203000]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263||||263|126.11|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|UMR [2035]|UMR OPTIONS [203501]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263||||263|11.22|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263||||263|236.7|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|263||||263|7.51|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|263||||263|14.22|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|263||||263|11.26|244.59|7.51
30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|263||||263|131.5|244.59|7.51
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|21.43|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|13.82|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|14.68|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|14.68|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|16.73|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|20.56|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|12.59|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242|30.49|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|16.73|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|14.91|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|14.18|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|18.29|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|13.82|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MULTIPLAN [1680]|HMA [168003]|242||||242|20.33|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|15.26|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|14.91|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|Self-pay|Self-pay|242||||242|72.6|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|13.28|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|19.78|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|13.5|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|9.04|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|12.59|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|13.55|225.06|9.04
30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR  B|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|9.04
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|AETNA [1015]|AETNA ACO WILCO [101532]|4070||||4070|24.02|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4070||||4070|17.23|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4070||||4070|18.3|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4070||||4070|18.3|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4070||||4070|2039.07|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4070||||4070|1428.57|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4070||||4070|17.77|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4070||||4070|1733.82|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4070||||4070|2035|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4070||||4070|2645.5|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|CORESOURCE [1315]|CORESOURCE [131500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4070||||4070|20.37|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4070||||4070|12.04|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|GEHA [1415]|GEHA [141500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4070||||4070|38|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HEALTHNET [1495]|HEALTHNET [149500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4070||||4070|17.77|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4070||||4070|3785.1|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4070||||4070|2442|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4070||||4070|18.58|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4070||||4070|2035|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4070||||4070|17.68|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4070||||4070|22.8|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4070||||4070|17.23|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MULTIPLAN [1680]|HMA [168003]|4070||||4070|25.34|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MULTIPLAN [1680]|IHC HS [168011]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4070||||4070|19.02|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4070||||4070|18.58|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|Self-pay|Self-pay|4070||||4070|1221|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4070||||4070|854.7|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4070||||4070|16.55|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4070||||4070|24.66|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|TRUSTMARK [2030]|STARMARK [203000]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4070||||4070|1951.57|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|UMR [2035]|UMR OPTIONS [203501]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4070||||4070|16.84|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4070||||4070|3663|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4070||||4070|10.13|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4070||||4070|12.04|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4070||||4070|16.89|3785.1|10.13
30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4070||||4070|2035|3785.1|10.13
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|24.18|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|16.57|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|16.57|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|18.89|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|23.24|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|14.23|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|18.89|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|16.01|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|17.22|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|Self-pay|Self-pay|202||||202|60.6|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|15.25|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|10.2|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|14.23|187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|10.2
30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|10.2
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|181||||181|19.35|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|181||||181|13.28|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|181||||181|13.28|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|181||||181|90.68|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|181||||181|63.53|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|181||||181|15.12|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|181||||181|77.11|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|181||||181|90.5|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|181||||181|117.65|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|CORESOURCE [1315]|CORESOURCE [131500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|181||||181|19.08|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|181||||181|11.68|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|GEHA [1415]|GEHA [141500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HEALTHNET [1495]|HEALTHNET [149500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|181||||181|15.12|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|181||||181|168.33|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|181||||181|108.6|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|181||||181|90.5|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|181||||181|12.82|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MULTIPLAN [1680]|HMA [168003]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MULTIPLAN [1680]|IHC HS [168011]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|181||||181|13.8|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|Self-pay|Self-pay|181||||181|54.3|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|181||||181|38.01|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|TRUSTMARK [2030]|STARMARK [203000]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|181||||181|86.79|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|UMR [2035]|UMR OPTIONS [203501]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|181||||181|12.21|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|181||||181|162.9|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|181||||181|8.17|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|181||||181|11.68|168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|181||||181||168.33|8.17
30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|181||||181|90.5|168.33|8.17
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|AETNA [1015]|AETNA ACO WILCO [101532]|187||||187|23.04|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|187||||187|17.55|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|187||||187|17.55|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|187||||187|93.69|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|187||||187|65.64|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|187||||187|16.28|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|187||||187|79.66|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|187||||187|93.5|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|187||||187|121.55|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|CORESOURCE [1315]|CORESOURCE [131500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|187||||187|19.83|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|187||||187|12.14|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|GEHA [1415]|GEHA [141500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HEALTHNET [1495]|HEALTHNET [149500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|187||||187|16.28|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|187||||187|173.91|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|187||||187|112.2|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|187||||187|93.5|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|187||||187|16.95|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MULTIPLAN [1680]|HMA [168003]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MULTIPLAN [1680]|IHC HS [168011]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|187||||187|18.24|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|Self-pay|Self-pay|187||||187|56.1|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|187||||187|39.27|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|TRUSTMARK [2030]|STARMARK [203000]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|187||||187|89.67|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|UMR [2035]|UMR OPTIONS [203501]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|187||||187|16.14|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|187||||187|168.3|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|187||||187|9.72|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|187||||187|12.14|173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|187||||187||173.91|9.72
30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|187||||187|93.5|173.91|9.72
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|170||||170|20.34|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170||||170|13.95|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170||||170|13.95|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170||||170|85.17|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170||||170|59.67|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170||||170|15.89|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170||||170|72.42|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170||||170|85|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170||||170|110.5|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|CORESOURCE [1315]|CORESOURCE [131500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170||||170|19.56|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170||||170|11.97|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|GEHA [1415]|GEHA [141500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HEALTHNET [1495]|HEALTHNET [149500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170||||170|15.89|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170||||170|158.1|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170||||170|102|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170||||170|85|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170||||170|13.47|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MULTIPLAN [1680]|HMA [168003]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MULTIPLAN [1680]|IHC HS [168011]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170||||170|14.5|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|Self-pay|Self-pay|170||||170|51|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170||||170|35.7|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|TRUSTMARK [2030]|STARMARK [203000]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170||||170|81.52|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|UMR [2035]|UMR OPTIONS [203501]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170||||170|12.83|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170||||170|153|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170||||170|8.58|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170||||170|11.97|158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170||||170||158.1|8.58
30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170||||170|85|158.1|8.58
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|AETNA [1015]|AETNA ACO WILCO [101532]|181||||181|20.63|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|181||||181|13.31|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|181||||181|14.14|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|181||||181|14.14|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|181||||181|90.68|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|181||||181|63.53|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|181||||181|16.11|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|181||||181|77.11|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|181||||181|90.5|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|181||||181|117.65|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|CORESOURCE [1315]|CORESOURCE [131500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|181||||181|19.77|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|181||||181|12.1|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|GEHA [1415]|GEHA [141500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|181||||181|29.36|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HEALTHNET [1495]|HEALTHNET [149500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|181||||181|16.11|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|181||||181|168.33|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|181||||181|108.6|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|181||||181|14.36|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|181||||181|90.5|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|181||||181|13.66|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|181||||181|17.62|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|181||||181|13.31|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MULTIPLAN [1680]|HMA [168003]|181||||181|19.58|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MULTIPLAN [1680]|IHC HS [168011]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|181||||181|14.7|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|181||||181|14.36|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|Self-pay|Self-pay|181||||181|54.3|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|181||||181|38.01|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|181||||181|12.79|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|181||||181|19.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|TRUSTMARK [2030]|STARMARK [203000]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|181||||181|86.79|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|UMR [2035]|UMR OPTIONS [203501]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|181||||181|13.01|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|181||||181|162.9|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|181||||181|8.7|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|181||||181|12.1|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|181||||181|13.05|168.33|8.7
30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|181||||181|90.5|168.33|8.7
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|20.92|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202|13.5|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|14.35|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|14.35|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|16.34|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|20.09|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|12.3|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202|29.79|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|16.34|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202|14.56|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|13.86|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202|17.87|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202|13.5|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MULTIPLAN [1680]|HMA [168003]|202||||202|19.86|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|14.92|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202|14.56|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|Self-pay|Self-pay|202||||202|60.6|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202|12.98|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202|19.33|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|13.2|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|8.83|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|12.3|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202|13.24|187.86|8.83
30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|8.83
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|187||||187|22.75|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|187||||187|17.32|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|187||||187|17.32|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|187||||187|93.69|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|187||||187|65.64|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|187||||187|16.28|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|187||||187|79.66|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|187||||187|93.5|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|187||||187|121.55|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|CORESOURCE [1315]|CORESOURCE [131500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|187||||187|19.83|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|187||||187|12.14|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|GEHA [1415]|GEHA [141500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HEALTHNET [1495]|HEALTHNET [149500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|187||||187|16.28|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|187||||187|173.91|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|187||||187|112.2|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|187||||187|93.5|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|187||||187|16.73|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MULTIPLAN [1680]|HMA [168003]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MULTIPLAN [1680]|IHC HS [168011]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|187||||187|18|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|Self-pay|Self-pay|187||||187|56.1|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|187||||187|39.27|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|TRUSTMARK [2030]|STARMARK [203000]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|187||||187|89.67|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|UMR [2035]|UMR OPTIONS [203501]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|187||||187|15.93|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|187||||187|168.3|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|187||||187|9.59|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|187||||187|12.14|173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|187||||187||173.91|9.59
30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|187||||187|93.5|173.91|9.59
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|465||||465|23.76|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|465||||465|15.33|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|465||||465|16.29|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|465||||465|16.29|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|465||||465|232.97|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|465||||465|163.22|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|465||||465|18.56|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|465||||465|198.09|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|465||||465|232.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|465||||465|302.25|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|465||||465|23.51|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|465||||465|14.39|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|GEHA [1415]|GEHA [141500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|465||||465|33.82|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|465||||465|18.56|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|465||||465|432.45|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|465||||465|279|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|465||||465|16.53|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|465||||465|232.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|465||||465|15.73|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|465||||465|20.29|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|465||||465|15.33|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MULTIPLAN [1680]|HMA [168003]|465||||465|22.55|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|465||||465|16.93|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|465||||465|16.53|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|Self-pay|Self-pay|465||||465|139.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|465||||465|97.65|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|465||||465|14.73|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|465||||465|21.94|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|465||||465|222.97|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|UMR [2035]|UMR OPTIONS [203501]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|465||||465|14.98|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|465||||465|418.5|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|465||||465|10.02|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|465||||465|14.39|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|465||||465|15.03|432.45|10.02
30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|465||||465|232.5|432.45|10.02
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|53||||53|20.84|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53||||53|14.29|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53||||53|14.29|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53||||53|26.55|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53||||53|18.6|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53||||53|16.28|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53||||53|22.58|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53||||53|26.5|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53||||53|34.45|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|CORESOURCE [1315]|CORESOURCE [131500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53||||53|19.83|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53||||53|12.14|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|GEHA [1415]|GEHA [141500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HEALTHNET [1495]|HEALTHNET [149500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53||||53|16.28|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53||||53|49.29|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53||||53|31.8|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53||||53|26.5|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53||||53|13.81|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MULTIPLAN [1680]|HMA [168003]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MULTIPLAN [1680]|IHC HS [168011]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53||||53|14.85|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|Self-pay|Self-pay|53||||53|15.9|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53||||53|11.13|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|TRUSTMARK [2030]|STARMARK [203000]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53||||53|25.41|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|UMR [2035]|UMR OPTIONS [203501]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53||||53|13.15|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53||||53|47.7|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53||||53|8.79|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53||||53|12.14|49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53||||53||49.29|8.79
30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53||||53|26.5|49.29|8.79
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|176||||176|19.58|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176||||176|13.43|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176||||176|13.43|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|176||||176|88.18|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176||||176|61.78|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176||||176|15.29|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|176||||176|74.98|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|176||||176|88|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176||||176|114.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|CORESOURCE [1315]|CORESOURCE [131500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|176||||176|19.25|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|176||||176|11.78|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|GEHA [1415]|GEHA [141500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HEALTHNET [1495]|HEALTHNET [149500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176||||176|15.29|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|176||||176|163.68|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176||||176|105.6|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176||||176|88|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176||||176|12.97|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MULTIPLAN [1680]|HMA [168003]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MULTIPLAN [1680]|IHC HS [168011]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|176||||176|13.96|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|Self-pay|Self-pay|176||||176|52.8|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176||||176|36.96|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|TRUSTMARK [2030]|STARMARK [203000]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176||||176|84.39|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|UMR [2035]|UMR OPTIONS [203501]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176||||176|12.35|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176||||176|158.4|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|176||||176|8.26|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|176||||176|11.78|163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|176||||176||163.68|8.26
30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|176||||176|88|163.68|8.26
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|AETNA [1015]|AETNA ACO WILCO [101532]|692||||692|22.6|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|692||||692|17.22|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|692||||692|17.22|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|692||||692|346.69|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|692||||692|242.89|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|692||||692|15.91|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|692||||692|294.79|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|692||||692|346|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|692||||692|449.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|CORESOURCE [1315]|CORESOURCE [131500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|692||||692|19.57|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|692||||692|11.98|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|GEHA [1415]|GEHA [141500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HEALTHNET [1495]|HEALTHNET [149500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|692||||692|15.91|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|692||||692|643.56|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|692||||692|415.2|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|692||||692|346|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|692||||692|16.63|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MULTIPLAN [1680]|HMA [168003]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MULTIPLAN [1680]|IHC HS [168011]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|692||||692|17.9|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|Self-pay|Self-pay|692||||692|207.6|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|692||||692|145.32|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|TRUSTMARK [2030]|STARMARK [203000]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|692||||692|331.81|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|UMR [2035]|UMR OPTIONS [203501]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|692||||692|15.84|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|692||||692|622.8|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|692||||692|9.53|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|692||||692|11.98|643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|692||||692||643.56|9.53
30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|692||||692|346|643.56|9.53
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|AETNA [1015]|AETNA ACO WILCO [101532]|273||||273|30.6|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273||||273|20.97|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273||||273|20.97|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|273||||273|136.77|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273||||273|95.82|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273||||273|23.9|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|273||||273|116.3|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|273||||273|136.5|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273||||273|177.45|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|CORESOURCE [1315]|CORESOURCE [131500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|273||||273|34.72|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|273||||273|21.26|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|GEHA [1415]|GEHA [141500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HEALTHNET [1495]|HEALTHNET [149500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273||||273|23.9|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|273||||273|253.89|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273||||273|163.8|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273||||273|136.5|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273||||273|20.25|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MULTIPLAN [1680]|HMA [168003]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MULTIPLAN [1680]|IHC HS [168011]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|273||||273|21.8|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|Self-pay|Self-pay|273||||273|81.9|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273||||273|57.33|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|TRUSTMARK [2030]|STARMARK [203000]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273||||273|130.9|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|UMR [2035]|UMR OPTIONS [203501]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273||||273|19.28|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273||||273|245.7|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|273||||273|12.91|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|273||||273|21.26|253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|273||||273||253.89|12.91
30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|273||||273|136.5|253.89|12.91
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|303||||303|22.75|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|303||||303|14.68|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|303||||303|15.59|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|303||||303|15.59|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|303||||303|151.8|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|303||||303|106.35|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|303||||303|17.77|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|303||||303|129.08|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|303||||303|151.5|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|303||||303|196.95|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|303||||303|21.75|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|303||||303|13.32|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|GEHA [1415]|GEHA [141500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|303||||303|32.38|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|303||||303|17.77|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|303||||303|281.79|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|303||||303|181.8|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|303||||303|15.83|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|303||||303|151.5|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|303||||303|15.06|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|303||||303|19.43|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|303||||303|14.68|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MULTIPLAN [1680]|HMA [168003]|303||||303|21.59|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MULTIPLAN [1680]|IHC HS [168011]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|303||||303|16.2|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|303||||303|15.83|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|Self-pay|Self-pay|303||||303|90.9|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|303||||303|63.63|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|303||||303|14.1|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|303||||303|21.01|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|TRUSTMARK [2030]|STARMARK [203000]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|303||||303|145.29|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|UMR [2035]|UMR OPTIONS [203501]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|303||||303|14.34|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|303||||303|272.7|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|303||||303|9.59|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|303||||303|13.32|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|303||||303|14.39|281.79|9.59
30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|303||||303|151.5|281.79|9.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|230||||230|20.35|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230||||230|13.14|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230||||230|13.96|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230||||230|13.96|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|230||||230|115.23|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230||||230|80.73|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230||||230|15.9|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|230||||230|97.98|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|230||||230|115|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230||||230|149.5|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|CORESOURCE [1315]|CORESOURCE [131500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|230||||230|20.64|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|230||||230|12.64|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|GEHA [1415]|GEHA [141500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|230||||230|28.98|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HEALTHNET [1495]|HEALTHNET [149500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230||||230|15.9|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|230||||230|213.9|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230||||230|138|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230||||230|14.17|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230||||230|115|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230||||230|13.48|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230||||230|17.39|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230||||230|13.14|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MULTIPLAN [1680]|HMA [168003]|230||||230|19.32|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MULTIPLAN [1680]|IHC HS [168011]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|230||||230|14.51|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230||||230|14.17|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|Self-pay|Self-pay|230||||230|69|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230||||230|48.3|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|230||||230|12.62|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230||||230|18.8|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|TRUSTMARK [2030]|STARMARK [203000]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230||||230|110.29|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|UMR [2035]|UMR OPTIONS [203501]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230||||230|12.84|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230||||230|207|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|230||||230|8.59|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|230||||230|12.64|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|230||||230|12.88|213.9|8.59
30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|230||||230|115|213.9|8.59
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|131||||131|20.84|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131||||131|14.29|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131||||131|14.29|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131||||131|65.63|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131||||131|45.98|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131||||131|16.28|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131||||131|55.81|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131||||131|65.5|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131||||131|85.15|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|131||||131|19.83|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131||||131|12.14|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|GEHA [1415]|GEHA [141500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131||||131|16.28|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|131||||131|121.83|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131||||131|78.6|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131||||131|65.5|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131||||131|13.81|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MULTIPLAN [1680]|HMA [168003]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MULTIPLAN [1680]|IHC HS [168011]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|131||||131|14.85|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|Self-pay|Self-pay|131||||131|39.3|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131||||131|27.51|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|TRUSTMARK [2030]|STARMARK [203000]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131||||131|62.81|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|UMR [2035]|UMR OPTIONS [203501]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131||||131|13.15|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131||||131|117.9|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131||||131|8.79|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131||||131|12.14|121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131||||131||121.83|8.79
30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131||||131|65.5|121.83|8.79
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|215||||215|23.39|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215||||215|16.03|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215||||215|16.03|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|215||||215|107.72|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215||||215|75.47|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215||||215|18.27|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|215||||215|91.59|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|215||||215|107.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215||||215|139.75|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|CORESOURCE [1315]|CORESOURCE [131500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|215||||215|23.36|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|215||||215|14.3|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|GEHA [1415]|GEHA [141500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HEALTHNET [1495]|HEALTHNET [149500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215||||215|18.27|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|215||||215|199.95|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215||||215|129|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215||||215|107.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215||||215|15.49|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MULTIPLAN [1680]|HMA [168003]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MULTIPLAN [1680]|IHC HS [168011]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|215||||215|16.66|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|Self-pay|Self-pay|215||||215|64.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215||||215|45.15|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|TRUSTMARK [2030]|STARMARK [203000]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215||||215|103.09|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|UMR [2035]|UMR OPTIONS [203501]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215||||215|14.75|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215||||215|193.5|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|215||||215|9.86|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|215||||215|14.3|199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|215||||215||199.95|9.86
30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|215||||215|107.5|199.95|9.86
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|AETNA [1015]|AETNA ACO WILCO [101532]|191||||191|22.75|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191||||191|14.68|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191||||191|15.59|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191||||191|15.59|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191||||191|95.69|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191||||191|67.04|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191||||191|17.77|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191||||191|81.37|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191||||191|95.5|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191||||191|124.15|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|CORESOURCE [1315]|CORESOURCE [131500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191||||191|21.75|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191||||191|13.32|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|GEHA [1415]|GEHA [141500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191||||191|32.38|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HEALTHNET [1495]|HEALTHNET [149500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191||||191|17.77|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191||||191|177.63|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191||||191|114.6|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191||||191|15.83|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191||||191|95.5|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191||||191|15.06|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191||||191|19.43|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191||||191|14.68|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MULTIPLAN [1680]|HMA [168003]|191||||191|21.59|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MULTIPLAN [1680]|IHC HS [168011]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191||||191|16.2|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191||||191|15.83|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|Self-pay|Self-pay|191||||191|57.3|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191||||191|40.11|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191||||191|14.1|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191||||191|21.01|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|TRUSTMARK [2030]|STARMARK [203000]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191||||191|91.58|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|UMR [2035]|UMR OPTIONS [203501]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191||||191|14.34|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191||||191|171.9|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|191||||191|9.59|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191||||191|13.32|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191||||191|14.39|177.63|9.59
30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191||||191|95.5|177.63|9.59
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|191||||191|22.77|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191||||191|14.7|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191||||191|15.62|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191||||191|15.62|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191||||191|95.69|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191||||191|67.04|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191||||191|17.78|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191||||191|81.37|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191||||191|95.5|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191||||191|124.15|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191||||191|22.44|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191||||191|13.74|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|GEHA [1415]|GEHA [141500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191||||191|32.42|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191||||191|17.78|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191||||191|177.63|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191||||191|114.6|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191||||191|15.85|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191||||191|95.5|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191||||191|15.08|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191||||191|19.45|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191||||191|14.7|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MULTIPLAN [1680]|HMA [168003]|191||||191|21.62|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MULTIPLAN [1680]|IHC HS [168011]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191||||191|16.24|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191||||191|15.85|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|Self-pay|Self-pay|191||||191|57.3|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191||||191|40.11|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191||||191|14.12|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191||||191|21.04|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|TRUSTMARK [2030]|STARMARK [203000]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191||||191|91.58|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|UMR [2035]|UMR OPTIONS [203501]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191||||191|14.36|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191||||191|171.9|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|191||||191|9.61|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191||||191|13.74|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191||||191|14.41|177.63|9.61
30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191||||191|95.5|177.63|9.61
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|301||||301|20.92|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|301||||301|13.5|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|301||||301|14.35|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|301||||301|14.35|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|301||||301|150.8|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|301||||301|105.65|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|301||||301|16.34|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|301||||301|128.23|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|301||||301|150.5|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|301||||301|195.65|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|CORESOURCE [1315]|CORESOURCE [131500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|301||||301|20.09|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|301||||301|12.3|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|GEHA [1415]|GEHA [141500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|301||||301|29.79|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HEALTHNET [1495]|HEALTHNET [149500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|301||||301|16.34|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|301||||301|279.93|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|301||||301|180.6|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|301||||301|14.56|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|301||||301|150.5|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|301||||301|13.86|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|301||||301|17.87|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|301||||301|13.5|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MULTIPLAN [1680]|HMA [168003]|301||||301|19.86|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MULTIPLAN [1680]|IHC HS [168011]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|301||||301|14.92|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|301||||301|14.56|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|Self-pay|Self-pay|301||||301|90.3|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|301||||301|63.21|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|301||||301|12.98|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|301||||301|19.33|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|TRUSTMARK [2030]|STARMARK [203000]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|301||||301|144.33|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|UMR [2035]|UMR OPTIONS [203501]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|301||||301|13.2|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|301||||301|270.9|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|301||||301|8.83|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|301||||301|12.3|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|301||||301|13.24|279.93|8.83
30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|301||||301|150.5|279.93|8.83
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|246||||246|19.86|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|246||||246|13.61|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|246||||246|13.61|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|246||||246|123.25|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|246||||246|86.35|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|246||||246|15.51|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|246||||246|104.8|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|246||||246|123|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|246||||246|159.9|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|246||||246|19.49|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|246||||246|11.93|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|GEHA [1415]|GEHA [141500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|246||||246|15.51|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|246||||246|228.78|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|246||||246|147.6|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|246||||246|123|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|246||||246|13.15|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MULTIPLAN [1680]|HMA [168003]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MULTIPLAN [1680]|IHC HS [168011]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|246||||246|14.15|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|Self-pay|Self-pay|246||||246|73.8|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|246||||246|51.66|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|TRUSTMARK [2030]|STARMARK [203000]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|246||||246|117.96|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|UMR [2035]|UMR OPTIONS [203501]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|246||||246|12.52|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|246||||246|221.4|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|246||||246|8.38|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|246||||246|11.93|228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|246||||246||228.78|8.38
30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|246||||246|123|228.78|8.38
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|AETNA [1015]|AETNA ACO WILCO [101532]|170||||170|20.35|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170||||170|13.14|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170||||170|13.96|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170||||170|13.96|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170||||170|85.17|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170||||170|59.67|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170||||170|15.9|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170||||170|72.42|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170||||170|85|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170||||170|110.5|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|CORESOURCE [1315]|CORESOURCE [131500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170||||170|20.48|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170||||170|12.54|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|GEHA [1415]|GEHA [141500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170||||170|28.98|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HEALTHNET [1495]|HEALTHNET [149500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170||||170|15.9|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170||||170|158.1|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170||||170|102|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170||||170|14.17|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170||||170|85|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170||||170|13.48|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170||||170|17.39|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170||||170|13.14|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MULTIPLAN [1680]|HMA [168003]|170||||170|19.32|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MULTIPLAN [1680]|IHC HS [168011]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170||||170|14.51|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170||||170|14.17|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|Self-pay|Self-pay|170||||170|51|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170||||170|35.7|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170||||170|12.62|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170||||170|18.8|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|TRUSTMARK [2030]|STARMARK [203000]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170||||170|81.52|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|UMR [2035]|UMR OPTIONS [203501]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170||||170|12.84|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170||||170|153|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170||||170|8.59|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170||||170|12.54|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170||||170|12.88|158.1|8.59
30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170||||170|85|158.1|8.59
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|AETNA [1015]|AETNA ACO WILCO [101532]|231||||231|26.62|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231||||231|17.19|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231||||231|18.26|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231||||231|18.26|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|231||||231|115.73|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231||||231|81.08|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231||||231|20.8|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|231||||231|98.41|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|231||||231|115.5|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231||||231|150.15|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|CORESOURCE [1315]|CORESOURCE [131500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|231||||231|25.31|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|231||||231|15.49|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|GEHA [1415]|GEHA [141500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|231||||231|37.91|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HEALTHNET [1495]|HEALTHNET [149500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231||||231|20.8|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|231||||231|214.83|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231||||231|138.6|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231||||231|18.54|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231||||231|115.5|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231||||231|17.64|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231||||231|22.75|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231||||231|17.19|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MULTIPLAN [1680]|HMA [168003]|231||||231|25.28|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MULTIPLAN [1680]|IHC HS [168011]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|231||||231|18.98|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231||||231|18.54|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|Self-pay|Self-pay|231||||231|69.3|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231||||231|48.51|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|231||||231|16.51|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231||||231|24.6|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|TRUSTMARK [2030]|STARMARK [203000]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231||||231|110.76|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|UMR [2035]|UMR OPTIONS [203501]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231||||231|16.8|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231||||231|207.9|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|231||||231|11.23|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|231||||231|15.49|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|231||||231|16.85|214.83|11.23
30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|231||||231|115.5|214.83|11.23
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|AETNA [1015]|AETNA ACO WILCO [101532]|228||||228|22.75|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|228||||228|14.68|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|228||||228|15.59|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|228||||228|15.59|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|228||||228|114.23|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|228||||228|80.03|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|228||||228|17.77|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|228||||228|97.13|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|228||||228|114|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|228||||228|148.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|CORESOURCE [1315]|CORESOURCE [131500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|228||||228|21.75|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|228||||228|13.32|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|GEHA [1415]|GEHA [141500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|228||||228|32.38|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HEALTHNET [1495]|HEALTHNET [149500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228||||228|17.77|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|228||||228|212.04|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|228||||228|136.8|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|228||||228|15.83|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228||||228|114|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|228||||228|15.06|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|228||||228|19.43|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|228||||228|14.68|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MULTIPLAN [1680]|HMA [168003]|228||||228|21.59|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MULTIPLAN [1680]|IHC HS [168011]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|228||||228|16.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|228||||228|15.83|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|Self-pay|Self-pay|228||||228|68.4|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|228||||228|47.88|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|228||||228|14.1|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|228||||228|21.01|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|TRUSTMARK [2030]|STARMARK [203000]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228||||228|109.33|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|UMR [2035]|UMR OPTIONS [203501]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|228||||228|14.34|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|228||||228|205.2|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|228||||228|9.59|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|228||||228|13.32|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|228||||228|14.39|212.04|9.59
30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|228||||228|114|212.04|9.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|AETNA [1015]|AETNA ACO WILCO [101532]|362||||362|20.35|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|362||||362|13.14|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|362||||362|13.96|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|362||||362|13.96|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|362||||362|181.36|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|362||||362|127.06|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|362||||362|15.9|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|362||||362|154.21|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|362||||362|181|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|362||||362|235.3|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|CORESOURCE [1315]|CORESOURCE [131500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|362||||362|19.66|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|362||||362|12.03|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|GEHA [1415]|GEHA [141500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|362||||362|28.98|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HEALTHNET [1495]|HEALTHNET [149500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|362||||362|15.9|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|362||||362|336.66|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|362||||362|217.2|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|362||||362|14.17|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|362||||362|181|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|362||||362|13.48|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|362||||362|17.39|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|362||||362|13.14|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MULTIPLAN [1680]|HMA [168003]|362||||362|19.32|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MULTIPLAN [1680]|IHC HS [168011]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|362||||362|14.51|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|362||||362|14.17|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|Self-pay|Self-pay|362||||362|108.6|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|362||||362|76.02|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|362||||362|12.62|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|362||||362|18.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|TRUSTMARK [2030]|STARMARK [203000]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|362||||362|173.58|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|UMR [2035]|UMR OPTIONS [203501]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|362||||362|12.84|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|362||||362|325.8|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|362||||362|8.59|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|362||||362|12.03|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|362||||362|12.88|336.66|8.59
30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|362||||362|181|336.66|8.59
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|187||||187|20.84|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|187||||187|14.29|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|187||||187|14.29|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|187||||187|93.69|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|187||||187|65.64|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|187||||187|16.28|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|187||||187|79.66|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|187||||187|93.5|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|187||||187|121.55|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|CORESOURCE [1315]|CORESOURCE [131500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|187||||187|19.86|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|187||||187|12.16|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|GEHA [1415]|GEHA [141500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HEALTHNET [1495]|HEALTHNET [149500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|187||||187|16.28|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|187||||187|173.91|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|187||||187|112.2|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|187||||187|93.5|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|187||||187|13.81|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MULTIPLAN [1680]|HMA [168003]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MULTIPLAN [1680]|IHC HS [168011]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|187||||187|14.85|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|Self-pay|Self-pay|187||||187|56.1|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|187||||187|39.27|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|TRUSTMARK [2030]|STARMARK [203000]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|187||||187|89.67|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|UMR [2035]|UMR OPTIONS [203501]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|187||||187|13.15|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|187||||187|168.3|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|187||||187|8.79|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|187||||187|12.16|173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|187||||187||173.91|8.79
30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|187||||187|93.5|173.91|8.79
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|166||||166|26.62|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166||||166|0|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166||||166|0|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|166||||166|83.17|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166||||166|58.27|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166||||166|20.8|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|166||||166|70.72|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|166||||166|83|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166||||166|107.9|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|CORESOURCE [1315]|CORESOURCE [131500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|166||||166|0|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|166||||166|13.46|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|GEHA [1415]|GEHA [141500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HEALTHNET [1495]|HEALTHNET [149500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166||||166|20.8|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|166||||166|154.38|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166||||166|99.6|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166||||166|83|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166||||166|0|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MULTIPLAN [1680]|HMA [168003]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MULTIPLAN [1680]|IHC HS [168011]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|166||||166|0|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|Self-pay|Self-pay|166||||166|49.8|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166||||166|34.86|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|TRUSTMARK [2030]|STARMARK [203000]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166||||166|79.6|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|UMR [2035]|UMR OPTIONS [203501]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166||||166|0|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166||||166|149.4|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|166||||166|11.23|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|166||||166|13.46|154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|166||||166||154.38|11.23
30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|166||||166|83|154.38|11.23
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|209||||209|25.13|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209||||209|16.23|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209||||209|17.24|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209||||209|17.24|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|209||||209|104.71|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209||||209|73.36|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209||||209|19.64|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|209||||209|89.03|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|209||||209|104.5|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209||||209|135.85|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|CORESOURCE [1315]|CORESOURCE [131500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|209||||209|25.41|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|209||||209|15.56|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|GEHA [1415]|GEHA [141500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|209||||209|35.8|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HEALTHNET [1495]|HEALTHNET [149500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209||||209|19.64|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|209||||209|194.37|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209||||209|125.4|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209||||209|17.5|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209||||209|104.5|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209||||209|16.65|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209||||209|21.48|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209||||209|16.23|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MULTIPLAN [1680]|HMA [168003]|209||||209|23.87|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MULTIPLAN [1680]|IHC HS [168011]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|209||||209|17.92|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209||||209|17.5|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|Self-pay|Self-pay|209||||209|62.7|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209||||209|43.89|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|209||||209|15.59|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209||||209|23.23|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|TRUSTMARK [2030]|STARMARK [203000]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209||||209|100.22|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|UMR [2035]|UMR OPTIONS [203501]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209||||209|15.86|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209||||209|188.1|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|209||||209|10.6|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|209||||209|15.56|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|209||||209|15.91|194.37|10.6
30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|209||||209|104.5|194.37|10.6
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|AETNA [1015]|AETNA ACO WILCO [101532]|252||||252|22.55|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|252||||252|14.56|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|252||||252|15.46|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|252||||252|15.46|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|252||||252|126.25|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|252||||252|88.45|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|252||||252|17.61|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|252||||252|107.35|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|252||||252|126|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|252||||252|163.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|CORESOURCE [1315]|CORESOURCE [131500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|252||||252|21.73|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|252||||252|13.3|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|GEHA [1415]|GEHA [141500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|252||||252|32.11|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HEALTHNET [1495]|HEALTHNET [149500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|252||||252|17.61|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|252||||252|234.36|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|252||||252|151.2|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|252||||252|15.7|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|252||||252|126|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|252||||252|14.93|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|252||||252|19.26|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|252||||252|14.56|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MULTIPLAN [1680]|HMA [168003]|252||||252|21.41|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MULTIPLAN [1680]|IHC HS [168011]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|252||||252|16.07|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|252||||252|15.7|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|Self-pay|Self-pay|252||||252|75.6|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|252||||252|52.92|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|252||||252|13.98|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|252||||252|20.83|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|TRUSTMARK [2030]|STARMARK [203000]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|252||||252|120.83|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|UMR [2035]|UMR OPTIONS [203501]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|252||||252|14.22|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|252||||252|226.8|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|252||||252|9.51|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|252||||252|13.3|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|252||||252|14.27|234.36|9.51
30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|252||||252|126|234.36|9.51
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|AETNA [1015]|AETNA ACO WILCO [101532]|432||||432|24.48|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|432||||432|16.78|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|432||||432|16.78|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|432||||432|216.43|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|432||||432|151.63|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|432||||432|19.13|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|432||||432|184.03|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|432||||432|216|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|432||||432|280.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|CORESOURCE [1315]|CORESOURCE [131500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|432||||432|24.86|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|432||||432|15.22|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|GEHA [1415]|GEHA [141500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HEALTHNET [1495]|HEALTHNET [149500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|432||||432|19.13|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|432||||432|401.76|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|432||||432|259.2|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|432||||432|216|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|432||||432|16.21|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MULTIPLAN [1680]|HMA [168003]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MULTIPLAN [1680]|IHC HS [168011]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|432||||432|17.44|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|Self-pay|Self-pay|432||||432|129.6|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|432||||432|90.72|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|TRUSTMARK [2030]|STARMARK [203000]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|432||||432|207.14|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|UMR [2035]|UMR OPTIONS [203501]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|432||||432|15.44|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|432||||432|388.8|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|432||||432|10.33|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|432||||432|15.22|401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|432||||432||401.76|10.33
30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|432||||432|216|401.76|10.33
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|AETNA [1015]|AETNA ACO WILCO [101532]|426||||426|40.78|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|426||||426|26.33|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|426||||426|27.96|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|426||||426|27.96|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|426||||426|213.43|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|426||||426|149.53|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|426||||426|31.86|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|426||||426|181.48|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|426||||426|213|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|426||||426|276.9|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|CORESOURCE [1315]|CORESOURCE [131500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|426||||426|85.23|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|426||||426|52.18|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|GEHA [1415]|GEHA [141500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|426||||426|58.07|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HEALTHNET [1495]|HEALTHNET [149500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|426||||426|31.86|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|426||||426|396.18|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|426||||426|255.6|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|426||||426|28.39|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|426||||426|213|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|426||||426|27.01|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|426||||426|34.84|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|426||||426|26.33|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MULTIPLAN [1680]|HMA [168003]|426||||426|38.72|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MULTIPLAN [1680]|IHC HS [168011]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|426||||426|29.06|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|426||||426|28.39|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|Self-pay|Self-pay|426||||426|127.8|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|426||||426|89.46|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|426||||426|25.29|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|426||||426|37.68|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|TRUSTMARK [2030]|STARMARK [203000]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|426||||426|204.27|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|UMR [2035]|UMR OPTIONS [203501]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|426||||426|25.73|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|426||||426|383.4|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|426||||426|17.2|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|426||||426|52.18|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|426||||426|25.81|396.18|17.2
30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|426||||426|213|396.18|17.2
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|AETNA [1015]|AETNA ACO WILCO [101532]|521||||521|91.66|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521||||521|62.84|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521||||521|62.84|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|521||||521|261.02|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521||||521|182.87|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521||||521|71.6|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|521||||521|221.95|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|521||||521|260.5|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521||||521|338.65|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|CORESOURCE [1315]|CORESOURCE [131500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|521||||521|91.12|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|521||||521|55.79|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|GEHA [1415]|GEHA [141500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HEALTHNET [1495]|HEALTHNET [149500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521||||521|71.6|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|521||||521|484.53|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|521||||521|312.6|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521||||521|260.5|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521||||521|60.69|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MULTIPLAN [1680]|HMA [168003]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MULTIPLAN [1680]|IHC HS [168011]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|521||||521|65.31|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|Self-pay|Self-pay|521||||521|156.3|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521||||521|109.41|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|TRUSTMARK [2030]|STARMARK [203000]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521||||521|249.82|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|UMR [2035]|UMR OPTIONS [203501]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521||||521|57.8|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521||||521|468.9|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|521||||521|38.66|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|521||||521|55.79|484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|521||||521||484.53|38.66
30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|521||||521|260.5|484.53|38.66
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|905||||905|150.98|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|905||||905|108.26|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|905||||905|114.99|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|905||||905|114.99|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|905||||905|453.41|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|905||||905|317.66|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|905||||905|385.53|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|905||||905|452.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|905||||905|588.25|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|CORESOURCE [1315]|CORESOURCE [131500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|905||||905|120.9|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|905||||905|74.02|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|GEHA [1415]|GEHA [141500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|905||||905|238.82|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HEALTHNET [1495]|HEALTHNET [149500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|905||||905|841.65|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|905||||905|543|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|905||||905|116.75|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|905||||905|452.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|905||||905|111.07|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|905||||905|143.29|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|905||||905|108.26|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MULTIPLAN [1680]|HMA [168003]|905||||905|159.21|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MULTIPLAN [1680]|IHC HS [168011]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|905||||905|119.52|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|905||||905|116.75|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|Self-pay|Self-pay|905||||905|271.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|905||||905|190.05|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|905||||905|104.02|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|905||||905|154.96|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|TRUSTMARK [2030]|STARMARK [203000]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|905||||905|433.95|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|UMR [2035]|UMR OPTIONS [203501]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|905||||905|105.78|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|905||||905|814.5|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|905||||905|63.68|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|905||||905|74.02|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|905||||905|106.14|841.65|63.68
30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|905||||905|452.5|841.65|63.68
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|295||||295|147.8|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295||||295|103.55|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295||||295|126.85|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|295||||295|125.67|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|295||||295|147.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295||||295|191.75|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|CORESOURCE [1315]|CORESOURCE [131500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|GEHA [1415]|GEHA [141500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HEALTHNET [1495]|HEALTHNET [149500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295||||295|126.85|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|295||||295|274.35|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295||||295|177|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295||||295|147.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MULTIPLAN [1680]|HMA [168003]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MULTIPLAN [1680]|IHC HS [168011]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|Self-pay|Self-pay|295||||295|88.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295||||295|61.95|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|TRUSTMARK [2030]|STARMARK [203000]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295||||295|141.45|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|UMR [2035]|UMR OPTIONS [203501]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295||||295|73.75|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295||||295|265.5|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|295||||295|0|274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|295||||295||274.35|61.95
30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|295||||295|147.5|274.35|61.95
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|13.9|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254|47.24|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|10.58|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|10.58|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254|45.88|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|9.77|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|14.92|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|9.13|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254|104.2|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|9.77|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254|50.46|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|121.87|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|10.22|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254|62.52|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254|47.24|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MULTIPLAN [1680]|HMA [168003]|254||||254|69.47|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|11|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254|50.46|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|Self-pay|Self-pay|254||||254|76.2|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254|45.39|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254|67.62|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|9.73|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|5.86|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|9.13|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254|46.31|236.22|5.86
30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|5.86
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|298||||298|42.96|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|298||||298|140|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|298||||298|144.16|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|298||||298|144.16|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|298||||298|137.52|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|298||||298|149.3|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|298||||298|104.6|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|298||||298|128.14|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|298||||298|126.95|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|298||||298|149|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|298||||298|193.7|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|CORESOURCE [1315]|CORESOURCE [131500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|298||||298|35.04|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|298||||298|21.71|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|GEHA [1415]|GEHA [141500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|298||||298|298|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HEALTHNET [1495]|HEALTHNET [149500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|298||||298|128.14|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|298||||298|277.14|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|298||||298|178.8|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|298||||298|151.27|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|298||||298|298|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|298||||298|159.37|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|298||||298|185.3|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|298||||298|140|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MULTIPLAN [1680]|HMA [168003]|298||||298|205.88|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MULTIPLAN [1680]|IHC HS [168011]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|298||||298|149.84|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|298||||298|151.27|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|Self-pay|Self-pay|298||||298|89.4|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|298||||298|62.58|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|298||||298|134.51|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|298||||298|200.39|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|TRUSTMARK [2030]|STARMARK [203000]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|298||||298|142.89|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|UMR [2035]|UMR OPTIONS [203501]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|298||||298|151.77|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|298||||298|268.2|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|298||||298|86.84|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|298||||298|21.71|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|298||||298|137.26|298|21.71
30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|298||||298|149|298|21.71
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|1135||||1135|59.01|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1135||||1135|276.49|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1135||||1135|241.38|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1135||||1135|241.38|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1135||||1135|268.52|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1135||||1135|568.64|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1135||||1135|398.39|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1135||||1135|488.05|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1135||||1135|483.51|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1135||||1135|567.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1135||||1135|737.75|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|CORESOURCE [1315]|CORESOURCE [131500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1135||||1135|43.28|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1135||||1135|28.9|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|GEHA [1415]|GEHA [141500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1135||||1135|609.91|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HEALTHNET [1495]|HEALTHNET [149500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1135||||1135|488.05|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1135||||1135|1055.55|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1135||||1135|681|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1135||||1135|295.37|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1135||||1135|655.46|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1135||||1135|266.84|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1135||||1135|365.95|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1135||||1135|276.49|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MULTIPLAN [1680]|HMA [168003]|1135||||1135|406.61|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MULTIPLAN [1680]|IHC HS [168011]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1135||||1135|250.88|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1135||||1135|295.37|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|Self-pay|Self-pay|1135||||1135|340.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1135||||1135|238.35|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1135||||1135|265.65|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1135||||1135|395.76|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|TRUSTMARK [2030]|STARMARK [203000]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1135||||1135|544.23|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|UMR [2035]|UMR OPTIONS [203501]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1135||||1135|254.12|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1135||||1135|1021.5|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1135||||1135|164.53|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1135||||1135|28.9|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1135||||1135|271.07|1055.55|28.9
30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1135||||1135|567.5|1055.55|28.9
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|AETNA [1015]|AETNA ACO WILCO [101532]|278||||278|8.52|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|278||||278|52.84|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|278||||278|5.84|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|278||||278|5.84|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|278||||278|51.31|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|278||||278|139.28|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|278||||278|97.58|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|278||||278|6.65|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|278||||278|118.43|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|278||||278|139|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|278||||278|180.7|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|CORESOURCE [1315]|CORESOURCE [131500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|278||||278|11.19|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|278||||278|6.85|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|GEHA [1415]|GEHA [141500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|278||||278|116.55|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HEALTHNET [1495]|HEALTHNET [149500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|278||||278|6.65|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|278||||278|258.54|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|278||||278|166.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|278||||278|56.44|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|278||||278|76.78|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|278||||278|5.64|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|278||||278|69.93|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|278||||278|52.84|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MULTIPLAN [1680]|HMA [168003]|278||||278|77.7|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MULTIPLAN [1680]|IHC HS [168011]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|278||||278|6.07|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|278||||278|56.44|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|Self-pay|Self-pay|278||||278|83.4|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|278||||278|58.38|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|278||||278|50.76|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|278||||278|75.63|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|TRUSTMARK [2030]|STARMARK [203000]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|278||||278|133.3|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|UMR [2035]|UMR OPTIONS [203501]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|278||||278|5.37|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|278||||278|250.2|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|278||||278|3.59|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|278||||278|6.85|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|278||||278|51.8|258.54|3.59
30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|278||||278|139|258.54|3.59
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|AETNA [1015]|AETNA ACO WILCO [101532]|619||||619|8.18|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|619||||619|5.61|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|619||||619|5.61|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|619||||619|310.12|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|619||||619|217.27|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|619||||619|6.39|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|619||||619|263.69|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|619||||619|309.5|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|619||||619|402.35|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|CORESOURCE [1315]|CORESOURCE [131500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|619||||619|13.43|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|619||||619|8.22|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|GEHA [1415]|GEHA [141500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HEALTHNET [1495]|HEALTHNET [149500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|619||||619|6.39|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|619||||619|575.67|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|619||||619|371.4|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|619||||619|345.93|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|619||||619|5.42|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MULTIPLAN [1680]|HMA [168003]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MULTIPLAN [1680]|IHC HS [168011]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|619||||619|5.83|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|Self-pay|Self-pay|619||||619|185.7|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|619||||619|129.99|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|TRUSTMARK [2030]|STARMARK [203000]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|619||||619|296.81|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|UMR [2035]|UMR OPTIONS [203501]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|619||||619|5.17|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|619||||619|557.1|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|619||||619|3.45|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|619||||619|8.22|575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|619||||619||575.67|3.45
30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT EACH AB TITER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|619||||619|309.5|575.67|3.45
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|AETNA [1015]|AETNA ACO WILCO [101532]|123||||123|4.73|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123||||123|106.28|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123||||123|3.24|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123||||123|3.24|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123||||123|103.21|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123||||123|61.62|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123||||123|43.17|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123||||123|3.69|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123||||123|52.4|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123||||123|61.5|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123||||123|79.95|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|CORESOURCE [1315]|CORESOURCE [131500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|123||||123|8.48|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123||||123|5.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|GEHA [1415]|GEHA [141500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123||||123|123|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HEALTHNET [1495]|HEALTHNET [149500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123||||123|3.69|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|123||||123|114.39|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123||||123|73.8|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123||||123|113.53|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123||||123|123|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123||||123|3.13|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123||||123|123|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123||||123|106.28|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MULTIPLAN [1680]|HMA [168003]|123||||123|123|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MULTIPLAN [1680]|IHC HS [168011]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|123||||123|3.37|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123||||123|113.53|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|Self-pay|Self-pay|123||||123|36.9|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123||||123|25.83|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123||||123|102.11|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123||||123|123|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|TRUSTMARK [2030]|STARMARK [203000]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123||||123|58.98|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|UMR [2035]|UMR OPTIONS [203501]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123||||123|2.98|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123||||123|110.7|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123||||123|1.99|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123||||123|5.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123||||123|104.19|123|1.99
30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123||||123|61.5|123|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|AETNA [1015]|AETNA ACO WILCO [101532]|96||||96|4.73|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96||||96|32.12|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96||||96|3.24|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96||||96|3.24|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96||||96|31.2|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96||||96|48.1|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96||||96|33.7|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96||||96|3.69|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96||||96|40.9|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96||||96|48|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96||||96|62.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|CORESOURCE [1315]|CORESOURCE [131500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96||||96|10.22|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96||||96|6.26|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|GEHA [1415]|GEHA [141500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96||||96|70.86|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HEALTHNET [1495]|HEALTHNET [149500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96||||96|3.69|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96||||96|89.28|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96||||96|57.6|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96||||96|34.32|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96||||96|76.78|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96||||96|3.13|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96||||96|42.52|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96||||96|32.12|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MULTIPLAN [1680]|HMA [168003]|96||||96|47.24|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MULTIPLAN [1680]|IHC HS [168011]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96||||96|3.37|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96||||96|34.32|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|Self-pay|Self-pay|96||||96|28.8|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96||||96|20.16|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96||||96|30.86|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96||||96|45.98|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|TRUSTMARK [2030]|STARMARK [203000]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96||||96|46.03|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|UMR [2035]|UMR OPTIONS [203501]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96||||96|2.98|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96||||96|86.4|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96||||96|1.99|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96||||96|6.26|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96||||96|31.49|89.28|1.99
30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96||||96|48|89.28|1.99
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|AETNA [1015]|AETNA ACO WILCO [101532]|814||||814|9.03|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|814||||814|276.49|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|814||||814|6.88|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|814||||814|6.88|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|814||||814|268.52|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|814||||814|407.81|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|814||||814|285.71|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|814||||814|6.35|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|814||||814|346.76|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|814||||814|407|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|814||||814|529.1|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|CORESOURCE [1315]|CORESOURCE [131500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|814||||814|5.96|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|814||||814|4.13|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|GEHA [1415]|GEHA [141500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|814||||814|609.91|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HEALTHNET [1495]|HEALTHNET [149500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|814||||814|6.35|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|814||||814|757.02|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|814||||814|488.4|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|814||||814|295.37|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|814||||814|655.46|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|814||||814|6.65|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|814||||814|365.95|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|814||||814|276.49|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MULTIPLAN [1680]|HMA [168003]|814||||814|406.61|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MULTIPLAN [1680]|IHC HS [168011]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|814||||814|7.15|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|814||||814|295.37|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|Self-pay|Self-pay|814||||814|244.2|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|814||||814|170.94|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|814||||814|265.65|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|814||||814|395.76|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|TRUSTMARK [2030]|STARMARK [203000]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|814||||814|390.31|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|UMR [2035]|UMR OPTIONS [203501]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|814||||814|6.33|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|814||||814|732.6|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|814||||814|3.81|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|814||||814|4.13|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|814||||814|271.07|757.02|3.81
30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA AG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|814||||814|407|757.02|3.81
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|814||||814|6.05|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|814||||814|276.49|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|814||||814|4.15|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|814||||814|4.15|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|814||||814|268.52|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|814||||814|407.81|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|814||||814|285.71|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|814||||814|4.73|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|814||||814|346.76|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|814||||814|407|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|814||||814|529.1|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|CORESOURCE [1315]|CORESOURCE [131500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|814||||814|7.5|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|814||||814|4.59|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|GEHA [1415]|GEHA [141500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|814||||814|609.91|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HEALTHNET [1495]|HEALTHNET [149500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|814||||814|4.73|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|814||||814|757.02|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|814||||814|488.4|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|814||||814|295.37|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|814||||814|655.46|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|814||||814|4.01|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|814||||814|365.95|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|814||||814|276.49|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MULTIPLAN [1680]|HMA [168003]|814||||814|406.61|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MULTIPLAN [1680]|IHC HS [168011]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|814||||814|4.31|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|814||||814|295.37|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|Self-pay|Self-pay|814||||814|244.2|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|814||||814|170.94|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|814||||814|265.65|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|814||||814|395.76|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|TRUSTMARK [2030]|STARMARK [203000]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|814||||814|390.31|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|UMR [2035]|UMR OPTIONS [203501]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|814||||814|3.81|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|814||||814|732.6|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|814||||814|2.55|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|814||||814|4.59|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|814||||814|271.07|757.02|2.55
30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|814||||814|407|757.02|2.55
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|195||||195|12.24|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195||||195|32.12|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195||||195|8.4|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195||||195|8.4|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195||||195|31.2|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|195||||195|97.7|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195||||195|68.45|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195||||195|9.57|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|195||||195|83.07|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|195||||195|97.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195||||195|126.75|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|CORESOURCE [1315]|CORESOURCE [131500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|195||||195|11.79|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|195||||195|7.22|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|GEHA [1415]|GEHA [141500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|195||||195|70.86|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HEALTHNET [1495]|HEALTHNET [149500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195||||195|9.57|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|195||||195|181.35|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195||||195|117|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195||||195|34.32|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195||||195|76.78|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195||||195|8.12|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195||||195|42.52|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195||||195|32.12|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MULTIPLAN [1680]|HMA [168003]|195||||195|47.24|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MULTIPLAN [1680]|IHC HS [168011]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|195||||195|8.73|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195||||195|34.32|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|Self-pay|Self-pay|195||||195|58.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195||||195|40.95|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|195||||195|30.86|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195||||195|45.98|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|TRUSTMARK [2030]|STARMARK [203000]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195||||195|93.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|UMR [2035]|UMR OPTIONS [203501]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195||||195|7.73|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195||||195|175.5|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|195||||195|5.17|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|195||||195|7.22|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|195||||195|31.49|181.35|5.17
30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|195||||195|97.5|181.35|5.17
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|AETNA [1015]|AETNA ACO WILCO [101532]|512||||512|47.69|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|512||||512|141.6|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|512||||512|144.16|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|512||||512|144.16|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|512||||512|137.52|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|512||||512|256.51|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|512||||512|179.71|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|512||||512|220.16|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|512||||512|218.11|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|512||||512|256|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|512||||512|332.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|CORESOURCE [1315]|CORESOURCE [131500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|512||||512|35.13|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|512||||512|23.43|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|GEHA [1415]|GEHA [141500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|512||||512|312.35|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HEALTHNET [1495]|HEALTHNET [149500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|512||||512|220.16|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|512||||512|476.16|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|512||||512|307.2|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|512||||512|151.27|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|512||||512|345.93|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|512||||512|159.37|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|512||||512|185.3|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|512||||512|141.6|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MULTIPLAN [1680]|HMA [168003]|512||||512|208.23|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MULTIPLAN [1680]|IHC HS [168011]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|512||||512|149.84|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|512||||512|151.27|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|Self-pay|Self-pay|512||||512|153.6|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|512||||512|107.52|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|512||||512|136.05|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|512||||512|202.68|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|TRUSTMARK [2030]|STARMARK [203000]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|512||||512|245.5|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|UMR [2035]|UMR OPTIONS [203501]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|512||||512|151.77|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|512||||512|460.8|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|512||||512|86.84|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|512||||512|23.43|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|512||||512|138.82|476.16|23.43
30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|512||||512|256|476.16|23.43
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|AETNA [1015]|AETNA ACO WILCO [101532]|410||||410|38.24|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|410||||410|141.6|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|410||||410|144.16|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|410||||410|144.16|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|410||||410|137.52|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|410||||410|205.41|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|410||||410|143.91|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|410||||410|176.3|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|410||||410|174.66|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|410||||410|205|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|410||||410|266.5|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|CORESOURCE [1315]|CORESOURCE [131500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|410||||410|29.67|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|410||||410|19.14|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|GEHA [1415]|GEHA [141500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|410||||410|312.35|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HEALTHNET [1495]|HEALTHNET [149500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|410||||410|176.3|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|410||||410|381.3|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|410||||410|246|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|410||||410|151.27|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|410||||410|345.93|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|410||||410|159.37|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|410||||410|187.41|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|410||||410|141.6|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MULTIPLAN [1680]|HMA [168003]|410||||410|208.23|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MULTIPLAN [1680]|IHC HS [168011]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|410||||410|149.84|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|410||||410|151.27|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|Self-pay|Self-pay|410||||410|123|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|410||||410|86.1|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|410||||410|134.51|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|410||||410|202.68|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|TRUSTMARK [2030]|STARMARK [203000]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|410||||410|196.6|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|UMR [2035]|UMR OPTIONS [203501]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|410||||410|151.77|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|410||||410|369|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|410||||410|86.84|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|410||||410|19.14|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|410||||410|138.82|381.3|19.14
30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|410||||410|205|381.3|19.14
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|417||||417|26.91|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|417||||417|17.06|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|417||||417|17.06|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|417||||417|208.92|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|417||||417|146.37|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|417||||417|179.31|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|417||||417|177.64|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|417||||417|208.5|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|417||||417|271.05|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|417||||417|20.74|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|417||||417|13.54|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|GEHA [1415]|GEHA [141500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|417||||417|179.31|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|417||||417|387.81|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|417||||417|250.2|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|417||||417|345.93|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|417||||417|18.86|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MULTIPLAN [1680]|HMA [168003]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|417||||417|17.73|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|Self-pay|Self-pay|417||||417|125.1|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|417||||417|87.57|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|417||||417|199.95|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|UMR [2035]|UMR OPTIONS [203501]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|417||||417|17.96|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|417||||417|375.3|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|417||||417|86.84|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|417||||417|13.54|387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|417||||417||387.81|13.54
30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|417||||417|208.5|387.81|13.54
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|235||||235|40.13|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235||||235|32.12|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235||||235|87.64|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235||||235|87.64|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235||||235|31.2|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|235||||235|117.74|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235||||235|82.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235||||235|101.05|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|235||||235|100.11|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|235||||235|117.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235||||235|152.75|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|CORESOURCE [1315]|CORESOURCE [131500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|235||||235|31.56|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|235||||235|20.07|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|GEHA [1415]|GEHA [141500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|235||||235|70.86|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HEALTHNET [1495]|HEALTHNET [149500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235||||235|101.05|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|235||||235|218.55|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235||||235|141|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235||||235|34.32|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235||||235|76.78|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235||||235|96.89|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235||||235|42.52|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235||||235|32.12|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MULTIPLAN [1680]|HMA [168003]|235||||235|47.24|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MULTIPLAN [1680]|IHC HS [168011]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|235||||235|91.09|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235||||235|34.32|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|Self-pay|Self-pay|235||||235|70.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235||||235|49.35|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|235||||235|30.86|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235||||235|45.98|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|TRUSTMARK [2030]|STARMARK [203000]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235||||235|112.68|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|UMR [2035]|UMR OPTIONS [203501]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235||||235|92.28|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235||||235|211.5|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|235||||235|19.27|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|235||||235|20.07|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|235||||235|31.49|218.55|19.27
30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|235||||235|117.5|218.55|19.27
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|AETNA [1015]|AETNA ACO WILCO [101532]|236||||236|44.86|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236||||236|144.16|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236||||236|144.16|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|236||||236|118.24|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236||||236|82.84|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236||||236|101.48|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|236||||236|100.54|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|236||||236|118|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236||||236|153.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|CORESOURCE [1315]|CORESOURCE [131500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|236||||236|33.88|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|236||||236|22.41|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|GEHA [1415]|GEHA [141500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HEALTHNET [1495]|HEALTHNET [149500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236||||236|101.48|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|236||||236|219.48|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236||||236|141.6|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236||||236|236|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236||||236|159.37|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MULTIPLAN [1680]|HMA [168003]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MULTIPLAN [1680]|IHC HS [168011]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|236||||236|149.84|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|Self-pay|Self-pay|236||||236|70.8|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236||||236|49.56|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|TRUSTMARK [2030]|STARMARK [203000]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236||||236|113.16|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|UMR [2035]|UMR OPTIONS [203501]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236||||236|151.77|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236||||236|212.4|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|236||||236|86.84|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|236||||236|22.41|236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|236||||236||236|22.41
30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|236||||236|118|236|22.41
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|AETNA [1015]|AETNA ACO WILCO [101532]|139||||139|40.13|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139||||139|33.81|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139||||139|33.81|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139||||139|69.64|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139||||139|48.79|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139||||139|59.77|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139||||139|59.21|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139||||139|69.5|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139||||139|90.35|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|CORESOURCE [1315]|CORESOURCE [131500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139||||139|32.45|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139||||139|20.07|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|GEHA [1415]|GEHA [141500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HEALTHNET [1495]|HEALTHNET [149500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139||||139|59.77|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139||||139|129.27|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139||||139|83.4|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139||||139|76.78|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139||||139|37.37|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MULTIPLAN [1680]|HMA [168003]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MULTIPLAN [1680]|IHC HS [168011]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139||||139|35.14|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|Self-pay|Self-pay|139||||139|41.7|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139||||139|29.19|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|TRUSTMARK [2030]|STARMARK [203000]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139||||139|66.65|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|UMR [2035]|UMR OPTIONS [203501]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139||||139|35.59|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139||||139|125.1|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139||||139|19.27|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139||||139|20.07|129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139||||139||129.27|19.27
30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139||||139|69.5|129.27|19.27
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|AETNA [1015]|AETNA ACO WILCO [101532]|823||||823|32.1|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|823||||823|276.49|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|823||||823|144.16|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|823||||823|144.16|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|823||||823|268.52|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|823||||823|412.32|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|823||||823|288.87|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|823||||823|353.89|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|823||||823|350.6|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|823||||823|411.5|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|823||||823|534.95|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|CORESOURCE [1315]|CORESOURCE [131500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|823||||823|25.23|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|823||||823|16.11|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|GEHA [1415]|GEHA [141500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|823||||823|609.91|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HEALTHNET [1495]|HEALTHNET [149500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|823||||823|353.89|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|823||||823|765.39|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|823||||823|493.8|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|823||||823|295.37|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|823||||823|655.46|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|823||||823|159.37|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|823||||823|365.95|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|823||||823|276.49|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MULTIPLAN [1680]|HMA [168003]|823||||823|406.61|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MULTIPLAN [1680]|IHC HS [168011]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|823||||823|149.84|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|823||||823|295.37|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|Self-pay|Self-pay|823||||823|246.9|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|823||||823|172.83|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|823||||823|265.65|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|823||||823|395.76|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|TRUSTMARK [2030]|STARMARK [203000]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|823||||823|394.63|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|UMR [2035]|UMR OPTIONS [203501]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|823||||823|151.77|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|823||||823|740.7|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|823||||823|164.53|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|823||||823|16.11|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|823||||823|271.07|765.39|16.11
30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|823||||823|411.5|765.39|16.11
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|AETNA [1015]|AETNA ACO WILCO [101532]|420||||420|47.69|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|420||||420|31.76|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|420||||420|87.64|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|420||||420|87.64|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|420||||420|31.2|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|420||||420|210.42|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|420||||420|147.42|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|420||||420|180.6|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|420||||420|178.92|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|420||||420|210|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|420||||420|273|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|CORESOURCE [1315]|CORESOURCE [131500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|420||||420|62.31|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|420||||420|38.15|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|GEHA [1415]|GEHA [141500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|420||||420|70.06|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HEALTHNET [1495]|HEALTHNET [149500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|420||||420|180.6|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|420||||420|390.6|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|420||||420|252|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|420||||420|34.32|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|420||||420|76.78|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|420||||420|96.89|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|420||||420|42.04|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|420||||420|31.76|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MULTIPLAN [1680]|HMA [168003]|420||||420|46.71|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MULTIPLAN [1680]|IHC HS [168011]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|420||||420|91.09|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|420||||420|34.32|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|Self-pay|Self-pay|420||||420|126|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|420||||420|88.2|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|420||||420|30.52|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|420||||420|45.46|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|TRUSTMARK [2030]|STARMARK [203000]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|420||||420|201.39|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|UMR [2035]|UMR OPTIONS [203501]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|420||||420|92.28|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|420||||420|378|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|420||||420|19.27|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|420||||420|38.15|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|420||||420|31.14|390.6|19.27
30286978|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ID ABSORPT DIFFERENTL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|420||||420|210|390.6|19.27
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|226||||226|34.93|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226||||226|144.16|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226||||226|144.16|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|226||||226|113.23|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226||||226|79.33|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226||||226|97.18|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|226||||226|96.28|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|226||||226|113|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226||||226|146.9|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|CORESOURCE [1315]|CORESOURCE [131500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|226||||226|28|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|226||||226|17.51|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|GEHA [1415]|GEHA [141500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HEALTHNET [1495]|HEALTHNET [149500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226||||226|97.18|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|226||||226|210.18|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226||||226|135.6|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226||||226|226|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226||||226|159.37|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MULTIPLAN [1680]|HMA [168003]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MULTIPLAN [1680]|IHC HS [168011]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|226||||226|149.84|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|Self-pay|Self-pay|226||||226|67.8|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226||||226|47.46|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|TRUSTMARK [2030]|STARMARK [203000]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226||||226|108.37|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|UMR [2035]|UMR OPTIONS [203501]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226||||226|151.77|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226||||226|203.4|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|226||||226|86.84|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|226||||226|17.51|226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|226||||226||226|17.51
30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|226||||226|113|226|17.51
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|AETNA [1015]|AETNA ACO WILCO [101532]|218||||218|7.12|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218||||218|5.22|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218||||218|5.22|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|218||||218|109.22|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218||||218|76.52|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218||||218|5.57|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|218||||218|92.87|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|218||||218|109|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218||||218|141.7|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|CORESOURCE [1315]|CORESOURCE [131500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|CORVEL CORP [2235]|CORVEL CORP [223500]|218||||218|9.3|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|218||||218|5.69|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|GEHA [1415]|GEHA [141500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HEALTHNET [1495]|HEALTHNET [149500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218||||218|5.57|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HEALTHSMART [1505]|HEALTHSMART [150501]|218||||218|202.74|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218||||218|130.8|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218||||218|109|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218||||218|5.04|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MULTIPLAN [1680]|HMA [168003]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MULTIPLAN [1680]|IHC HS [168011]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|218||||218|5.43|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|Self-pay|Self-pay|218||||218|65.4|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218||||218|45.78|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|TRUSTMARK [2030]|STARMARK [203000]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218||||218|104.53|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|UMR [2035]|UMR OPTIONS [203501]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218||||218|4.8|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218||||218|196.2|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|218||||218|3.01|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|218||||218|5.69|202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|218||||218||202.74|3.01
30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|218||||218|109|202.74|3.01
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|91||||91|5.43|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91||||91|3.88|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91||||91|4.11|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91||||91|4.11|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91||||91|45.59|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91||||91|31.94|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91||||91|4.24|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91||||91|38.77|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91||||91|45.5|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91||||91|59.15|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|CORESOURCE [1315]|CORESOURCE [131500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91||||91|5.53|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91||||91|3.39|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|GEHA [1415]|GEHA [141500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91||||91|8.55|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HEALTHNET [1495]|HEALTHNET [149500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91||||91|4.24|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91||||91|84.63|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91||||91|54.6|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91||||91|4.18|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91||||91|45.5|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91||||91|3.97|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91||||91|5.13|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91||||91|3.88|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MULTIPLAN [1680]|HMA [168003]|91||||91|5.7|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MULTIPLAN [1680]|IHC HS [168011]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91||||91|4.27|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91||||91|4.18|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|Self-pay|Self-pay|91||||91|27.3|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91||||91|19.11|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91||||91|3.72|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91||||91|5.55|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|TRUSTMARK [2030]|STARMARK [203000]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91||||91|43.63|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|UMR [2035]|UMR OPTIONS [203501]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91||||91|3.78|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91||||91|81.9|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91||||91|2.29|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91||||91|3.39|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91||||91|3.8|84.63|2.29
30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91||||91|45.5|84.63|2.29
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|AETNA [1015]|AETNA ACO WILCO [101532]|26||||26|9.96|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26||||26|7.58|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26||||26|7.58|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26||||26|13.03|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26||||26|9.13|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26||||26|7|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26||||26|11.08|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26||||26|13|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26||||26|16.9|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|CORESOURCE [1315]|CORESOURCE [131500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26||||26|6.21|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26||||26|4.35|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|GEHA [1415]|GEHA [141500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HEALTHNET [1495]|HEALTHNET [149500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26||||26|7|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26||||26|24.18|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26||||26|15.6|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26||||26|13|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26||||26|7.32|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MULTIPLAN [1680]|HMA [168003]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MULTIPLAN [1680]|IHC HS [168011]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26||||26|7.88|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|Self-pay|Self-pay|26||||26|7.8|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26||||26|5.46|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|TRUSTMARK [2030]|STARMARK [203000]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26||||26|12.47|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|UMR [2035]|UMR OPTIONS [203501]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26||||26|6.97|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26||||26|23.4|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26||||26|4.2|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26||||26|4.35|24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26||||26||24.18|4.2
30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26||||26|13|24.18|4.2
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|AETNA [1015]|AETNA ACO WILCO [101532]|101||||101|3.74|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101||||101|2.42|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101||||101|2.57|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101||||101|2.57|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|101||||101|50.6|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101||||101|35.45|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101||||101|2.93|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|101||||101|43.03|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|101||||101|50.5|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101||||101|65.65|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|CORESOURCE [1315]|CORESOURCE [131500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|101||||101|4.09|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|101||||101|2.5|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|GEHA [1415]|GEHA [141500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|101||||101|5.33|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HEALTHNET [1495]|HEALTHNET [149500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101||||101|2.93|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|101||||101|93.93|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101||||101|60.6|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101||||101|2.61|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101||||101|50.5|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101||||101|2.48|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101||||101|3.2|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101||||101|2.42|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MULTIPLAN [1680]|HMA [168003]|101||||101|3.56|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MULTIPLAN [1680]|IHC HS [168011]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|101||||101|2.67|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101||||101|2.61|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|Self-pay|Self-pay|101||||101|30.3|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101||||101|21.21|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|101||||101|2.32|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101||||101|3.46|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|TRUSTMARK [2030]|STARMARK [203000]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101||||101|48.43|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|UMR [2035]|UMR OPTIONS [203501]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101||||101|2.36|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101||||101|90.9|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|101||||101|1.58|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|101||||101|2.5|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|101||||101|2.37|93.93|1.58
30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|101||||101|50.5|93.93|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|102||||102|3.74|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102||||102|2.42|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102||||102|2.57|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102||||102|2.57|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102||||102|51.1|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102||||102|35.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102||||102|2.93|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102||||102|43.45|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102||||102|51|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102||||102|66.3|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|CORESOURCE [1315]|CORESOURCE [131500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102||||102|4.9|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102||||102|3|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|GEHA [1415]|GEHA [141500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102||||102|5.33|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HEALTHNET [1495]|HEALTHNET [149500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102||||102|2.93|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102||||102|94.86|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102||||102|61.2|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102||||102|2.61|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102||||102|51|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102||||102|2.48|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102||||102|3.2|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102||||102|2.42|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MULTIPLAN [1680]|HMA [168003]|102||||102|3.56|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MULTIPLAN [1680]|IHC HS [168011]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102||||102|2.67|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102||||102|2.61|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|Self-pay|Self-pay|102||||102|30.6|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102||||102|21.42|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102||||102|2.32|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102||||102|3.46|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|TRUSTMARK [2030]|STARMARK [203000]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102||||102|48.91|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|UMR [2035]|UMR OPTIONS [203501]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102||||102|2.36|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102||||102|91.8|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102||||102|1.58|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102||||102|3|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102||||102|2.37|94.86|1.58
30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102||||102|51|94.86|1.58
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|AETNA [1015]|AETNA ACO WILCO [101532]|237||||237|12.28|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237||||237|7.93|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237||||237|8.41|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237||||237|8.41|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|237||||237|118.74|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237||||237|83.19|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237||||237|9.59|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|237||||237|100.96|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|237||||237|118.5|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237||||237|154.05|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|CORESOURCE [1315]|CORESOURCE [131500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|237||||237|15.9|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|237||||237|9.73|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|GEHA [1415]|GEHA [141500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|237||||237|17.48|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HEALTHNET [1495]|HEALTHNET [149500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237||||237|9.59|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|237||||237|220.41|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237||||237|142.2|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237||||237|8.55|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237||||237|118.5|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237||||237|8.13|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237||||237|10.49|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237||||237|7.93|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MULTIPLAN [1680]|HMA [168003]|237||||237|11.66|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MULTIPLAN [1680]|IHC HS [168011]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|237||||237|8.74|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237||||237|8.55|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|Self-pay|Self-pay|237||||237|71.1|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237||||237|49.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|237||||237|7.61|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237||||237|11.34|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|TRUSTMARK [2030]|STARMARK [203000]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237||||237|113.64|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|UMR [2035]|UMR OPTIONS [203501]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237||||237|7.74|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237||||237|213.3|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|237||||237|5.18|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|237||||237|9.73|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|237||||237|7.77|220.41|5.18
30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|237||||237|118.5|220.41|5.18
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|10.21|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120|6.6|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|7.01|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|7.01|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|7.98|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|13.92|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|8.52|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120|14.56|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|7.98|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120|7.12|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|60|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|6.77|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120|8.73|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120|6.6|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MULTIPLAN [1680]|HMA [168003]|120||||120|9.71|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|7.29|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120|7.12|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|Self-pay|Self-pay|120||||120|36|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120|6.34|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120|9.45|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|6.44|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|4.31|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|8.52|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120|6.47|111.6|4.31
30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|4.31
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|64||||64|6.81|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64||||64|4.67|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64||||64|4.67|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64||||64|32.06|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64||||64|22.46|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64||||64|5.32|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64||||64|27.26|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64||||64|32|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64||||64|41.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64||||64|8.17|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64||||64|5|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|GEHA [1415]|GEHA [141500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64||||64|5.32|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64||||64|59.52|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64||||64|38.4|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64||||64|32|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64||||64|4.51|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MULTIPLAN [1680]|HMA [168003]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MULTIPLAN [1680]|IHC HS [168011]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64||||64|4.85|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|Self-pay|Self-pay|64||||64|19.2|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64||||64|13.44|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|TRUSTMARK [2030]|STARMARK [203000]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64||||64|30.69|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|UMR [2035]|UMR OPTIONS [203501]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64||||64|4.29|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64||||64|57.6|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64||||64|2.87|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64||||64|5|59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64||||64||59.52|2.87
30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64||||64|32|59.52|2.87
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|AETNA [1015]|AETNA ACO WILCO [101532]|66||||66|4.76|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66||||66|3.27|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66||||66|3.27|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66||||66|33.07|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66||||66|23.17|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66||||66|3.73|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66||||66|28.12|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66||||66|33|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66||||66|42.9|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|CORESOURCE [1315]|CORESOURCE [131500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66||||66|5.76|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66||||66|3.53|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|GEHA [1415]|GEHA [141500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HEALTHNET [1495]|HEALTHNET [149500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66||||66|3.73|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66||||66|61.38|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66||||66|39.6|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66||||66|33|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66||||66|3.17|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MULTIPLAN [1680]|HMA [168003]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MULTIPLAN [1680]|IHC HS [168011]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66||||66|3.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|Self-pay|Self-pay|66||||66|19.8|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66||||66|13.86|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|TRUSTMARK [2030]|STARMARK [203000]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66||||66|31.65|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|UMR [2035]|UMR OPTIONS [203501]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66||||66|3.01|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66||||66|59.4|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66||||66|2.01|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66||||66|3.53|61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66||||66||61.38|2.01
30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66||||66|33|61.38|2.01
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|AETNA [1015]|AETNA ACO WILCO [101532]|118||||118|6.32|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118||||118|4.07|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118||||118|4.32|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118||||118|4.32|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118||||118|59.12|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118||||118|41.42|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118||||118|4.93|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118||||118|50.27|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118||||118|59|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118||||118|76.7|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|CORESOURCE [1315]|CORESOURCE [131500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118||||118|6.45|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118||||118|3.95|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|GEHA [1415]|GEHA [141500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118||||118|8.98|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HEALTHNET [1495]|HEALTHNET [149500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118||||118|4.93|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118||||118|109.74|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118||||118|70.8|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118||||118|4.39|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118||||118|59|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118||||118|4.18|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118||||118|5.39|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118||||118|4.07|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MULTIPLAN [1680]|HMA [168003]|118||||118|5.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MULTIPLAN [1680]|IHC HS [168011]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118||||118|4.49|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118||||118|4.39|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|Self-pay|Self-pay|118||||118|35.4|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118||||118|24.78|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118||||118|3.91|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118||||118|5.83|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|TRUSTMARK [2030]|STARMARK [203000]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118||||118|56.58|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|UMR [2035]|UMR OPTIONS [203501]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118||||118|3.98|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118||||118|106.2|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118||||118|2.66|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118||||118|3.95|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118||||118|3.99|109.74|2.66
30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118||||118|59|109.74|2.66
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|AETNA [1015]|AETNA ACO WILCO [101532]|30||||30|4.01|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30||||30|2.59|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30||||30|2.75|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30||||30|2.75|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30||||30|15.03|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30||||30|10.53|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30||||30|3.13|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30||||30|12.78|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30||||30|15|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30||||30|19.5|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|CORESOURCE [1315]|CORESOURCE [131500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30||||30|5.98|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30||||30|3.66|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|GEHA [1415]|GEHA [141500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30||||30|5.72|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HEALTHNET [1495]|HEALTHNET [149500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30||||30|3.13|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30||||30|27.9|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30||||30|18|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30||||30|2.79|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30||||30|15|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30||||30|2.66|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30||||30|3.43|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30||||30|2.59|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MULTIPLAN [1680]|HMA [168003]|30||||30|3.81|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MULTIPLAN [1680]|IHC HS [168011]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30||||30|2.86|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30||||30|2.79|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|Self-pay|Self-pay|30||||30|9|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30||||30|6.3|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30||||30|2.49|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30||||30|3.71|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|TRUSTMARK [2030]|STARMARK [203000]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30||||30|14.39|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|UMR [2035]|UMR OPTIONS [203501]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30||||30|27|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30||||30|1.69|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30||||30|3.66|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30||||30|2.54|27.9|1.69
30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30||||30|15|27.9|1.69
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|AETNA [1015]|AETNA ACO WILCO [101532]|133||||133|7.07|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133||||133|4.57|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133||||133|4.85|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133||||133|4.85|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|133||||133|66.63|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133||||133|46.68|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133||||133|5.53|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|133||||133|56.66|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|133||||133|66.5|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133||||133|86.45|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|CORESOURCE [1315]|CORESOURCE [131500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|133||||133|8.17|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|133||||133|5|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|GEHA [1415]|GEHA [141500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|133||||133|10.08|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HEALTHNET [1495]|HEALTHNET [149500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133||||133|5.53|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|133||||133|123.69|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133||||133|79.8|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133||||133|4.93|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133||||133|66.5|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133||||133|4.68|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133||||133|6.05|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133||||133|4.57|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MULTIPLAN [1680]|HMA [168003]|133||||133|6.72|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MULTIPLAN [1680]|IHC HS [168011]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|133||||133|5.04|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133||||133|4.93|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|Self-pay|Self-pay|133||||133|39.9|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133||||133|27.93|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|133||||133|4.39|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133||||133|6.54|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|TRUSTMARK [2030]|STARMARK [203000]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133||||133|63.77|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|UMR [2035]|UMR OPTIONS [203501]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133||||133|4.46|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133||||133|119.7|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|133||||133|2.98|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|133||||133|5|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|133||||133|4.48|123.69|2.98
30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|133||||133|66.5|123.69|2.98
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|755||||755|71.68|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|755||||755|615.86|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|755||||755|66.48|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|755||||755|66.48|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|755||||755|604.93|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|755||||755|378.26|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|755||||755|265.01|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|755||||755|324.65|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|755||||755|321.63|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|755||||755|377.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|755||||755|490.75|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|CORESOURCE [1315]|CORESOURCE [131500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|755||||755|92.97|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|755||||755|56.92|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|GEHA [1415]|GEHA [141500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|755||||755|755|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HEALTHNET [1495]|HEALTHNET [149500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|755||||755|324.65|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|755||||755|702.15|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|755||||755|453|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|755||||755|665.42|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|755||||755|755|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|755||||755|71.37|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|755||||755|755|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|755||||755|615.86|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MULTIPLAN [1680]|HMA [168003]|755||||755|755|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MULTIPLAN [1680]|IHC HS [168011]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|755||||755|69.1|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|755||||755|665.42|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|Self-pay|Self-pay|755||||755|226.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|755||||755|158.55|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|755||||755|591.71|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|755||||755|755|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|TRUSTMARK [2030]|STARMARK [203000]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|755||||755|362.02|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|UMR [2035]|UMR OPTIONS [203501]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|755||||755|67.97|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|755||||755|679.5|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|755||||755|334.87|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|755||||755|56.92|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|755||||755|603.79|755|56.92
30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|755||||755|377.5|755|56.92
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|AETNA [1015]|AETNA ACO WILCO [101532]|917||||917|20.53|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|917||||917|13.24|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|917||||917|14.06|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|917||||917|14.06|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|917||||917|459.42|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|917||||917|321.87|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|917||||917|16.03|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|917||||917|390.64|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|917||||917|458.5|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|917||||917|596.05|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|CORESOURCE [1315]|CORESOURCE [131500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|CORVEL CORP [2235]|CORVEL CORP [223500]|917||||917|26.23|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|917||||917|16.06|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|GEHA [1415]|GEHA [141500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|917||||917|29.21|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HEALTHNET [1495]|HEALTHNET [149500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|917||||917|16.03|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HEALTHSMART [1505]|HEALTHSMART [150501]|917||||917|852.81|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|917||||917|550.2|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|917||||917|14.28|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|917||||917|458.5|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|917||||917|13.58|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|917||||917|17.52|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|917||||917|13.24|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MULTIPLAN [1680]|HMA [168003]|917||||917|19.47|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MULTIPLAN [1680]|IHC HS [168011]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|917||||917|14.61|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|917||||917|14.28|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|Self-pay|Self-pay|917||||917|275.1|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|917||||917|192.57|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|917||||917|12.72|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|917||||917|18.95|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|TRUSTMARK [2030]|STARMARK [203000]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|917||||917|439.7|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|UMR [2035]|UMR OPTIONS [203501]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|917||||917|12.93|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|917||||917|825.3|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|917||||917|8.66|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|917||||917|16.06|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|917||||917|12.98|852.81|8.66
30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|917||||917|458.5|852.81|8.66
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|222||||222|27.89|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222||||222|19.12|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222||||222|19.12|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|222||||222|111.22|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222||||222|77.92|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222||||222|21.79|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|222||||222|94.57|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|222||||222|111|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222||||222|144.3|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|CORESOURCE [1315]|CORESOURCE [131500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|222||||222|39.14|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|222||||222|23.96|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|GEHA [1415]|GEHA [141500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HEALTHNET [1495]|HEALTHNET [149500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222||||222|21.79|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|222||||222|206.46|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222||||222|133.2|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222||||222|111|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222||||222|18.47|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MULTIPLAN [1680]|HMA [168003]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MULTIPLAN [1680]|IHC HS [168011]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|222||||222|19.87|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|Self-pay|Self-pay|222||||222|66.6|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222||||222|46.62|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|TRUSTMARK [2030]|STARMARK [203000]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222||||222|106.45|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|UMR [2035]|UMR OPTIONS [203501]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222||||222|17.59|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222||||222|199.8|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|222||||222|11.77|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|222||||222|23.96|206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|222||||222||206.46|11.77
30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|222||||222|111|206.46|11.77
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|AETNA [1015]|AETNA ACO WILCO [101532]|681||||681|28.29|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|681||||681|18.26|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|681||||681|19.4|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|681||||681|19.4|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|681||||681|341.18|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|681||||681|239.03|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|681||||681|22.1|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|681||||681|290.11|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|681||||681|340.5|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|681||||681|442.65|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|CORESOURCE [1315]|CORESOURCE [131500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|CORVEL CORP [2235]|CORVEL CORP [223500]|681||||681|39.14|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|681||||681|23.96|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|GEHA [1415]|GEHA [141500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|681||||681|40.28|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HEALTHNET [1495]|HEALTHNET [149500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|681||||681|22.1|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HEALTHSMART [1505]|HEALTHSMART [150501]|681||||681|633.33|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|681||||681|408.6|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|681||||681|19.69|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|681||||681|340.5|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|681||||681|18.74|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|681||||681|24.17|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|681||||681|18.26|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MULTIPLAN [1680]|HMA [168003]|681||||681|26.85|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MULTIPLAN [1680]|IHC HS [168011]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|681||||681|20.16|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|681||||681|19.69|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|Self-pay|Self-pay|681||||681|204.3|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|681||||681|143.01|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|681||||681|17.54|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|681||||681|26.13|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|TRUSTMARK [2030]|STARMARK [203000]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|681||||681|326.54|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|UMR [2035]|UMR OPTIONS [203501]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|681||||681|17.85|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|681||||681|612.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|681||||681|11.93|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|681||||681|23.96|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|681||||681|17.9|633.33|11.93
30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|681||||681|340.5|633.33|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|AETNA [1015]|AETNA ACO WILCO [101532]|527||||527|28.29|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|527||||527|18.26|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|527||||527|19.4|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|527||||527|19.4|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|527||||527|264.03|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|527||||527|184.98|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|527||||527|22.1|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|527||||527|224.5|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|527||||527|263.5|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|527||||527|342.55|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|CORESOURCE [1315]|CORESOURCE [131500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|527||||527|39.45|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|527||||527|24.16|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|GEHA [1415]|GEHA [141500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|527||||527|40.28|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HEALTHNET [1495]|HEALTHNET [149500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|527||||527|22.1|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|527||||527|490.11|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|527||||527|316.2|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|527||||527|19.69|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|527||||527|263.5|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|527||||527|18.74|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|527||||527|24.17|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|527||||527|18.26|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MULTIPLAN [1680]|HMA [168003]|527||||527|26.85|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MULTIPLAN [1680]|IHC HS [168011]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|527||||527|20.16|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|527||||527|19.69|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|Self-pay|Self-pay|527||||527|158.1|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|527||||527|110.67|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|527||||527|17.54|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|527||||527|26.13|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|TRUSTMARK [2030]|STARMARK [203000]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|527||||527|252.7|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|UMR [2035]|UMR OPTIONS [203501]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|527||||527|17.85|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|527||||527|474.3|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|527||||527|11.93|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|527||||527|24.16|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|527||||527|17.9|490.11|11.93
30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|527||||527|263.5|490.11|11.93
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|AETNA [1015]|AETNA ACO WILCO [101532]|92||||92|32.28|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92||||92|22.12|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92||||92|22.12|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|92||||92|46.09|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92||||92|32.29|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92||||92|25.21|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|92||||92|39.19|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|92||||92|46|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92||||92|59.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|CORESOURCE [1315]|CORESOURCE [131500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|92||||92|41.54|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|92||||92|25.43|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|GEHA [1415]|GEHA [141500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HEALTHNET [1495]|HEALTHNET [149500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92||||92|25.21|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|92||||92|85.56|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92||||92|55.2|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92||||92|46|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92||||92|21.36|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MULTIPLAN [1680]|HMA [168003]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MULTIPLAN [1680]|IHC HS [168011]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|92||||92|22.99|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|Self-pay|Self-pay|92||||92|27.6|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92||||92|19.32|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|TRUSTMARK [2030]|STARMARK [203000]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92||||92|44.11|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|UMR [2035]|UMR OPTIONS [203501]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92||||92|20.34|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92||||92|82.8|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|92||||92|13.61|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|92||||92|25.43|85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|92||||92||85.56|13.61
30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|92||||92|46|85.56|13.61
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|505||||505|36.25|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|505||||505|23.4|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|505||||505|24.85|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|505||||505|24.85|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|505||||505|253.01|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|505||||505|177.26|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|505||||505|28.32|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|505||||505|215.13|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|505||||505|252.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|505||||505|328.25|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|CORESOURCE [1315]|CORESOURCE [131500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|505||||505|45.25|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|505||||505|27.71|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|GEHA [1415]|GEHA [141500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|505||||505|51.62|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HEALTHNET [1495]|HEALTHNET [149500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|505||||505|28.32|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|505||||505|469.65|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|505||||505|303|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|505||||505|25.23|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|505||||505|252.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|505||||505|24|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|505||||505|30.97|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|505||||505|23.4|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MULTIPLAN [1680]|HMA [168003]|505||||505|34.41|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MULTIPLAN [1680]|IHC HS [168011]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|505||||505|25.83|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|505||||505|25.23|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|Self-pay|Self-pay|505||||505|151.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|505||||505|106.05|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|505||||505|22.48|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|505||||505|33.49|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|TRUSTMARK [2030]|STARMARK [203000]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|505||||505|242.15|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|UMR [2035]|UMR OPTIONS [203501]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|505||||505|22.86|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|505||||505|454.5|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|505||||505|15.29|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|505||||505|27.71|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|505||||505|22.94|469.65|15.29
30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|505||||505|252.5|469.65|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|AETNA [1015]|AETNA ACO WILCO [101532]|1028||||1028|36.25|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1028||||1028|23.4|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1028||||1028|24.85|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1028||||1028|24.85|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1028||||1028|515.03|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1028||||1028|360.83|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1028||||1028|28.32|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1028||||1028|437.93|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1028||||1028|514|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1028||||1028|668.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|CORESOURCE [1315]|CORESOURCE [131500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1028||||1028|45.25|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1028||||1028|27.71|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|GEHA [1415]|GEHA [141500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1028||||1028|51.62|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HEALTHNET [1495]|HEALTHNET [149500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1028||||1028|28.32|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1028||||1028|956.04|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1028||||1028|616.8|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1028||||1028|25.23|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1028||||1028|514|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1028||||1028|24|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1028||||1028|30.97|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1028||||1028|23.4|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MULTIPLAN [1680]|HMA [168003]|1028||||1028|34.41|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MULTIPLAN [1680]|IHC HS [168011]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1028||||1028|25.83|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1028||||1028|25.23|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|Self-pay|Self-pay|1028||||1028|308.4|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1028||||1028|215.88|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1028||||1028|22.48|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1028||||1028|33.49|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|TRUSTMARK [2030]|STARMARK [203000]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1028||||1028|492.93|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|UMR [2035]|UMR OPTIONS [203501]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1028||||1028|22.86|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1028||||1028|925.2|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1028||||1028|15.29|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1028||||1028|27.71|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1028||||1028|22.94|956.04|15.29
30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1028||||1028|514|956.04|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|294||||294|36.25|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|294||||294|23.4|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|294||||294|24.85|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|294||||294|24.85|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|294||||294|147.29|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|294||||294|103.19|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|294||||294|28.32|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|294||||294|125.24|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|294||||294|147|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|294||||294|191.1|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|CORESOURCE [1315]|CORESOURCE [131500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|294||||294|45.25|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|294||||294|27.71|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|GEHA [1415]|GEHA [141500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|294||||294|51.62|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HEALTHNET [1495]|HEALTHNET [149500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|294||||294|28.32|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|294||||294|273.42|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|294||||294|176.4|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|294||||294|25.23|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|294||||294|147|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|294||||294|24|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|294||||294|30.97|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|294||||294|23.4|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MULTIPLAN [1680]|HMA [168003]|294||||294|34.41|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MULTIPLAN [1680]|IHC HS [168011]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|294||||294|25.83|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|294||||294|25.23|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|Self-pay|Self-pay|294||||294|88.2|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|294||||294|61.74|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|294||||294|22.48|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|294||||294|33.49|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|TRUSTMARK [2030]|STARMARK [203000]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|294||||294|140.97|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|UMR [2035]|UMR OPTIONS [203501]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|294||||294|22.86|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|294||||294|264.6|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|294||||294|15.29|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|294||||294|27.71|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|294||||294|22.94|273.42|15.29
30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETRIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|294||||294|147|273.42|15.29
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|AETNA [1015]|AETNA ACO WILCO [101532]|460||||460|30.09|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|460||||460|19.42|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|460||||460|20.63|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|460||||460|20.63|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|460||||460|230.46|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|460||||460|161.46|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|460||||460|23.51|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|460||||460|195.96|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|460||||460|230|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|460||||460|299|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|CORESOURCE [1315]|CORESOURCE [131500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|460||||460|39.77|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|460||||460|24.35|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|GEHA [1415]|GEHA [141500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|460||||460|42.84|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HEALTHNET [1495]|HEALTHNET [149500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|460||||460|23.51|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|460||||460|427.8|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|460||||460|276|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|460||||460|20.94|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|460||||460|230|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|460||||460|19.93|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|460||||460|25.7|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|460||||460|19.42|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MULTIPLAN [1680]|HMA [168003]|460||||460|28.56|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MULTIPLAN [1680]|IHC HS [168011]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|460||||460|21.44|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|460||||460|20.94|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|Self-pay|Self-pay|460||||460|138|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|460||||460|96.6|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|460||||460|18.66|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|460||||460|27.8|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|TRUSTMARK [2030]|STARMARK [203000]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|460||||460|220.57|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|UMR [2035]|UMR OPTIONS [203501]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|460||||460|18.98|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|460||||460|414|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|460||||460|12.7|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|460||||460|24.35|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|460||||460|19.04|427.8|12.7
30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|460||||460|230|427.8|12.7
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|AETNA [1015]|AETNA ACO WILCO [101532]|280||||280|28.29|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|280||||280|18.26|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|280||||280|19.4|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|280||||280|19.4|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|280||||280|140.28|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|280||||280|98.28|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|280||||280|22.1|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|280||||280|119.28|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|280||||280|140|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|280||||280|182|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|CORESOURCE [1315]|CORESOURCE [131500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|280||||280|39.77|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|280||||280|24.35|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|GEHA [1415]|GEHA [141500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|280||||280|40.28|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HEALTHNET [1495]|HEALTHNET [149500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|280||||280|22.1|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|280||||280|260.4|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280||||280|168|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|280||||280|19.69|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|280||||280|140|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|280||||280|18.74|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|280||||280|24.17|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|280||||280|18.26|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MULTIPLAN [1680]|HMA [168003]|280||||280|26.85|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MULTIPLAN [1680]|IHC HS [168011]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|280||||280|20.16|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|280||||280|19.69|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|Self-pay|Self-pay|280||||280|84|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|280||||280|58.8|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|280||||280|17.54|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|280||||280|26.13|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|TRUSTMARK [2030]|STARMARK [203000]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|280||||280|134.26|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|UMR [2035]|UMR OPTIONS [203501]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|280||||280|17.85|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|280||||280|252|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|280||||280|11.93|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|280||||280|24.35|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|280||||280|17.9|260.4|11.93
30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|280||||280|140|260.4|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|28.29|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|19.4|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|19.4|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|22.1|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|39.77|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|24.35|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|22.1|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|18.74|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MULTIPLAN [1680]|HMA [168003]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|20.16|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|Self-pay|Self-pay|374||||374|112.2|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|17.85|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|11.93|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|24.35|347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374||347.82|11.93
30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|11.93
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|AETNA [1015]|AETNA ACO WILCO [101532]|403||||403|30.59|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|403||||403|20.97|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|403||||403|20.97|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|403||||403|201.9|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|403||||403|141.45|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|403||||403|23.89|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|403||||403|171.68|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|403||||403|201.5|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|403||||403|261.95|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|CORESOURCE [1315]|CORESOURCE [131500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|CORVEL CORP [2235]|CORVEL CORP [223500]|403||||403|39.77|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|403||||403|24.35|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|GEHA [1415]|GEHA [141500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HEALTHNET [1495]|HEALTHNET [149500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|403||||403|23.89|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HEALTHSMART [1505]|HEALTHSMART [150501]|403||||403|374.79|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|403||||403|241.8|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|403||||403|201.5|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|403||||403|20.25|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MULTIPLAN [1680]|HMA [168003]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MULTIPLAN [1680]|IHC HS [168011]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|403||||403|21.8|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|Self-pay|Self-pay|403||||403|120.9|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|403||||403|84.63|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|TRUSTMARK [2030]|STARMARK [203000]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|403||||403|193.24|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|UMR [2035]|UMR OPTIONS [203501]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|403||||403|19.28|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|403||||403|362.7|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|403||||403|12.9|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|403||||403|24.35|374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|403||||403||374.79|12.9
30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|403||||403|201.5|374.79|12.9
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|AETNA [1015]|AETNA ACO WILCO [101532]|243||||243|25.82|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|243||||243|17.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|243||||243|17.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|243||||243|121.74|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|243||||243|85.29|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|243||||243|20.17|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|243||||243|103.52|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|243||||243|121.5|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|243||||243|157.95|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|CORESOURCE [1315]|CORESOURCE [131500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|CORVEL CORP [2235]|CORVEL CORP [223500]|243||||243|38.5|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|243||||243|23.57|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|GEHA [1415]|GEHA [141500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HEALTHNET [1495]|HEALTHNET [149500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|243||||243|20.17|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HEALTHSMART [1505]|HEALTHSMART [150501]|243||||243|225.99|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|243||||243|145.8|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|243||||243|121.5|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|243||||243|17.1|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MULTIPLAN [1680]|HMA [168003]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MULTIPLAN [1680]|IHC HS [168011]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|243||||243|18.4|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|Self-pay|Self-pay|243||||243|72.9|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|243||||243|51.03|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|TRUSTMARK [2030]|STARMARK [203000]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|243||||243|116.52|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|UMR [2035]|UMR OPTIONS [203501]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|243||||243|16.29|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|243||||243|218.7|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|243||||243|10.89|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|243||||243|23.57|225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|243||||243||225.99|10.89
30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|243||||243|121.5|225.99|10.89
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|280||||280|29.93|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|280||||280|20.5|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|280||||280|20.5|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|280||||280|140.28|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|280||||280|98.28|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|280||||280|23.37|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|280||||280|119.28|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|280||||280|140|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|280||||280|182|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|280||||280|41.12|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|280||||280|25.17|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|GEHA [1415]|GEHA [141500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|280||||280|23.37|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|280||||280|260.4|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280||||280|168|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|280||||280|140|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|280||||280|19.81|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MULTIPLAN [1680]|HMA [168003]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|280||||280|21.31|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|Self-pay|Self-pay|280||||280|84|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|280||||280|58.8|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|280||||280|134.26|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|280||||280|18.87|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|280||||280|252|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|280||||280|12.62|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|280||||280|25.17|260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|280||||280||260.4|12.62
30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|280||||280|140|260.4|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|300||||300|29.93|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300||||300|20.5|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300||||300|20.5|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|300||||300|150.3|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300||||300|105.3|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300||||300|23.37|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|300||||300|127.8|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|300||||300|150|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300||||300|195|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|300||||300|41.12|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|300||||300|25.17|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|GEHA [1415]|GEHA [141500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300||||300|23.37|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|300||||300|279|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300||||300|180|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300||||300|150|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300||||300|19.81|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MULTIPLAN [1680]|HMA [168003]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|300||||300|21.31|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|Self-pay|Self-pay|300||||300|90|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300||||300|63|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|300||||300|143.85|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300||||300|18.87|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|300||||300|270|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|300||||300|12.62|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|300||||300|25.17|279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|300||||300||279|12.62
30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|300||||300|150|279|12.62
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|539||||539|18.74|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|539||||539|12.09|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|539||||539|12.84|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|539||||539|12.84|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|539||||539|270.04|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|539||||539|189.19|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|539||||539|14.63|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|539||||539|229.61|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|539||||539|269.5|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|539||||539|350.35|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|CORESOURCE [1315]|CORESOURCE [131500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|539||||539|27.89|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|539||||539|17.08|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|GEHA [1415]|GEHA [141500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|539||||539|26.66|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HEALTHNET [1495]|HEALTHNET [149500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|539||||539|14.63|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|539||||539|501.27|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|539||||539|323.4|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|539||||539|13.04|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|539||||539|269.5|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|539||||539|12.4|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|539||||539|16|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|539||||539|12.09|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MULTIPLAN [1680]|HMA [168003]|539||||539|17.78|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MULTIPLAN [1680]|IHC HS [168011]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|539||||539|13.35|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|539||||539|13.04|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|Self-pay|Self-pay|539||||539|161.7|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|539||||539|113.19|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|539||||539|11.61|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|539||||539|17.3|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|TRUSTMARK [2030]|STARMARK [203000]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|539||||539|258.45|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|UMR [2035]|UMR OPTIONS [203501]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|539||||539|11.81|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|539||||539|485.1|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|539||||539|7.9|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|539||||539|17.08|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|539||||539|11.85|501.27|7.9
30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|539||||539|269.5|501.27|7.9
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|428||||428|18.98|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|428||||428|12.25|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|428||||428|13.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|428||||428|13.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|428||||428|214.43|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|428||||428|150.23|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|428||||428|14.83|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|428||||428|182.33|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|428||||428|214|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|428||||428|278.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|428||||428|30.99|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|428||||428|18.98|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|GEHA [1415]|GEHA [141500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|428||||428|27.02|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|428||||428|14.83|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|428||||428|398.04|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|428||||428|256.8|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|428||||428|13.21|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|428||||428|214|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|428||||428|12.57|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|428||||428|16.21|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|428||||428|12.25|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MULTIPLAN [1680]|HMA [168003]|428||||428|18.02|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MULTIPLAN [1680]|IHC HS [168011]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|428||||428|13.52|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|428||||428|13.21|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|Self-pay|Self-pay|428||||428|128.4|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|428||||428|89.88|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|428||||428|11.77|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|428||||428|17.53|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|TRUSTMARK [2030]|STARMARK [203000]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|428||||428|205.23|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|UMR [2035]|UMR OPTIONS [203501]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|428||||428|11.97|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|428||||428|385.2|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|428||||428|8.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|428||||428|18.98|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|428||||428|12.01|398.04|8.01
30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|428||||428|214|398.04|8.01
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|648||||648|21.86|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|648||||648|14.12|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|648||||648|15|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|648||||648|15|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|648||||648|324.65|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|648||||648|227.45|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|648||||648|17.08|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|648||||648|276.05|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|648||||648|324|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|648||||648|421.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|CORESOURCE [1315]|CORESOURCE [131500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|648||||648|25.07|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|648||||648|15.35|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|GEHA [1415]|GEHA [141500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|648||||648|31.14|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HEALTHNET [1495]|HEALTHNET [149500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|648||||648|17.08|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|648||||648|602.64|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|648||||648|388.8|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|648||||648|15.22|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|648||||648|324|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|648||||648|14.48|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|648||||648|18.68|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|648||||648|14.12|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MULTIPLAN [1680]|HMA [168003]|648||||648|20.76|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MULTIPLAN [1680]|IHC HS [168011]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|648||||648|15.59|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|648||||648|15.22|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|Self-pay|Self-pay|648||||648|194.4|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|648||||648|136.08|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|648||||648|13.56|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|648||||648|20.21|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|TRUSTMARK [2030]|STARMARK [203000]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|648||||648|310.72|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|UMR [2035]|UMR OPTIONS [203501]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|648||||648|13.79|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|648||||648|583.2|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|648||||648|9.22|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|648||||648|15.35|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|648||||648|13.84|602.64|9.22
30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|648||||648|324|602.64|9.22
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|492||||492|18.35|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|492||||492|11.84|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|492||||492|12.57|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|492||||492|12.57|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|492||||492|246.49|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|492||||492|172.69|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|492||||492|14.33|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|492||||492|209.59|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|492||||492|246|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|492||||492|319.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|492||||492|23.13|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|492||||492|14.16|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|GEHA [1415]|GEHA [141500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|492||||492|26.12|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|492||||492|14.33|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|492||||492|457.56|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|492||||492|295.2|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|492||||492|12.77|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|492||||492|246|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|492||||492|12.15|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|492||||492|15.67|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|492||||492|11.84|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MULTIPLAN [1680]|HMA [168003]|492||||492|17.42|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|492||||492|13.06|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|492||||492|12.77|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|Self-pay|Self-pay|492||||492|147.6|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|492||||492|103.32|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|492||||492|11.38|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|492||||492|16.95|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|492||||492|235.91|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|492||||492|11.57|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|492||||492|442.8|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|492||||492|7.74|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|492||||492|14.16|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|492||||492|11.61|457.56|7.74
30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|492||||492|246|457.56|7.74
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|896||||896|24.23|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|896||||896|15.63|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|896||||896|16.6|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|896||||896|16.6|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|896||||896|448.9|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|896||||896|314.5|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|896||||896|18.92|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|896||||896|381.7|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|896||||896|448|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|896||||896|582.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|896||||896|27.29|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|896||||896|16.71|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|GEHA [1415]|GEHA [141500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|896||||896|34.47|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|896||||896|18.92|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|896||||896|833.28|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|896||||896|537.6|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|896||||896|16.85|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|896||||896|448|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|896||||896|16.03|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|896||||896|20.68|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|896||||896|15.63|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MULTIPLAN [1680]|HMA [168003]|896||||896|22.98|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MULTIPLAN [1680]|IHC HS [168011]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|896||||896|17.25|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|896||||896|16.85|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|Self-pay|Self-pay|896||||896|268.8|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|896||||896|188.16|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|896||||896|15.01|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|896||||896|22.37|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|TRUSTMARK [2030]|STARMARK [203000]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|896||||896|429.63|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|UMR [2035]|UMR OPTIONS [203501]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|896||||896|15.27|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|896||||896|806.4|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|896||||896|10.22|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|896||||896|16.71|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|896||||896|15.32|833.28|10.22
30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|896||||896|448|833.28|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|260||||260|24.23|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260||||260|15.63|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260||||260|16.6|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260||||260|16.6|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|260||||260|130.26|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260||||260|91.26|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260||||260|18.92|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|260||||260|110.76|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|260||||260|130|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260||||260|169|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|260||||260|26.75|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|260||||260|16.38|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|GEHA [1415]|GEHA [141500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|260||||260|34.47|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260||||260|18.92|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|260||||260|241.8|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260||||260|156|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260||||260|16.85|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260||||260|130|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260||||260|16.03|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260||||260|20.68|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260||||260|15.63|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MULTIPLAN [1680]|HMA [168003]|260||||260|22.98|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|260||||260|17.25|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260||||260|16.85|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|Self-pay|Self-pay|260||||260|78|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260||||260|54.6|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|260||||260|15.01|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260||||260|22.37|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260||||260|124.67|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260||||260|15.27|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260||||260|234|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|260||||260|10.22|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|260||||260|16.38|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|260||||260|15.32|241.8|10.22
30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|260||||260|130|241.8|10.22
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|AETNA [1015]|AETNA ACO WILCO [101532]|217||||217|20.34|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|217||||217|13.13|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|217||||217|13.95|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|217||||217|13.95|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|217||||217|108.72|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|217||||217|76.17|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|217||||217|15.89|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|217||||217|92.44|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|217||||217|108.5|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|217||||217|141.05|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|CORESOURCE [1315]|CORESOURCE [131500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|217||||217|21.98|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|217||||217|13.46|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|GEHA [1415]|GEHA [141500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|217||||217|28.96|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HEALTHNET [1495]|HEALTHNET [149500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|217||||217|15.89|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|217||||217|201.81|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|217||||217|130.2|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|217||||217|14.16|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|217||||217|108.5|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|217||||217|13.47|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|217||||217|17.37|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|217||||217|13.13|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MULTIPLAN [1680]|HMA [168003]|217||||217|19.31|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MULTIPLAN [1680]|IHC HS [168011]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|217||||217|14.5|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|217||||217|14.16|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|Self-pay|Self-pay|217||||217|65.1|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|217||||217|45.57|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|217||||217|12.61|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|217||||217|18.79|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|TRUSTMARK [2030]|STARMARK [203000]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|217||||217|104.05|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|UMR [2035]|UMR OPTIONS [203501]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|217||||217|12.83|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|217||||217|195.3|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|217||||217|8.58|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|217||||217|13.46|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|217||||217|12.87|201.81|8.58
30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|217||||217|108.5|201.81|8.58
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|6.73|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120|4.37|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|4.63|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|4.63|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|5.26|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|7.14|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|4.37|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120|9.63|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|5.26|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120|4.71|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|60|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|4.47|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120|5.78|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120|4.37|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MULTIPLAN [1680]|HMA [168003]|120||||120|6.42|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|4.81|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120|4.71|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|Self-pay|Self-pay|120||||120|36|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120|4.19|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120|6.25|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|4.26|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|2.84|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|4.37|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120|4.28|111.6|2.84
30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|2.84
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|125||||125|13.28|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125||||125|9.12|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125||||125|9.12|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|125||||125|62.63|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125||||125|43.88|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125||||125|10.38|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|125||||125|53.25|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|125||||125|62.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125||||125|81.25|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|CORESOURCE [1315]|CORESOURCE [131500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|125||||125|15.75|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|125||||125|9.64|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|GEHA [1415]|GEHA [141500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HEALTHNET [1495]|HEALTHNET [149500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125||||125|10.38|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|125||||125|116.25|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125||||125|75|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125||||125|62.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125||||125|8.81|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MULTIPLAN [1680]|HMA [168003]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MULTIPLAN [1680]|IHC HS [168011]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|125||||125|9.48|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|Self-pay|Self-pay|125||||125|37.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125||||125|26.25|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|TRUSTMARK [2030]|STARMARK [203000]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125||||125|59.94|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|UMR [2035]|UMR OPTIONS [203501]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125||||125|8.39|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125||||125|112.5|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|125||||125|5.6|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|125||||125|9.64|116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|125||||125||116.25|5.6
30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|125||||125|62.5|116.25|5.6
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|419||||419|10.89|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|419||||419|7.47|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|419||||419|7.47|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|419||||419|209.92|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|419||||419|147.07|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|419||||419|8.51|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|419||||419|178.49|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|419||||419|209.5|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|419||||419|272.35|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|CORESOURCE [1315]|CORESOURCE [131500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|419||||419|16.01|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|419||||419|9.8|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|GEHA [1415]|GEHA [141500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HEALTHNET [1495]|HEALTHNET [149500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|419||||419|8.51|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|419||||419|389.67|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|419||||419|251.4|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|419||||419|209.5|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|419||||419|7.21|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MULTIPLAN [1680]|HMA [168003]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MULTIPLAN [1680]|IHC HS [168011]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|419||||419|7.76|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|Self-pay|Self-pay|419||||419|125.7|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|419||||419|87.99|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|TRUSTMARK [2030]|STARMARK [203000]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|419||||419|200.91|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|UMR [2035]|UMR OPTIONS [203501]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|419||||419|6.87|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|419||||419|377.1|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|419||||419|4.59|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|419||||419|9.8|389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|419||||419||389.67|4.59
30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|419||||419|209.5|389.67|4.59
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|177||||177|13.82|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177||||177|10.53|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177||||177|10.53|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|177||||177|88.68|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177||||177|62.13|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177||||177|9.72|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|177||||177|75.4|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|177||||177|88.5|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177||||177|115.05|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|CORESOURCE [1315]|CORESOURCE [131500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|177||||177|11.82|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|177||||177|7.24|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|GEHA [1415]|GEHA [141500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HEALTHNET [1495]|HEALTHNET [149500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177||||177|9.72|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|177||||177|164.61|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177||||177|106.2|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177||||177|88.5|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177||||177|10.17|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MULTIPLAN [1680]|HMA [168003]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MULTIPLAN [1680]|IHC HS [168011]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|177||||177|10.94|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|Self-pay|Self-pay|177||||177|53.1|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177||||177|37.17|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|TRUSTMARK [2030]|STARMARK [203000]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177||||177|84.87|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|UMR [2035]|UMR OPTIONS [203501]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177||||177|9.69|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177||||177|159.3|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|177||||177|5.83|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|177||||177|7.24|164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|177||||177||164.61|5.83
30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|177||||177|88.5|164.61|5.83
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|252||||252|16.08|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|252||||252|10.38|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|252||||252|11.03|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|252||||252|11.03|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|252||||252|126.25|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|252||||252|88.45|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|252||||252|12.56|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|252||||252|107.35|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|252||||252|126|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|252||||252|163.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|CORESOURCE [1315]|CORESOURCE [131500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|252||||252|15.45|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|252||||252|9.46|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|GEHA [1415]|GEHA [141500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|252||||252|22.91|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HEALTHNET [1495]|HEALTHNET [149500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|252||||252|12.56|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|252||||252|234.36|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|252||||252|151.2|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|252||||252|11.2|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|252||||252|126|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|252||||252|10.65|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|252||||252|13.74|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|252||||252|10.38|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MULTIPLAN [1680]|HMA [168003]|252||||252|15.27|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MULTIPLAN [1680]|IHC HS [168011]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|252||||252|11.46|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|252||||252|11.2|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|Self-pay|Self-pay|252||||252|75.6|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|252||||252|52.92|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|252||||252|9.98|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|252||||252|14.86|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|TRUSTMARK [2030]|STARMARK [203000]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|252||||252|120.83|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|UMR [2035]|UMR OPTIONS [203501]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|252||||252|10.14|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|252||||252|226.8|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|252||||252|6.79|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|252||||252|9.46|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|252||||252|10.18|234.36|6.79
30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|252||||252|126|234.36|6.79
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|290||||290|13.82|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|290||||290|9.91|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|290||||290|10.53|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|290||||290|10.53|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|290||||290|145.29|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|290||||290|101.79|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|290||||290|10.49|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|290||||290|123.54|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|290||||290|145|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|290||||290|188.5|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|CORESOURCE [1315]|CORESOURCE [131500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|290||||290|14.21|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|290||||290|8.7|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|GEHA [1415]|GEHA [141500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|290||||290|21.87|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HEALTHNET [1495]|HEALTHNET [149500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|290||||290|10.49|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|290||||290|269.7|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|290||||290|174|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|290||||290|10.69|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|290||||290|145|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|290||||290|10.17|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|290||||290|13.12|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|290||||290|9.91|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MULTIPLAN [1680]|HMA [168003]|290||||290|14.58|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MULTIPLAN [1680]|IHC HS [168011]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|290||||290|10.94|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|290||||290|10.69|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|Self-pay|Self-pay|290||||290|87|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|290||||290|60.9|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|290||||290|9.53|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|290||||290|14.19|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|TRUSTMARK [2030]|STARMARK [203000]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|290||||290|139.06|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|UMR [2035]|UMR OPTIONS [203501]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|290||||290|9.69|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|290||||290|261|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|290||||290|5.83|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|290||||290|8.7|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|290||||290|9.72|269.7|5.83
30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|290||||290|145|269.7|5.83
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|126||||126|20.56|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126||||126|15.66|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126||||126|15.66|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|126||||126|63.13|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126||||126|44.23|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126||||126|14.46|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|126||||126|53.68|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|126||||126|63|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126||||126|81.9|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|126||||126|14.21|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|126||||126|9.35|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|GEHA [1415]|GEHA [141500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126||||126|14.46|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|126||||126|117.18|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126||||126|75.6|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126||||126|63|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126||||126|15.13|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MULTIPLAN [1680]|HMA [168003]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MULTIPLAN [1680]|IHC HS [168011]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|126||||126|16.28|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|Self-pay|Self-pay|126||||126|37.8|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126||||126|26.46|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|TRUSTMARK [2030]|STARMARK [203000]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126||||126|60.42|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|UMR [2035]|UMR OPTIONS [203501]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126||||126|14.41|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126||||126|113.4|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|126||||126|8.68|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|126||||126|9.35|117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|126||||126||117.18|8.68
30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|126||||126|63|117.18|8.68
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|AETNA [1015]|AETNA ACO WILCO [101532]|364||||364|43.89|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|364||||364|33.44|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|364||||364|33.44|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|364||||364|182.36|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|364||||364|127.76|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|364||||364|30.86|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|364||||364|155.06|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|364||||364|182|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|364||||364|236.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|CORESOURCE [1315]|CORESOURCE [131500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|364||||364|31.61|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|364||||364|19.58|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|GEHA [1415]|GEHA [141500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HEALTHNET [1495]|HEALTHNET [149500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|364||||364|30.86|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|364||||364|338.52|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|364||||364|218.4|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|364||||364|182|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|364||||364|32.29|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MULTIPLAN [1680]|HMA [168003]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MULTIPLAN [1680]|IHC HS [168011]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|364||||364|34.76|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|Self-pay|Self-pay|364||||364|109.2|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|364||||364|76.44|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|TRUSTMARK [2030]|STARMARK [203000]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|364||||364|174.54|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|UMR [2035]|UMR OPTIONS [203501]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|364||||364|30.76|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|364||||364|327.6|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|364||||364|18.52|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|364||||364|19.58|338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|364||||364||338.52|18.52
30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|364||||364|182|338.52|18.52
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|AETNA [1015]|AETNA ACO WILCO [101532]|19||||19|12.17|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19||||19|8.36|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19||||19|8.36|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19||||19|9.52|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19||||19|6.67|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19||||19|9.51|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19||||19|8.09|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19||||19|9.5|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19||||19|12.35|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|CORESOURCE [1315]|CORESOURCE [131500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19||||19|13.47|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19||||19|8.24|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|GEHA [1415]|GEHA [141500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HEALTHNET [1495]|HEALTHNET [149500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19||||19|9.51|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19||||19|17.67|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19||||19|11.4|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19||||19|9.5|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19||||19|8.08|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MULTIPLAN [1680]|HMA [168003]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MULTIPLAN [1680]|IHC HS [168011]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19||||19|8.69|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|Self-pay|Self-pay|19||||19|5.7|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19||||19|3.99|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|TRUSTMARK [2030]|STARMARK [203000]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19||||19|9.11|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|UMR [2035]|UMR OPTIONS [203501]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19||||19|7.69|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19||||19|17.1|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19||||19|5.14|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19||||19|8.24|17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19||||19||17.67|3.99
30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19||||19|9.5|17.67|3.99
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|AETNA [1015]|AETNA ACO WILCO [101532]|267||||267|27.17|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267||||267|17.53|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267||||267|18.63|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267||||267|18.63|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267||||267|133.77|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267||||267|93.72|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267||||267|21.22|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267||||267|113.74|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267||||267|133.5|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267||||267|173.55|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|CORESOURCE [1315]|CORESOURCE [131500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267||||267|26.02|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267||||267|15.93|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|GEHA [1415]|GEHA [141500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267||||267|38.68|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HEALTHNET [1495]|HEALTHNET [149500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267||||267|21.22|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267||||267|248.31|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267||||267|160.2|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267||||267|18.91|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267||||267|133.5|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267||||267|17.99|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267||||267|23.21|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267||||267|17.53|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MULTIPLAN [1680]|HMA [168003]|267||||267|25.79|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MULTIPLAN [1680]|IHC HS [168011]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267||||267|19.36|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267||||267|18.91|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|Self-pay|Self-pay|267||||267|80.1|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267||||267|56.07|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267||||267|16.85|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267||||267|25.1|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|TRUSTMARK [2030]|STARMARK [203000]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267||||267|128.03|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|UMR [2035]|UMR OPTIONS [203501]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267||||267|17.13|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267||||267|240.3|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267||||267|11.46|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267||||267|15.93|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267||||267|17.19|248.31|11.46
30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267||||267|133.5|248.31|11.46
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|317||||317|10.33|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|317||||317|6.66|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|317||||317|7.08|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|317||||317|7.08|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|317||||317|158.82|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|317||||317|111.27|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|317||||317|8.06|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|317||||317|135.04|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|317||||317|158.5|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|317||||317|206.05|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|317||||317|17.46|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|317||||317|10.69|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|GEHA [1415]|GEHA [141500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|317||||317|14.69|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|317||||317|8.06|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|317||||317|294.81|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|317||||317|190.2|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|317||||317|7.18|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|317||||317|158.5|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|317||||317|6.83|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|317||||317|8.82|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|317||||317|6.66|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MULTIPLAN [1680]|HMA [168003]|317||||317|9.8|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MULTIPLAN [1680]|IHC HS [168011]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|317||||317|7.36|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|317||||317|7.18|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|Self-pay|Self-pay|317||||317|95.1|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|317||||317|66.57|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|317||||317|6.4|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|317||||317|9.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|TRUSTMARK [2030]|STARMARK [203000]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|317||||317|152|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|UMR [2035]|UMR OPTIONS [203501]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|317||||317|6.51|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|317||||317|285.3|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|317||||317|4.36|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|317||||317|10.69|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|317||||317|6.53|294.81|4.36
30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|317||||317|158.5|294.81|4.36
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|AETNA [1015]|AETNA ACO WILCO [101532]|100||||100|6.64|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100||||100|4.55|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100||||100|4.55|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100||||100|50.1|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100||||100|35.1|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100||||100|5.18|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100||||100|42.6|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100||||100|50|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100||||100|65|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|CORESOURCE [1315]|CORESOURCE [131500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100||||100|6.75|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100||||100|4.13|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|GEHA [1415]|GEHA [141500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HEALTHNET [1495]|HEALTHNET [149500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100||||100|5.18|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100||||100|93|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100||||100|60|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100||||100|50|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100||||100|4.4|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MULTIPLAN [1680]|HMA [168003]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MULTIPLAN [1680]|IHC HS [168011]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100||||100|4.73|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|Self-pay|Self-pay|100||||100|30|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100||||100|21|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|TRUSTMARK [2030]|STARMARK [203000]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100||||100|47.95|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|UMR [2035]|UMR OPTIONS [203501]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100||||100|4.19|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100||||100|90|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100||||100|2.8|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100||||100|4.13|93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100||||100||93|2.8
30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100||||100|50|93|2.8
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|179||||179|12.22|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179||||179|7.88|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179||||179|8.38|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179||||179|8.38|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|179||||179|89.68|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179||||179|62.83|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179||||179|9.55|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|179||||179|76.25|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|179||||179|89.5|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179||||179|116.35|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|CORESOURCE [1315]|CORESOURCE [131500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|179||||179|13.77|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|179||||179|8.43|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|GEHA [1415]|GEHA [141500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|179||||179|17.39|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HEALTHNET [1495]|HEALTHNET [149500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179||||179|9.55|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|179||||179|166.47|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179||||179|107.4|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179||||179|8.5|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179||||179|89.5|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179||||179|8.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179||||179|10.44|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179||||179|7.88|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MULTIPLAN [1680]|HMA [168003]|179||||179|11.6|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MULTIPLAN [1680]|IHC HS [168011]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|179||||179|8.71|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179||||179|8.5|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|Self-pay|Self-pay|179||||179|53.7|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179||||179|37.59|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|179||||179|7.58|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179||||179|11.29|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|TRUSTMARK [2030]|STARMARK [203000]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179||||179|85.83|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|UMR [2035]|UMR OPTIONS [203501]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179||||179|7.71|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179||||179|161.1|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|179||||179|5.15|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|179||||179|8.43|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|179||||179|7.73|166.47|5.15
30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|179||||179|89.5|166.47|5.15
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|AETNA [1015]|AETNA ACO WILCO [101532]|95||||95|13.32|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95||||95|10.14|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95||||95|10.14|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95||||95|47.6|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95||||95|33.35|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95||||95|9.36|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95||||95|40.47|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95||||95|47.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95||||95|61.75|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|CORESOURCE [1315]|CORESOURCE [131500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95||||95|11.35|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95||||95|6.95|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|GEHA [1415]|GEHA [141500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HEALTHNET [1495]|HEALTHNET [149500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95||||95|9.36|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95||||95|88.35|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95||||95|57|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95||||95|47.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95||||95|9.8|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MULTIPLAN [1680]|HMA [168003]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MULTIPLAN [1680]|IHC HS [168011]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95||||95|10.54|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|Self-pay|Self-pay|95||||95|28.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95||||95|19.95|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|TRUSTMARK [2030]|STARMARK [203000]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95||||95|45.55|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|UMR [2035]|UMR OPTIONS [203501]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95||||95|9.33|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95||||95|85.5|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95||||95|5.62|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95||||95|6.95|88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95||||95||88.35|5.62
30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95||||95|47.5|88.35|5.62
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|195||||195|20.7|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195||||195|13.35|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195||||195|14.18|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195||||195|14.18|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|195||||195|97.7|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195||||195|68.45|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195||||195|16.16|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|195||||195|83.07|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|195||||195|97.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195||||195|126.75|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|CORESOURCE [1315]|CORESOURCE [131500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|195||||195|22.84|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|195||||195|13.98|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|GEHA [1415]|GEHA [141500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|195||||195|29.45|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HEALTHNET [1495]|HEALTHNET [149500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195||||195|16.16|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|195||||195|181.35|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195||||195|117|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195||||195|14.4|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195||||195|97.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195||||195|13.7|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195||||195|17.67|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195||||195|13.35|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MULTIPLAN [1680]|HMA [168003]|195||||195|19.64|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MULTIPLAN [1680]|IHC HS [168011]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|195||||195|14.74|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195||||195|14.4|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|Self-pay|Self-pay|195||||195|58.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195||||195|40.95|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|195||||195|12.83|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195||||195|19.11|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|TRUSTMARK [2030]|STARMARK [203000]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195||||195|93.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|UMR [2035]|UMR OPTIONS [203501]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195||||195|13.04|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195||||195|175.5|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|195||||195|8.73|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|195||||195|13.98|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|195||||195|13.09|181.35|8.73
30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|195||||195|97.5|181.35|8.73
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|488||||488|13.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|488||||488|8.77|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|488||||488|9.31|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|488||||488|9.31|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|488||||488|244.49|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|488||||488|171.29|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|488||||488|10.62|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|488||||488|207.89|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|488||||488|244|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|488||||488|317.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|CORESOURCE [1315]|CORESOURCE [131500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|488||||488|16.94|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|488||||488|10.37|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|GEHA [1415]|GEHA [141500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|488||||488|19.35|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HEALTHNET [1495]|HEALTHNET [149500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|488||||488|10.62|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|488||||488|453.84|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|488||||488|292.8|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|488||||488|9.46|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|488||||488|244|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|488||||488|8.99|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|488||||488|11.61|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|488||||488|8.77|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MULTIPLAN [1680]|HMA [168003]|488||||488|12.9|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MULTIPLAN [1680]|IHC HS [168011]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|488||||488|9.68|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|488||||488|9.46|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|Self-pay|Self-pay|488||||488|146.4|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|488||||488|102.48|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|488||||488|8.43|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|488||||488|12.56|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|TRUSTMARK [2030]|STARMARK [203000]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|488||||488|234|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|UMR [2035]|UMR OPTIONS [203501]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|488||||488|8.56|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|488||||488|439.2|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|488||||488|5.74|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|488||||488|10.37|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|488||||488|8.6|453.84|5.74
30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|488||||488|244|453.84|5.74
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|222||||222|29.62|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222||||222|20.32|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222||||222|20.32|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|222||||222|111.22|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222||||222|77.92|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222||||222|23.15|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|222||||222|94.57|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|222||||222|111|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222||||222|144.3|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|CORESOURCE [1315]|CORESOURCE [131500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|222||||222|39.17|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|222||||222|23.98|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|GEHA [1415]|GEHA [141500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HEALTHNET [1495]|HEALTHNET [149500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222||||222|23.15|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|222||||222|206.46|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222||||222|133.2|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222||||222|111|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222||||222|19.62|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MULTIPLAN [1680]|HMA [168003]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MULTIPLAN [1680]|IHC HS [168011]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|222||||222|21.12|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|Self-pay|Self-pay|222||||222|66.6|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222||||222|46.62|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|TRUSTMARK [2030]|STARMARK [203000]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222||||222|106.45|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|UMR [2035]|UMR OPTIONS [203501]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222||||222|18.69|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222||||222|199.8|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|222||||222|12.5|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|222||||222|23.98|206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|222||||222||206.46|12.5
30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|222||||222|111|206.46|12.5
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|AETNA [1015]|AETNA ACO WILCO [101532]|76||||76|10.63|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76||||76|8.09|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76||||76|8.09|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76||||76|38.08|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76||||76|26.68|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76||||76|8.25|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76||||76|32.38|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76||||76|38|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76||||76|49.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|CORESOURCE [1315]|CORESOURCE [131500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76||||76|12.62|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76||||76|7.73|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|GEHA [1415]|GEHA [141500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HEALTHNET [1495]|HEALTHNET [149500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76||||76|8.25|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76||||76|70.68|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76||||76|45.6|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76||||76|38|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76||||76|7.81|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MULTIPLAN [1680]|HMA [168003]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MULTIPLAN [1680]|IHC HS [168011]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76||||76|8.41|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|Self-pay|Self-pay|76||||76|22.8|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76||||76|15.96|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|TRUSTMARK [2030]|STARMARK [203000]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76||||76|36.44|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|UMR [2035]|UMR OPTIONS [203501]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76||||76|7.44|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76||||76|68.4|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76||||76|4.48|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76||||76|7.73|70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76||||76||70.68|4.48
30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76||||76|38|70.68|4.48
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|224||||224|21.11|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|224||||224|14.48|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|224||||224|14.48|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|224||||224|112.22|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|224||||224|78.62|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|224||||224|16.49|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|224||||224|95.42|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|224||||224|112|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|224||||224|145.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|CORESOURCE [1315]|CORESOURCE [131500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|224||||224|29.31|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|224||||224|17.94|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|GEHA [1415]|GEHA [141500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HEALTHNET [1495]|HEALTHNET [149500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|224||||224|16.49|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|224||||224|208.32|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|224||||224|134.4|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|224||||224|112|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|224||||224|13.98|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MULTIPLAN [1680]|HMA [168003]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MULTIPLAN [1680]|IHC HS [168011]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|224||||224|15.05|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|Self-pay|Self-pay|224||||224|67.2|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|224||||224|47.04|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|TRUSTMARK [2030]|STARMARK [203000]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|224||||224|107.41|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|UMR [2035]|UMR OPTIONS [203501]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|224||||224|13.31|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|224||||224|201.6|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|224||||224|8.9|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|224||||224|17.94|208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|224||||224||208.32|8.9
30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|224||||224|112|208.32|8.9
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|153||||153|35.44|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|153||||153|26.99|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|153||||153|26.99|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|153||||153|76.65|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|153||||153|53.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|153||||153|26.52|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|153||||153|65.18|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|153||||153|76.5|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|153||||153|99.45|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|CORESOURCE [1315]|CORESOURCE [131500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|153||||153|44.74|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|153||||153|27.39|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|GEHA [1415]|GEHA [141500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HEALTHNET [1495]|HEALTHNET [149500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153||||153|26.52|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|153||||153|142.29|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|153||||153|91.8|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|153||||153|76.5|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|153||||153|26.07|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MULTIPLAN [1680]|HMA [168003]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MULTIPLAN [1680]|IHC HS [168011]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|153||||153|28.05|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|Self-pay|Self-pay|153||||153|45.9|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|153||||153|32.13|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|TRUSTMARK [2030]|STARMARK [203000]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153||||153|73.36|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|UMR [2035]|UMR OPTIONS [203501]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|153||||153|24.83|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|153||||153|137.7|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|153||||153|14.95|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|153||||153|27.39|142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|153||||153||142.29|14.95
30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|153||||153|76.5|142.29|14.95
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|219||||219|28.4|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219||||219|19.48|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219||||219|19.48|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|219||||219|109.72|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219||||219|76.87|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219||||219|22.19|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|219||||219|93.29|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|219||||219|109.5|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219||||219|142.35|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|CORESOURCE [1315]|CORESOURCE [131500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|219||||219|27.21|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|219||||219|16.66|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|GEHA [1415]|GEHA [141500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HEALTHNET [1495]|HEALTHNET [149500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219||||219|22.19|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|219||||219|203.67|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219||||219|131.4|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219||||219|109.5|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219||||219|18.82|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MULTIPLAN [1680]|HMA [168003]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MULTIPLAN [1680]|IHC HS [168011]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|219||||219|20.25|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|Self-pay|Self-pay|219||||219|65.7|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219||||219|45.99|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|TRUSTMARK [2030]|STARMARK [203000]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219||||219|105.01|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|UMR [2035]|UMR OPTIONS [203501]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219||||219|17.92|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219||||219|197.1|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|219||||219|11.98|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|219||||219|16.66|203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|219||||219||203.67|11.98
30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|219||||219|109.5|203.67|11.98
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|AETNA [1015]|AETNA ACO WILCO [101532]|194||||194|6.22|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194||||194|4.38|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194||||194|4.64|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194||||194|4.64|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|194||||194|97.19|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194||||194|68.09|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194||||194|4.85|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|194||||194|82.64|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|194||||194|97|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194||||194|126.1|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|CORESOURCE [1315]|CORESOURCE [131500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|194||||194|6.67|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|194||||194|4.09|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|GEHA [1415]|GEHA [141500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|194||||194|9.65|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HEALTHNET [1495]|HEALTHNET [149500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194||||194|4.85|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|194||||194|180.42|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194||||194|116.4|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194||||194|4.72|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194||||194|97|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194||||194|4.49|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194||||194|5.79|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194||||194|4.38|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MULTIPLAN [1680]|HMA [168003]|194||||194|6.44|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MULTIPLAN [1680]|IHC HS [168011]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|194||||194|4.82|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194||||194|4.72|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|Self-pay|Self-pay|194||||194|58.2|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194||||194|40.74|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|194||||194|4.2|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194||||194|6.26|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|TRUSTMARK [2030]|STARMARK [203000]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194||||194|93.02|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|UMR [2035]|UMR OPTIONS [203501]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194||||194|4.27|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194||||194|174.6|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|194||||194|2.62|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|194||||194|4.09|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|194||||194|4.29|180.42|2.62
30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|194||||194|97|180.42|2.62
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|6.23|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|4.26|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|4.26|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|4.87|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|6.45|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|3.95|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|4.87|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|127|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|4.11|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MULTIPLAN [1680]|HMA [168003]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|4.43|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|Self-pay|Self-pay|254||||254|76.2|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|3.92|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|2.63|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|3.95|236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254||236.22|2.63
30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|2.63
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|316||||316|15.13|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|316||||316|9.77|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|316||||316|10.38|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|316||||316|10.38|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|316||||316|158.32|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|316||||316|110.92|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|316||||316|11.83|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|316||||316|134.62|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|316||||316|158|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|316||||316|205.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|CORESOURCE [1315]|CORESOURCE [131500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|316||||316|15.31|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|316||||316|9.37|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|GEHA [1415]|GEHA [141500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|316||||316|21.56|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HEALTHNET [1495]|HEALTHNET [149500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|316||||316|11.83|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|316||||316|293.88|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|316||||316|189.6|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|316||||316|10.54|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|316||||316|158|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|316||||316|10.03|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|316||||316|12.93|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|316||||316|9.77|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MULTIPLAN [1680]|HMA [168003]|316||||316|14.37|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MULTIPLAN [1680]|IHC HS [168011]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|316||||316|10.79|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|316||||316|10.54|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|Self-pay|Self-pay|316||||316|94.8|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|316||||316|66.36|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|316||||316|9.39|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|316||||316|13.99|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|TRUSTMARK [2030]|STARMARK [203000]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|316||||316|151.52|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|UMR [2035]|UMR OPTIONS [203501]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|316||||316|9.55|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|316||||316|284.4|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|316||||316|6.38|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|316||||316|9.37|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|316||||316|9.58|293.88|6.38
30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|316||||316|158|293.88|6.38
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|144||||144|15.56|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144||||144|10.67|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144||||144|10.67|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|144||||144|72.14|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144||||144|50.54|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144||||144|12.16|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|144||||144|61.34|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|144||||144|72|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144||||144|93.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|CORESOURCE [1315]|CORESOURCE [131500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|144||||144|22.1|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|144||||144|13.53|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|GEHA [1415]|GEHA [141500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HEALTHNET [1495]|HEALTHNET [149500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144||||144|12.16|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|144||||144|133.92|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144||||144|86.4|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144||||144|72|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144||||144|10.31|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MULTIPLAN [1680]|HMA [168003]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MULTIPLAN [1680]|IHC HS [168011]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|144||||144|11.09|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|Self-pay|Self-pay|144||||144|43.2|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144||||144|30.24|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|TRUSTMARK [2030]|STARMARK [203000]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144||||144|69.05|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|UMR [2035]|UMR OPTIONS [203501]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144||||144|9.82|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144||||144|129.6|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|144||||144|6.56|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|144||||144|13.53|133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|144||||144||133.92|6.56
30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|144||||144|72|133.92|6.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|AETNA [1015]|AETNA ACO WILCO [101532]|109||||109|6.07|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109||||109|4.36|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109||||109|4.62|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109||||109|4.62|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109||||109|54.61|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109||||109|38.26|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109||||109|4.38|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109||||109|46.43|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109||||109|54.5|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109||||109|70.85|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|CORESOURCE [1315]|CORESOURCE [131500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|109||||109|7.5|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109||||109|4.59|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|GEHA [1415]|GEHA [141500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109||||109|9.61|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HEALTHNET [1495]|HEALTHNET [149500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109||||109|4.38|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|109||||109|101.37|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109||||109|65.4|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109||||109|4.7|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109||||109|54.5|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109||||109|4.46|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109||||109|5.76|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109||||109|4.36|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MULTIPLAN [1680]|HMA [168003]|109||||109|6.41|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MULTIPLAN [1680]|IHC HS [168011]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|109||||109|4.8|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109||||109|4.7|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|Self-pay|Self-pay|109||||109|32.7|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109||||109|22.89|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109||||109|4.18|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109||||109|6.23|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|TRUSTMARK [2030]|STARMARK [203000]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109||||109|52.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|UMR [2035]|UMR OPTIONS [203501]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109||||109|4.25|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109||||109|98.1|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109||||109|2.56|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109||||109|4.59|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109||||109|4.27|101.37|2.56
30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109||||109|54.5|101.37|2.56
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|AETNA [1015]|AETNA ACO WILCO [101532]|109||||109|4.27|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109||||109|2.75|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109||||109|2.93|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109||||109|2.93|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109||||109|54.61|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109||||109|38.26|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109||||109|3.33|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109||||109|46.43|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109||||109|54.5|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109||||109|70.85|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|CORESOURCE [1315]|CORESOURCE [131500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|109||||109|6.72|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109||||109|4.11|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|GEHA [1415]|GEHA [141500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109||||109|6.08|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HEALTHNET [1495]|HEALTHNET [149500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109||||109|3.33|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|109||||109|101.37|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109||||109|65.4|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109||||109|2.97|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109||||109|54.5|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109||||109|2.83|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109||||109|3.65|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109||||109|2.75|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MULTIPLAN [1680]|HMA [168003]|109||||109|4.05|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MULTIPLAN [1680]|IHC HS [168011]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|109||||109|3.05|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109||||109|2.97|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|Self-pay|Self-pay|109||||109|32.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109||||109|22.89|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109||||109|2.65|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109||||109|3.94|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|TRUSTMARK [2030]|STARMARK [203000]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109||||109|52.27|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|UMR [2035]|UMR OPTIONS [203501]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109||||109|2.69|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109||||109|98.1|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109||||109|1.8|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109||||109|4.11|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109||||109|2.7|101.37|1.8
30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109||||109|54.5|101.37|1.8
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|103||||103|8.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103||||103|5.62|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103||||103|5.97|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103||||103|5.97|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|103||||103|51.6|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103||||103|36.15|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103||||103|6.8|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|103||||103|43.88|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|103||||103|51.5|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103||||103|66.95|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|CORESOURCE [1315]|CORESOURCE [131500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|103||||103|8.9|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|103||||103|5.45|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|GEHA [1415]|GEHA [141500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|103||||103|12.4|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HEALTHNET [1495]|HEALTHNET [149500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103||||103|6.8|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|103||||103|95.79|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103||||103|61.8|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103||||103|6.06|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103||||103|51.5|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103||||103|5.76|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103||||103|7.44|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103||||103|5.62|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MULTIPLAN [1680]|HMA [168003]|103||||103|8.27|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MULTIPLAN [1680]|IHC HS [168011]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|103||||103|6.21|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103||||103|6.06|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|Self-pay|Self-pay|103||||103|30.9|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103||||103|21.63|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|103||||103|5.4|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103||||103|8.04|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|TRUSTMARK [2030]|STARMARK [203000]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103||||103|49.39|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|UMR [2035]|UMR OPTIONS [203501]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103||||103|5.49|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103||||103|92.7|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|103||||103|3.67|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|103||||103|5.45|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|103||||103|5.51|95.79|3.67
30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLING RBC REDUCTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|103||||103|51.5|95.79|3.67
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|AETNA [1015]|AETNA ACO WILCO [101532]|179||||179|9.12|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179||||179|6.25|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179||||179|6.25|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|179||||179|89.68|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179||||179|62.83|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179||||179|7.12|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|179||||179|76.25|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|179||||179|89.5|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179||||179|116.35|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|CORESOURCE [1315]|CORESOURCE [131500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|179||||179|11.92|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|179||||179|7.3|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|GEHA [1415]|GEHA [141500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HEALTHNET [1495]|HEALTHNET [149500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179||||179|7.12|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|179||||179|166.47|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179||||179|107.4|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179||||179|89.5|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179||||179|6.04|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MULTIPLAN [1680]|HMA [168003]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MULTIPLAN [1680]|IHC HS [168011]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|179||||179|6.5|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|Self-pay|Self-pay|179||||179|53.7|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179||||179|37.59|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|TRUSTMARK [2030]|STARMARK [203000]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179||||179|85.83|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|UMR [2035]|UMR OPTIONS [203501]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179||||179|5.75|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179||||179|161.1|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|179||||179|3.85|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|179||||179|7.3|166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|179||||179||166.47|3.85
30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|179||||179|89.5|166.47|3.85
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|AETNA [1015]|AETNA ACO WILCO [101532]|179||||179|15.22|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179||||179|10.43|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179||||179|10.43|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|179||||179|89.68|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179||||179|62.83|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179||||179|11.89|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|179||||179|76.25|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|179||||179|89.5|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179||||179|116.35|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|CORESOURCE [1315]|CORESOURCE [131500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|179||||179|14.63|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|179||||179|8.96|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|GEHA [1415]|GEHA [141500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HEALTHNET [1495]|HEALTHNET [149500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179||||179|11.89|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|179||||179|166.47|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179||||179|107.4|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179||||179|89.5|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179||||179|10.07|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MULTIPLAN [1680]|HMA [168003]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MULTIPLAN [1680]|IHC HS [168011]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|179||||179|10.84|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|Self-pay|Self-pay|179||||179|53.7|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179||||179|37.59|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|TRUSTMARK [2030]|STARMARK [203000]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179||||179|85.83|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|UMR [2035]|UMR OPTIONS [203501]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179||||179|9.59|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179||||179|161.1|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|179||||179|6.42|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|179||||179|8.96|166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|179||||179||166.47|6.42
30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|179||||179|89.5|166.47|6.42
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|AETNA [1015]|AETNA ACO WILCO [101532]|186||||186|9.49|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186||||186|6.13|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186||||186|6.51|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186||||186|6.51|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186||||186|93.19|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186||||186|65.29|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186||||186|7.42|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186||||186|79.24|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186||||186|93|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186||||186|120.9|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|CORESOURCE [1315]|CORESOURCE [131500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|186||||186|9.56|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186||||186|5.85|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|GEHA [1415]|GEHA [141500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186||||186|13.52|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HEALTHNET [1495]|HEALTHNET [149500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186||||186|7.42|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|186||||186|172.98|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186||||186|111.6|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186||||186|6.61|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186||||186|93|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186||||186|6.29|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186||||186|8.11|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186||||186|6.13|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MULTIPLAN [1680]|HMA [168003]|186||||186|9.02|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MULTIPLAN [1680]|IHC HS [168011]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|186||||186|6.77|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186||||186|6.61|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|Self-pay|Self-pay|186||||186|55.8|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186||||186|39.06|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186||||186|5.89|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186||||186|8.77|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|TRUSTMARK [2030]|STARMARK [203000]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186||||186|89.19|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|UMR [2035]|UMR OPTIONS [203501]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186||||186|5.99|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186||||186|167.4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186||||186|4|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186||||186|5.85|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186||||186|6.01|172.98|4
30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186||||186|93|172.98|4
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|250||||250|10.21|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250||||250|6.6|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250||||250|7.01|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250||||250|7.01|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|250||||250|125.25|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250||||250|87.75|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250||||250|7.98|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|250||||250|106.5|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|250||||250|125|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250||||250|162.5|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|CORESOURCE [1315]|CORESOURCE [131500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|250||||250|13.48|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|250||||250|8.25|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|GEHA [1415]|GEHA [141500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|250||||250|14.56|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HEALTHNET [1495]|HEALTHNET [149500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250||||250|7.98|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|250||||250|232.5|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250||||250|150|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250||||250|7.12|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250||||250|125|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250||||250|6.77|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250||||250|8.73|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250||||250|6.6|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MULTIPLAN [1680]|HMA [168003]|250||||250|9.71|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MULTIPLAN [1680]|IHC HS [168011]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|250||||250|7.29|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250||||250|7.12|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|Self-pay|Self-pay|250||||250|75|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250||||250|52.5|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|250||||250|6.34|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250||||250|9.45|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|TRUSTMARK [2030]|STARMARK [203000]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250||||250|119.88|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|UMR [2035]|UMR OPTIONS [203501]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250||||250|6.44|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250||||250|225|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|250||||250|4.31|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|250||||250|8.25|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|250||||250|6.47|232.5|4.31
30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|250||||250|125|232.5|4.31
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|270||||270|18.45|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|270||||270|11.9|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|270||||270|12.64|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|270||||270|12.64|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|270||||270|135.27|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|270||||270|94.77|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|270||||270|14.41|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|270||||270|115.02|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|270||||270|135|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|270||||270|175.5|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|CORESOURCE [1315]|CORESOURCE [131500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|270||||270|17.9|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|270||||270|10.96|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|GEHA [1415]|GEHA [141500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|270||||270|26.26|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HEALTHNET [1495]|HEALTHNET [149500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|270||||270|14.41|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|270||||270|251.1|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|270||||270|162|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|270||||270|12.84|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|270||||270|135|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|270||||270|12.21|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|270||||270|15.75|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|270||||270|11.9|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MULTIPLAN [1680]|HMA [168003]|270||||270|17.51|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MULTIPLAN [1680]|IHC HS [168011]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|270||||270|13.14|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|270||||270|12.84|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|Self-pay|Self-pay|270||||270|81|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|270||||270|56.7|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|270||||270|11.44|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|270||||270|17.04|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|TRUSTMARK [2030]|STARMARK [203000]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|270||||270|129.47|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|UMR [2035]|UMR OPTIONS [203501]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|270||||270|11.63|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|270||||270|243|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|270||||270|7.78|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|270||||270|10.96|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|270||||270|11.67|251.1|7.78
30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|270||||270|135|251.1|7.78
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|AETNA [1015]|AETNA ACO WILCO [101532]|200||||200|0|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200||||200|52.34|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200||||200|59.16|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200||||200|59.16|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|200||||200|100.2|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200||||200|70.2|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200||||200|86|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|200||||200|85.2|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|200||||200|100|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200||||200|130|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|CORESOURCE [1315]|CORESOURCE [131500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|200||||200|0|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|200||||200|51.33|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|GEHA [1415]|GEHA [141500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|200||||200|115.45|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HEALTHNET [1495]|HEALTHNET [149500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200||||200|86|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|200||||200|186|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200||||200|120|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200||||200|56.44|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200||||200|0|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200||||200|57.15|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200||||200|69.27|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200||||200|52.34|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MULTIPLAN [1680]|HMA [168003]|200||||200|76.97|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MULTIPLAN [1680]|IHC HS [168011]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|200||||200|61.49|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200||||200|56.44|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|Self-pay|Self-pay|200||||200|60|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200||||200|42|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|200||||200|50.28|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200||||200|74.91|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|TRUSTMARK [2030]|STARMARK [203000]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200||||200|95.9|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|UMR [2035]|UMR OPTIONS [203501]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200||||200|0|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200||||200|180|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|200||||200|51.33|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|200||||200|51.33|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|200||||200|51.31|186|42
30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|200||||200|100|186|42
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|AETNA [1015]|AETNA ACO WILCO [101532]|300||||300|0|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300||||300|76.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300||||300|86.45|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300||||300|86.45|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|300||||300|150.3|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300||||300|105.3|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300||||300|129|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|300||||300|127.8|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|300||||300|150|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300||||300|195|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|CORESOURCE [1315]|CORESOURCE [131500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|300||||300|0|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|300||||300|100|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|GEHA [1415]|GEHA [141500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|300||||300|168.75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HEALTHNET [1495]|HEALTHNET [149500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300||||300|129|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|300||||300|279|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300||||300|180|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300||||300|82.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300||||300|0|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300||||300|83.49|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300||||300|101.25|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300||||300|76.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MULTIPLAN [1680]|HMA [168003]|300||||300|112.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MULTIPLAN [1680]|IHC HS [168011]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|300||||300|89.85|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300||||300|82.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|Self-pay|Self-pay|300||||300|90|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300||||300|63|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|300||||300|73.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300||||300|109.5|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|TRUSTMARK [2030]|STARMARK [203000]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|300||||300|143.85|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|UMR [2035]|UMR OPTIONS [203501]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300||||300|0|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|300||||300|270|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|300||||300|100|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|300||||300|100|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|300||||300|75|279|63
30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP HIGH THROUGHPUT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|300||||300|150|279|63
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|65||||65|10.55|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65||||65|6.81|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65||||65|7.24|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65||||65|7.24|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65||||65|32.57|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65||||65|22.82|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65||||65|8.24|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65||||65|27.69|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65||||65|32.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65||||65|42.25|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|CORESOURCE [1315]|CORESOURCE [131500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65||||65|13.97|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65||||65|8.55|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|GEHA [1415]|GEHA [141500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65||||65|15.03|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HEALTHNET [1495]|HEALTHNET [149500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65||||65|8.24|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65||||65|60.45|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65||||65|39|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65||||65|7.35|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65||||65|32.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65||||65|7|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65||||65|9.02|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65||||65|6.81|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MULTIPLAN [1680]|HMA [168003]|65||||65|10.02|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MULTIPLAN [1680]|IHC HS [168011]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65||||65|7.53|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65||||65|7.35|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|Self-pay|Self-pay|65||||65|19.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65||||65|13.65|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65||||65|6.55|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65||||65|9.75|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|TRUSTMARK [2030]|STARMARK [203000]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65||||65|31.17|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|UMR [2035]|UMR OPTIONS [203501]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65||||65|6.66|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65||||65|58.5|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65||||65|4.45|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65||||65|8.55|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65||||65|6.68|60.45|4.45
30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65||||65|32.5|60.45|4.45
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|AETNA [1015]|AETNA ACO WILCO [101532]|580||||580|16.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|580||||580|10.53|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|580||||580|11.18|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|580||||580|11.18|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|580||||580|290.58|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|580||||580|203.58|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|580||||580|12.74|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|580||||580|247.08|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|580||||580|290|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|580||||580|377|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|CORESOURCE [1315]|CORESOURCE [131500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|580||||580|16.81|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|580||||580|10.29|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|GEHA [1415]|GEHA [141500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|580||||580|23.22|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HEALTHNET [1495]|HEALTHNET [149500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|580||||580|12.74|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|580||||580|539.4|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|580||||580|348|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|580||||580|11.35|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|580||||580|290|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|580||||580|10.79|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|580||||580|13.93|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|580||||580|10.53|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MULTIPLAN [1680]|HMA [168003]|580||||580|15.48|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MULTIPLAN [1680]|IHC HS [168011]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|580||||580|11.62|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|580||||580|11.35|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|Self-pay|Self-pay|580||||580|174|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|580||||580|121.8|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|580||||580|10.11|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|580||||580|15.07|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|TRUSTMARK [2030]|STARMARK [203000]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|580||||580|278.11|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|UMR [2035]|UMR OPTIONS [203501]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|580||||580|10.28|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|580||||580|522|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|580||||580|6.88|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|580||||580|10.29|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|580||||580|10.32|539.4|6.88
30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|580||||580|290|539.4|6.88
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|297||||297|14.92|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297||||297|10.22|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297||||297|10.22|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|297||||297|148.8|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297||||297|104.25|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297||||297|11.66|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|297||||297|126.52|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|297||||297|148.5|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297||||297|193.05|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|CORESOURCE [1315]|CORESOURCE [131500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|297||||297|19.76|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|297||||297|12.1|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|GEHA [1415]|GEHA [141500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HEALTHNET [1495]|HEALTHNET [149500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297||||297|11.66|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|297||||297|276.21|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297||||297|178.2|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297||||297|148.5|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297||||297|9.88|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MULTIPLAN [1680]|HMA [168003]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MULTIPLAN [1680]|IHC HS [168011]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|297||||297|10.62|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|Self-pay|Self-pay|297||||297|89.1|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297||||297|62.37|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|TRUSTMARK [2030]|STARMARK [203000]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297||||297|142.41|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|UMR [2035]|UMR OPTIONS [203501]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297||||297|9.41|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297||||297|267.3|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|297||||297|6.29|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|297||||297|12.1|276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|297||||297||276.21|6.29
30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|297||||297|148.5|276.21|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|AETNA [1015]|AETNA ACO WILCO [101532]|124||||124|14.92|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124||||124|9.63|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124||||124|10.22|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124||||124|10.22|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124||||124|62.12|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124||||124|43.52|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124||||124|11.66|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124||||124|52.82|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124||||124|62|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124||||124|80.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|CORESOURCE [1315]|CORESOURCE [131500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124||||124|12.47|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124||||124|7.52|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|GEHA [1415]|GEHA [141500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124||||124|21.24|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HEALTHNET [1495]|HEALTHNET [149500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124||||124|11.66|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124||||124|115.32|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124||||124|74.4|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124||||124|10.38|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124||||124|62|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124||||124|9.88|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124||||124|12.74|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124||||124|9.63|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MULTIPLAN [1680]|HMA [168003]|124||||124|14.16|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MULTIPLAN [1680]|IHC HS [168011]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124||||124|10.62|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124||||124|10.38|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|Self-pay|Self-pay|124||||124|37.2|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124||||124|26.04|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124||||124|9.25|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124||||124|13.78|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|TRUSTMARK [2030]|STARMARK [203000]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124||||124|59.46|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|UMR [2035]|UMR OPTIONS [203501]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124||||124|9.41|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124||||124|111.6|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124||||124|6.29|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124||||124|7.52|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124||||124|9.44|115.32|6.29
30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124||||124|62|115.32|6.29
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|290||||290|13.61|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|290||||290|8.79|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|290||||290|9.34|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|290||||290|9.34|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|290||||290|145.29|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|290||||290|101.79|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|290||||290|10.64|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|290||||290|123.54|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|290||||290|145|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|290||||290|188.5|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|290||||290|13.3|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|290||||290|8.14|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|GEHA [1415]|GEHA [141500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|290||||290|19.4|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|290||||290|10.64|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|290||||290|269.7|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|290||||290|174|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|290||||290|9.48|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|290||||290|145|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|290||||290|9.01|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|290||||290|11.64|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|290||||290|8.79|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MULTIPLAN [1680]|HMA [168003]|290||||290|12.93|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|290||||290|9.71|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|290||||290|9.48|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|Self-pay|Self-pay|290||||290|87|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|290||||290|60.9|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|290||||290|8.45|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|290||||290|12.59|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|290||||290|139.06|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|290||||290|8.59|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|290||||290|261|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|290||||290|5.74|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|290||||290|8.14|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|290||||290|8.62|269.7|5.74
30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|290||||290|145|269.7|5.74
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|95||||95|14.92|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95||||95|10.72|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95||||95|10.72|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95||||95|47.6|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95||||95|33.35|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95||||95|11.66|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95||||95|40.47|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95||||95|47.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95||||95|61.75|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|CORESOURCE [1315]|CORESOURCE [131500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95||||95|13.51|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95||||95|8.27|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|GEHA [1415]|GEHA [141500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HEALTHNET [1495]|HEALTHNET [149500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95||||95|11.66|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95||||95|88.35|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95||||95|57|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95||||95|47.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95||||95|10.36|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MULTIPLAN [1680]|HMA [168003]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MULTIPLAN [1680]|IHC HS [168011]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95||||95|11.14|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|Self-pay|Self-pay|95||||95|28.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95||||95|19.95|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|TRUSTMARK [2030]|STARMARK [203000]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95||||95|45.55|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|UMR [2035]|UMR OPTIONS [203501]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95||||95|9.86|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95||||95|85.5|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95||||95|6.29|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95||||95|8.27|88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95||||95||88.35|6.29
30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95||||95|47.5|88.35|6.29
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|327||||327|14.96|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|327||||327|9.66|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|327||||327|10.26|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|327||||327|10.26|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|327||||327|163.83|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|327||||327|114.78|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|327||||327|11.69|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|327||||327|139.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|327||||327|163.5|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|327||||327|212.55|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|CORESOURCE [1315]|CORESOURCE [131500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|327||||327|16.22|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|327||||327|9.93|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|GEHA [1415]|GEHA [141500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|327||||327|21.31|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HEALTHNET [1495]|HEALTHNET [149500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|327||||327|11.69|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|327||||327|304.11|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|327||||327|196.2|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|327||||327|10.42|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|327||||327|163.5|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|327||||327|9.91|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|327||||327|12.78|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|327||||327|9.66|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MULTIPLAN [1680]|HMA [168003]|327||||327|14.21|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MULTIPLAN [1680]|IHC HS [168011]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|327||||327|10.66|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|327||||327|10.42|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|Self-pay|Self-pay|327||||327|98.1|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|327||||327|68.67|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|327||||327|9.28|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|327||||327|13.83|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|TRUSTMARK [2030]|STARMARK [203000]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|327||||327|156.8|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|UMR [2035]|UMR OPTIONS [203501]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|327||||327|9.44|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|327||||327|294.3|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|327||||327|6.31|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|327||||327|9.93|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|327||||327|9.47|304.11|6.31
30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|327||||327|163.5|304.11|6.31
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|AETNA [1015]|AETNA ACO WILCO [101532]|258||||258|12.76|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|258||||258|8.24|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|258||||258|8.76|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|258||||258|8.76|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|258||||258|129.26|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|258||||258|90.56|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|258||||258|9.97|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|258||||258|109.91|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|258||||258|129|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|258||||258|167.7|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|CORESOURCE [1315]|CORESOURCE [131500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|258||||258|22.16|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|258||||258|13.57|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|GEHA [1415]|GEHA [141500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|258||||258|18.18|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HEALTHNET [1495]|HEALTHNET [149500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|258||||258|9.97|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|258||||258|239.94|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|258||||258|154.8|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|258||||258|8.89|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|258||||258|129|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|258||||258|8.46|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|258||||258|10.91|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|258||||258|8.24|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MULTIPLAN [1680]|HMA [168003]|258||||258|12.12|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MULTIPLAN [1680]|IHC HS [168011]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|258||||258|9.1|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|258||||258|8.89|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|Self-pay|Self-pay|258||||258|77.4|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|258||||258|54.18|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|258||||258|7.92|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|258||||258|11.8|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|TRUSTMARK [2030]|STARMARK [203000]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|258||||258|123.71|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|UMR [2035]|UMR OPTIONS [203501]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|258||||258|8.06|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|258||||258|232.2|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|258||||258|5.38|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|258||||258|13.57|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|258||||258|8.08|239.94|5.38
30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|258||||258|129|239.94|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|209||||209|12.76|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209||||209|8.24|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209||||209|8.76|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209||||209|8.76|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|209||||209|104.71|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209||||209|73.36|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209||||209|9.97|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|209||||209|89.03|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|209||||209|104.5|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209||||209|135.85|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|CORESOURCE [1315]|CORESOURCE [131500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|209||||209|13.01|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|209||||209|7.96|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|GEHA [1415]|GEHA [141500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|209||||209|18.18|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HEALTHNET [1495]|HEALTHNET [149500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209||||209|9.97|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|209||||209|194.37|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209||||209|125.4|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209||||209|8.89|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209||||209|104.5|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209||||209|8.46|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209||||209|10.91|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209||||209|8.24|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MULTIPLAN [1680]|HMA [168003]|209||||209|12.12|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MULTIPLAN [1680]|IHC HS [168011]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|209||||209|9.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209||||209|8.89|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|Self-pay|Self-pay|209||||209|62.7|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209||||209|43.89|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|209||||209|7.92|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209||||209|11.8|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|TRUSTMARK [2030]|STARMARK [203000]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209||||209|100.22|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|UMR [2035]|UMR OPTIONS [203501]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209||||209|8.06|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209||||209|188.1|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|209||||209|5.38|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|209||||209|7.96|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|209||||209|8.08|194.37|5.38
30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|209||||209|104.5|194.37|5.38
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|AETNA [1015]|AETNA ACO WILCO [101532]|429||||429|10.47|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|429||||429|6.76|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|429||||429|7.18|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|429||||429|7.18|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|429||||429|214.93|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|429||||429|150.58|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|429||||429|8.18|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|429||||429|182.75|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|429||||429|214.5|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|429||||429|278.85|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|CORESOURCE [1315]|CORESOURCE [131500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|429||||429|10.7|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|429||||429|6.55|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|GEHA [1415]|GEHA [141500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|429||||429|14.92|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HEALTHNET [1495]|HEALTHNET [149500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|429||||429|8.18|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|429||||429|398.97|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|429||||429|257.4|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|429||||429|7.29|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|429||||429|214.5|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|429||||429|6.93|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|429||||429|8.95|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|429||||429|6.76|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MULTIPLAN [1680]|HMA [168003]|429||||429|9.95|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MULTIPLAN [1680]|IHC HS [168011]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|429||||429|7.46|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|429||||429|7.29|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|Self-pay|Self-pay|429||||429|128.7|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|429||||429|90.09|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|429||||429|6.5|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|429||||429|9.68|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|TRUSTMARK [2030]|STARMARK [203000]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|429||||429|205.71|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|UMR [2035]|UMR OPTIONS [203501]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|429||||429|6.6|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|429||||429|386.1|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|429||||429|4.42|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|429||||429|6.55|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|429||||429|6.63|398.97|4.42
30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|429||||429|214.5|398.97|4.42
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|315||||315|12.76|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|315||||315|8.23|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|315||||315|8.75|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|315||||315|8.75|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|315||||315|157.82|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|315||||315|110.57|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|315||||315|9.96|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|315||||315|134.19|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|315||||315|157.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|315||||315|204.75|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|CORESOURCE [1315]|CORESOURCE [131500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|315||||315|13.01|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|315||||315|7.96|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|GEHA [1415]|GEHA [141500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|315||||315|18.16|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HEALTHNET [1495]|HEALTHNET [149500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|315||||315|9.96|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|315||||315|292.95|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|315||||315|189|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|315||||315|8.88|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|315||||315|157.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|315||||315|8.45|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|315||||315|10.89|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|315||||315|8.23|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MULTIPLAN [1680]|HMA [168003]|315||||315|12.11|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MULTIPLAN [1680]|IHC HS [168011]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|315||||315|9.09|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|315||||315|8.88|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|Self-pay|Self-pay|315||||315|94.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|315||||315|66.15|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|315||||315|7.91|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|315||||315|11.78|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|TRUSTMARK [2030]|STARMARK [203000]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|315||||315|151.04|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|UMR [2035]|UMR OPTIONS [203501]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|315||||315|8.04|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|315||||315|283.5|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|315||||315|5.38|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|315||||315|7.96|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|315||||315|8.07|292.95|5.38
30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|315||||315|157.5|292.95|5.38
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|186||||186|12.79|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186||||186|8.76|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186||||186|8.76|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|186||||186|93.19|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186||||186|65.29|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186||||186|9.99|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|186||||186|79.24|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|186||||186|93|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186||||186|120.9|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|CORESOURCE [1315]|CORESOURCE [131500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|186||||186|13.55|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|186||||186|8.3|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|GEHA [1415]|GEHA [141500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HEALTHNET [1495]|HEALTHNET [149500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186||||186|9.99|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|186||||186|172.98|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186||||186|111.6|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186||||186|93|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186||||186|8.46|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MULTIPLAN [1680]|HMA [168003]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MULTIPLAN [1680]|IHC HS [168011]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|186||||186|9.1|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|Self-pay|Self-pay|186||||186|55.8|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186||||186|39.06|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|TRUSTMARK [2030]|STARMARK [203000]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186||||186|89.19|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|UMR [2035]|UMR OPTIONS [203501]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186||||186|8.06|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186||||186|167.4|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|186||||186|5.39|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|186||||186|8.3|172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|186||||186||172.98|5.39
30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|186||||186|93|172.98|5.39
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|AETNA [1015]|AETNA ACO WILCO [101532]|435||||435|12.17|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435||||435|8.36|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435||||435|8.36|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|435||||435|217.94|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435||||435|152.69|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435||||435|9.51|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|435||||435|185.31|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|435||||435|217.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435||||435|282.75|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|CORESOURCE [1315]|CORESOURCE [131500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|435||||435|17.71|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|435||||435|10.84|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|GEHA [1415]|GEHA [141500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HEALTHNET [1495]|HEALTHNET [149500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435||||435|9.51|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|435||||435|404.55|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435||||435|261|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435||||435|217.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435||||435|8.08|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MULTIPLAN [1680]|HMA [168003]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MULTIPLAN [1680]|IHC HS [168011]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|435||||435|8.69|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|Self-pay|Self-pay|435||||435|130.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435||||435|91.35|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|TRUSTMARK [2030]|STARMARK [203000]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435||||435|208.58|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|UMR [2035]|UMR OPTIONS [203501]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435||||435|7.69|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435||||435|391.5|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|435||||435|5.14|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|435||||435|10.84|404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|435||||435||404.55|5.14
30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|435||||435|217.5|404.55|5.14
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|AETNA [1015]|AETNA ACO WILCO [101532]|222||||222|13.28|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222||||222|8.58|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222||||222|9.12|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222||||222|9.12|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|222||||222|111.22|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222||||222|77.92|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222||||222|10.38|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|222||||222|94.57|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|222||||222|111|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222||||222|144.3|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|CORESOURCE [1315]|CORESOURCE [131500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|222||||222|17.71|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|222||||222|10.84|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|GEHA [1415]|GEHA [141500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|222||||222|18.92|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HEALTHNET [1495]|HEALTHNET [149500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222||||222|10.38|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|222||||222|206.46|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222||||222|133.2|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222||||222|9.25|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222||||222|111|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222||||222|8.81|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222||||222|11.35|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222||||222|8.58|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MULTIPLAN [1680]|HMA [168003]|222||||222|12.62|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MULTIPLAN [1680]|IHC HS [168011]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|222||||222|9.48|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222||||222|9.25|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|Self-pay|Self-pay|222||||222|66.6|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222||||222|46.62|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|222||||222|8.24|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222||||222|12.28|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|TRUSTMARK [2030]|STARMARK [203000]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222||||222|106.45|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|UMR [2035]|UMR OPTIONS [203501]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222||||222|8.39|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222||||222|199.8|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|222||||222|5.6|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|222||||222|10.84|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|222||||222|8.41|206.46|5.6
30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|222||||222|111|206.46|5.6
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|AETNA [1015]|AETNA ACO WILCO [101532]|170||||170|29.1|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170||||170|22.16|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170||||170|22.16|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170||||170|85.17|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170||||170|59.67|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170||||170|20.46|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170||||170|72.42|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170||||170|85|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170||||170|110.5|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|CORESOURCE [1315]|CORESOURCE [131500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170||||170|21.5|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170||||170|13.46|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|GEHA [1415]|GEHA [141500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HEALTHNET [1495]|HEALTHNET [149500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170||||170|20.46|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170||||170|158.1|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170||||170|102|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170||||170|85|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170||||170|21.4|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MULTIPLAN [1680]|HMA [168003]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MULTIPLAN [1680]|IHC HS [168011]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170||||170|23.03|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|Self-pay|Self-pay|170||||170|51|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170||||170|35.7|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|TRUSTMARK [2030]|STARMARK [203000]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170||||170|81.52|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|UMR [2035]|UMR OPTIONS [203501]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170||||170|20.38|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170||||170|153|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170||||170|12.28|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170||||170|13.46|158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170||||170||158.1|12.28
30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170||||170|85|158.1|12.28
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|AETNA [1015]|AETNA ACO WILCO [101532]|163||||163|16.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163||||163|10.53|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163||||163|11.18|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163||||163|11.18|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|163||||163|81.66|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163||||163|57.21|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163||||163|12.74|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|163||||163|69.44|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|163||||163|81.5|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163||||163|105.95|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|CORESOURCE [1315]|CORESOURCE [131500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|163||||163|19.77|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|163||||163|12.11|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|GEHA [1415]|GEHA [141500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|163||||163|23.22|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HEALTHNET [1495]|HEALTHNET [149500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163||||163|12.74|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|163||||163|151.59|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163||||163|97.8|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163||||163|11.35|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163||||163|81.5|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163||||163|10.79|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163||||163|13.93|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163||||163|10.53|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MULTIPLAN [1680]|HMA [168003]|163||||163|15.48|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MULTIPLAN [1680]|IHC HS [168011]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|163||||163|11.62|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163||||163|11.35|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|Self-pay|Self-pay|163||||163|48.9|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163||||163|34.23|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|163||||163|10.11|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163||||163|15.07|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|TRUSTMARK [2030]|STARMARK [203000]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163||||163|78.16|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|UMR [2035]|UMR OPTIONS [203501]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163||||163|10.28|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163||||163|146.7|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|163||||163|6.88|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|163||||163|12.11|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|163||||163|10.32|151.59|6.88
30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|163||||163|81.5|151.59|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|AETNA [1015]|AETNA ACO WILCO [101532]|102||||102|16.32|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102||||102|11.18|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102||||102|11.18|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102||||102|51.1|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102||||102|35.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102||||102|12.74|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102||||102|43.45|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102||||102|51|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102||||102|66.3|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|CORESOURCE [1315]|CORESOURCE [131500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102||||102|17.82|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102||||102|10.91|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|GEHA [1415]|GEHA [141500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HEALTHNET [1495]|HEALTHNET [149500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102||||102|12.74|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102||||102|94.86|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102||||102|61.2|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102||||102|51|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102||||102|10.79|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MULTIPLAN [1680]|HMA [168003]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MULTIPLAN [1680]|IHC HS [168011]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102||||102|11.62|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|Self-pay|Self-pay|102||||102|30.6|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102||||102|21.42|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|TRUSTMARK [2030]|STARMARK [203000]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102||||102|48.91|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|UMR [2035]|UMR OPTIONS [203501]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102||||102|10.28|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102||||102|91.8|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102||||102|6.88|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102||||102|10.91|94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102||||102||94.86|6.88
30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102||||102|51|94.86|6.88
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|AETNA [1015]|AETNA ACO WILCO [101532]|231||||231|24.33|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231||||231|16.68|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231||||231|16.68|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|231||||231|115.73|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231||||231|81.08|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231||||231|19|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|231||||231|98.41|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|231||||231|115.5|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231||||231|150.15|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|CORESOURCE [1315]|CORESOURCE [131500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|231||||231|26.82|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|231||||231|16.42|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|GEHA [1415]|GEHA [141500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HEALTHNET [1495]|HEALTHNET [149500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231||||231|19|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|231||||231|214.83|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231||||231|138.6|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231||||231|115.5|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231||||231|16.11|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MULTIPLAN [1680]|HMA [168003]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MULTIPLAN [1680]|IHC HS [168011]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|231||||231|17.34|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|Self-pay|Self-pay|231||||231|69.3|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231||||231|48.51|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|TRUSTMARK [2030]|STARMARK [203000]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231||||231|110.76|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|UMR [2035]|UMR OPTIONS [203501]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231||||231|15.34|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231||||231|207.9|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|231||||231|10.26|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|231||||231|16.42|214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|231||||231||214.83|10.26
30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|231||||231|115.5|214.83|10.26
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|208||||208|30.97|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208||||208|21.23|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208||||208|21.23|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|208||||208|104.21|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208||||208|73.01|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208||||208|24.19|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|208||||208|88.61|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|208||||208|104|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208||||208|135.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|CORESOURCE [1315]|CORESOURCE [131500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|208||||208|30.05|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|208||||208|18.4|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|GEHA [1415]|GEHA [141500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HEALTHNET [1495]|HEALTHNET [149500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208||||208|24.19|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|208||||208|193.44|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208||||208|124.8|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208||||208|104|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208||||208|20.51|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MULTIPLAN [1680]|HMA [168003]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MULTIPLAN [1680]|IHC HS [168011]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|208||||208|22.07|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|Self-pay|Self-pay|208||||208|62.4|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208||||208|43.68|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|TRUSTMARK [2030]|STARMARK [203000]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208||||208|99.74|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|UMR [2035]|UMR OPTIONS [203501]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208||||208|19.53|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208||||208|187.2|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|208||||208|13.06|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|208||||208|18.4|193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|208||||208||193.44|13.06
30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|208||||208|104|193.44|13.06
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|AETNA [1015]|AETNA ACO WILCO [101532]|256||||256|17.07|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|256||||256|11.02|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|256||||256|11.7|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|256||||256|11.7|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|256||||256|128.26|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|256||||256|89.86|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|256||||256|13.34|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|256||||256|109.06|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|256||||256|128|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|256||||256|166.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|CORESOURCE [1315]|CORESOURCE [131500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|256||||256|20.37|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|256||||256|12.47|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|GEHA [1415]|GEHA [141500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|256||||256|24.3|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HEALTHNET [1495]|HEALTHNET [149500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|256||||256|13.34|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|256||||256|238.08|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|256||||256|153.6|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|256||||256|11.88|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|256||||256|128|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|256||||256|11.3|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|256||||256|14.58|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|256||||256|11.02|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MULTIPLAN [1680]|HMA [168003]|256||||256|16.2|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MULTIPLAN [1680]|IHC HS [168011]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|256||||256|12.16|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|256||||256|11.88|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|Self-pay|Self-pay|256||||256|76.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|256||||256|53.76|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|256||||256|10.58|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|256||||256|15.77|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|TRUSTMARK [2030]|STARMARK [203000]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|256||||256|122.75|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|UMR [2035]|UMR OPTIONS [203501]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|256||||256|10.76|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|256||||256|230.4|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|256||||256|7.2|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|256||||256|12.47|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|256||||256|10.8|238.08|7.2
30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|256||||256|128|238.08|7.2
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|AETNA [1015]|AETNA ACO WILCO [101532]|118||||118|20.78|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118||||118|15.83|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118||||118|15.83|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118||||118|59.12|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118||||118|41.42|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118||||118|14.61|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118||||118|50.27|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118||||118|59|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118||||118|76.7|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|CORESOURCE [1315]|CORESOURCE [131500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118||||118|22.49|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118||||118|13.77|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|GEHA [1415]|GEHA [141500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HEALTHNET [1495]|HEALTHNET [149500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118||||118|14.61|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118||||118|109.74|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118||||118|70.8|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118||||118|59|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118||||118|15.28|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MULTIPLAN [1680]|HMA [168003]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MULTIPLAN [1680]|IHC HS [168011]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118||||118|16.45|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|Self-pay|Self-pay|118||||118|35.4|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118||||118|24.78|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|TRUSTMARK [2030]|STARMARK [203000]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118||||118|56.58|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|UMR [2035]|UMR OPTIONS [203501]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118||||118|14.55|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118||||118|106.2|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118||||118|8.77|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118||||118|13.77|109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118||||118||109.74|8.77
30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118||||118|59|109.74|8.77
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|AETNA [1015]|AETNA ACO WILCO [101532]|60||||60|8.8|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60||||60|6.04|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60||||60|6.04|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60||||60|30.06|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60||||60|21.06|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60||||60|6.88|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60||||60|25.56|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60||||60|30|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60||||60|39|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|CORESOURCE [1315]|CORESOURCE [131500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60||||60|21.46|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60||||60|13.14|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|GEHA [1415]|GEHA [141500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HEALTHNET [1495]|HEALTHNET [149500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60||||60|6.88|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60||||60|55.8|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60||||60|36|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60||||60|30|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60||||60|5.83|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MULTIPLAN [1680]|HMA [168003]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MULTIPLAN [1680]|IHC HS [168011]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60||||60|6.28|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|Self-pay|Self-pay|60||||60|18|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60||||60|12.6|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|TRUSTMARK [2030]|STARMARK [203000]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60||||60|28.77|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|UMR [2035]|UMR OPTIONS [203501]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60||||60|5.55|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60||||60|54|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60||||60|3.71|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60||||60|13.14|55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60||||60||55.8|3.71
30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60||||60|30|55.8|3.71
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|AETNA [1015]|AETNA ACO WILCO [101532]|176||||176|19.8|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176||||176|13.57|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176||||176|13.57|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|176||||176|88.18|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176||||176|61.78|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176||||176|15.46|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|176||||176|74.98|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|176||||176|88|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176||||176|114.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|CORESOURCE [1315]|CORESOURCE [131500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|176||||176|23.39|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|176||||176|14.32|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|GEHA [1415]|GEHA [141500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HEALTHNET [1495]|HEALTHNET [149500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176||||176|15.46|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|176||||176|163.68|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176||||176|105.6|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176||||176|88|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176||||176|13.11|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MULTIPLAN [1680]|HMA [168003]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MULTIPLAN [1680]|IHC HS [168011]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|176||||176|14.1|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|Self-pay|Self-pay|176||||176|52.8|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176||||176|36.96|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|TRUSTMARK [2030]|STARMARK [203000]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176||||176|84.39|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|UMR [2035]|UMR OPTIONS [203501]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176||||176|12.48|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176||||176|158.4|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|176||||176|8.35|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|176||||176|14.32|163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|176||||176||163.68|8.35
30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|176||||176|88|163.68|8.35
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|61||||61|8.18|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61||||61|5.61|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61||||61|5.61|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61||||61|30.56|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61||||61|21.41|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61||||61|6.39|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61||||61|25.99|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61||||61|30.5|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61||||61|39.65|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|CORESOURCE [1315]|CORESOURCE [131500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61||||61|19.62|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61||||61|12.01|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|GEHA [1415]|GEHA [141500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HEALTHNET [1495]|HEALTHNET [149500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61||||61|6.39|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61||||61|56.73|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61||||61|36.6|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61||||61|30.5|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61||||61|5.42|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MULTIPLAN [1680]|HMA [168003]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MULTIPLAN [1680]|IHC HS [168011]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61||||61|5.83|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|Self-pay|Self-pay|61||||61|18.3|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61||||61|12.81|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|TRUSTMARK [2030]|STARMARK [203000]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61||||61|29.25|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|UMR [2035]|UMR OPTIONS [203501]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61||||61|5.17|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61||||61|54.9|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61||||61|3.45|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61||||61|12.01|56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61||||61||56.73|3.45
30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61||||61|30.5|56.73|3.45
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|379||||379|31.7|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|379||||379|21.73|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|379||||379|21.73|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|379||||379|189.88|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|379||||379|133.03|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|379||||379|24.76|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|379||||379|161.45|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|379||||379|189.5|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|379||||379|246.35|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|379||||379|35.12|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|379||||379|21.5|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|GEHA [1415]|GEHA [141500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|379||||379|24.76|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|379||||379|352.47|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|379||||379|227.4|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|379||||379|189.5|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|379||||379|20.99|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MULTIPLAN [1680]|HMA [168003]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|379||||379|22.59|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|Self-pay|Self-pay|379||||379|113.7|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|379||||379|79.59|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|379||||379|181.73|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|UMR [2035]|UMR OPTIONS [203501]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|379||||379|19.99|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|379||||379|341.1|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|379||||379|13.37|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|379||||379|21.5|352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|379||||379||352.47|13.37
30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING NUC ACID DIRECT PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|379||||379|189.5|352.47|13.37
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|428||||428|55.46|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|428||||428|35.79|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|428||||428|38.01|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|428||||428|38.01|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|428||||428|214.43|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|428||||428|150.23|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|428||||428|43.33|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|428||||428|182.33|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|428||||428|214|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|428||||428|278.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|428||||428|52.98|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|428||||428|32.44|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|GEHA [1415]|GEHA [141500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|428||||428|78.95|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|428||||428|43.33|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|428||||428|398.04|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|428||||428|256.8|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|428||||428|38.6|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|428||||428|214|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|428||||428|36.71|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|428||||428|47.37|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|428||||428|35.79|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MULTIPLAN [1680]|HMA [168003]|428||||428|52.64|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|428||||428|39.51|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|428||||428|38.6|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|Self-pay|Self-pay|428||||428|128.4|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|428||||428|89.88|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|428||||428|34.39|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|428||||428|51.23|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|428||||428|205.23|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|UMR [2035]|UMR OPTIONS [203501]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|428||||428|34.97|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|428||||428|385.2|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|428||||428|23.39|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|428||||428|32.44|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|428||||428|35.09|398.04|23.39
30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|428||||428|214|398.04|23.39
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|AETNA [1015]|AETNA ACO WILCO [101532]|75||||75|11.01|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75||||75|8.39|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75||||75|8.39|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75||||75|37.58|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75||||75|26.33|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75||||75|7.74|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75||||75|31.95|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75||||75|37.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75||||75|48.75|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|CORESOURCE [1315]|CORESOURCE [131500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75||||75|9.51|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75||||75|5.82|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|GEHA [1415]|GEHA [141500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HEALTHNET [1495]|HEALTHNET [149500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75||||75|7.74|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75||||75|69.75|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75||||75|45|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75||||75|37.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75||||75|8.11|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MULTIPLAN [1680]|HMA [168003]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MULTIPLAN [1680]|IHC HS [168011]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75||||75|8.72|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|Self-pay|Self-pay|75||||75|22.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75||||75|15.75|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|TRUSTMARK [2030]|STARMARK [203000]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75||||75|35.96|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|UMR [2035]|UMR OPTIONS [203501]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75||||75|7.72|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75||||75|67.5|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75||||75|4.64|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75||||75|5.82|69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75||||75||69.75|4.64
30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75||||75|37.5|69.75|4.64
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|1407||||1407|182.31|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1407||||1407|124.99|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1407||||1407|124.99|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1407||||1407|704.91|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1407||||1407|493.86|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1407||||1407|142.42|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1407||||1407|599.38|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1407||||1407|703.5|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1407||||1407|914.55|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|CORESOURCE [1315]|CORESOURCE [131500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1407||||1407|174.23|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1407||||1407|106.67|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|GEHA [1415]|GEHA [141500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HEALTHNET [1495]|HEALTHNET [149500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1407||||1407|142.42|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1407||||1407|1308.51|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1407||||1407|844.2|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1407||||1407|703.5|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1407||||1407|120.72|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MULTIPLAN [1680]|HMA [168003]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MULTIPLAN [1680]|IHC HS [168011]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1407||||1407|129.91|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|Self-pay|Self-pay|1407||||1407|422.1|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1407||||1407|295.47|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|TRUSTMARK [2030]|STARMARK [203000]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1407||||1407|674.66|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|UMR [2035]|UMR OPTIONS [203501]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1407||||1407|114.97|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1407||||1407|1266.3|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1407||||1407|76.9|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1407||||1407|106.67|1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1407||||1407||1308.51|76.9
30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1407||||1407|703.5|1308.51|76.9
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|74||||74|11.01|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74||||74|8.39|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74||||74|8.39|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74||||74|37.07|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74||||74|25.97|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74||||74|7.74|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74||||74|31.52|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74||||74|37|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74||||74|48.1|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|CORESOURCE [1315]|CORESOURCE [131500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74||||74|7.91|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74||||74|5.11|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|GEHA [1415]|GEHA [141500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HEALTHNET [1495]|HEALTHNET [149500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74||||74|7.74|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74||||74|68.82|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74||||74|44.4|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74||||74|37|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74||||74|8.11|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MULTIPLAN [1680]|HMA [168003]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MULTIPLAN [1680]|IHC HS [168011]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74||||74|8.72|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|Self-pay|Self-pay|74||||74|22.2|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74||||74|15.54|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|TRUSTMARK [2030]|STARMARK [203000]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74||||74|35.48|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|UMR [2035]|UMR OPTIONS [203501]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74||||74|7.72|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74||||74|66.6|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74||||74|4.64|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74||||74|5.11|68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74||||74||68.82|4.64
30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74||||74|37|68.82|4.64
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|63||||63|6.75|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63||||63|4.62|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63||||63|4.62|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63||||63|31.56|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63||||63|22.11|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63||||63|5.27|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63||||63|26.84|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63||||63|31.5|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63||||63|40.95|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|CORESOURCE [1315]|CORESOURCE [131500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63||||63|7.59|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63||||63|4.65|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|GEHA [1415]|GEHA [141500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HEALTHNET [1495]|HEALTHNET [149500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63||||63|5.27|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63||||63|58.59|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63||||63|37.8|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63||||63|31.5|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63||||63|4.46|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MULTIPLAN [1680]|HMA [168003]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MULTIPLAN [1680]|IHC HS [168011]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63||||63|4.8|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|Self-pay|Self-pay|63||||63|18.9|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63||||63|13.23|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|TRUSTMARK [2030]|STARMARK [203000]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63||||63|30.21|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|UMR [2035]|UMR OPTIONS [203501]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63||||63|4.25|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63||||63|56.7|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63||||63|2.85|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63||||63|4.65|58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63||||63||58.59|2.85
30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63||||63|31.5|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|AETNA [1015]|AETNA ACO WILCO [101532]|63||||63|6.75|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63||||63|4.67|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63||||63|4.67|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63||||63|31.56|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63||||63|22.11|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63||||63|5.27|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63||||63|26.84|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63||||63|31.5|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63||||63|40.95|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|CORESOURCE [1315]|CORESOURCE [131500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63||||63|7.59|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63||||63|4.65|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|GEHA [1415]|GEHA [141500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HEALTHNET [1495]|HEALTHNET [149500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63||||63|5.27|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63||||63|58.59|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63||||63|37.8|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63||||63|31.5|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63||||63|4.51|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MULTIPLAN [1680]|HMA [168003]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MULTIPLAN [1680]|IHC HS [168011]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63||||63|4.85|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|Self-pay|Self-pay|63||||63|18.9|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63||||63|13.23|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|TRUSTMARK [2030]|STARMARK [203000]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63||||63|30.21|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|UMR [2035]|UMR OPTIONS [203501]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63||||63|4.29|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63||||63|56.7|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63||||63|2.85|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63||||63|4.65|58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63||||63||58.59|2.85
30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63||||63|31.5|58.59|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|AETNA [1015]|AETNA ACO WILCO [101532]|96||||96|6.75|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96||||96|4.62|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96||||96|4.62|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96||||96|48.1|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96||||96|33.7|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96||||96|5.27|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96||||96|40.9|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96||||96|48|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96||||96|62.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|CORESOURCE [1315]|CORESOURCE [131500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96||||96|7.59|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96||||96|4.65|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|GEHA [1415]|GEHA [141500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HEALTHNET [1495]|HEALTHNET [149500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96||||96|5.27|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96||||96|89.28|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96||||96|57.6|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96||||96|48|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96||||96|4.46|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MULTIPLAN [1680]|HMA [168003]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MULTIPLAN [1680]|IHC HS [168011]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96||||96|4.8|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|Self-pay|Self-pay|96||||96|28.8|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96||||96|20.16|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|TRUSTMARK [2030]|STARMARK [203000]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96||||96|46.03|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|UMR [2035]|UMR OPTIONS [203501]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96||||96|4.25|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96||||96|86.4|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96||||96|2.85|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96||||96|4.65|89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96||||96||89.28|2.85
30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PINWORM EXAM (EG CELLOPHANE TAPE PREP)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96||||96|48|89.28|2.85
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|AETNA [1015]|AETNA ACO WILCO [101532]|195||||195|14.07|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195||||195|9.08|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195||||195|9.65|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195||||195|9.65|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|195||||195|97.7|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195||||195|68.45|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195||||195|10.99|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|195||||195|83.07|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|195||||195|97.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195||||195|126.75|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|CORESOURCE [1315]|CORESOURCE [131500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|195||||195|16.01|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|195||||195|9.8|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|GEHA [1415]|GEHA [141500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|195||||195|20.03|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HEALTHNET [1495]|HEALTHNET [149500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195||||195|10.99|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|195||||195|181.35|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195||||195|117|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195||||195|9.79|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195||||195|97.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195||||195|9.32|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195||||195|12.02|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195||||195|9.08|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MULTIPLAN [1680]|HMA [168003]|195||||195|13.35|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MULTIPLAN [1680]|IHC HS [168011]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|195||||195|10.03|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195||||195|9.79|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|Self-pay|Self-pay|195||||195|58.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195||||195|40.95|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|195||||195|8.72|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195||||195|12.99|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|TRUSTMARK [2030]|STARMARK [203000]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195||||195|93.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|UMR [2035]|UMR OPTIONS [203501]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195||||195|8.88|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195||||195|175.5|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|195||||195|5.93|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|195||||195|9.8|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|195||||195|8.9|181.35|5.93
30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|195||||195|97.5|181.35|5.93
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|71||||71|7.49|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71||||71|5.15|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71||||71|5.15|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71||||71|35.57|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71||||71|24.92|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71||||71|5.86|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71||||71|30.25|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71||||71|35.5|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71||||71|46.15|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|CORESOURCE [1315]|CORESOURCE [131500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71||||71|11.7|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71||||71|7.16|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|GEHA [1415]|GEHA [141500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HEALTHNET [1495]|HEALTHNET [149500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71||||71|5.86|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71||||71|66.03|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71||||71|42.6|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71||||71|35.5|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71||||71|4.98|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MULTIPLAN [1680]|HMA [168003]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MULTIPLAN [1680]|IHC HS [168011]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71||||71|5.35|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|Self-pay|Self-pay|71||||71|21.3|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71||||71|14.91|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|TRUSTMARK [2030]|STARMARK [203000]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71||||71|34.04|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|UMR [2035]|UMR OPTIONS [203501]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71||||71|4.74|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71||||71|63.9|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71||||71|3.16|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71||||71|7.16|66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71||||71||66.03|3.16
30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71||||71|35.5|66.03|3.16
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|113||||113|10.9|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113||||113|7.63|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113||||113|8.1|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113||||113|8.1|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|113||||113|56.61|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113||||113|39.66|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113||||113|8.51|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|113||||113|48.14|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|113||||113|56.5|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113||||113|73.45|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|CORESOURCE [1315]|CORESOURCE [131500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|113||||113|10.85|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|113||||113|6.65|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|GEHA [1415]|GEHA [141500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|113||||113|16.83|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HEALTHNET [1495]|HEALTHNET [149500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113||||113|8.51|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|113||||113|105.09|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113||||113|67.8|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113||||113|8.23|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113||||113|56.5|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113||||113|7.83|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113||||113|10.1|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113||||113|7.63|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MULTIPLAN [1680]|HMA [168003]|113||||113|11.22|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MULTIPLAN [1680]|IHC HS [168011]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|113||||113|8.42|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113||||113|8.23|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|Self-pay|Self-pay|113||||113|33.9|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113||||113|23.73|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|113||||113|7.33|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113||||113|10.92|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|TRUSTMARK [2030]|STARMARK [203000]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113||||113|54.18|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|UMR [2035]|UMR OPTIONS [203501]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113||||113|7.45|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113||||113|101.7|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|113||||113|4.6|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|113||||113|6.65|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|113||||113|7.48|105.09|4.6
30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|113||||113|56.5|105.09|4.6
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|59||||59|7.49|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59||||59|5.15|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59||||59|5.15|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|59||||59|29.56|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59||||59|20.71|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59||||59|5.86|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|59||||59|25.13|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|59||||59|29.5|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59||||59|38.35|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|CORESOURCE [1315]|CORESOURCE [131500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|59||||59|8.9|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|59||||59|5.45|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|GEHA [1415]|GEHA [141500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HEALTHNET [1495]|HEALTHNET [149500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59||||59|5.86|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|59||||59|54.87|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59||||59|35.4|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59||||59|29.5|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59||||59|4.98|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MULTIPLAN [1680]|HMA [168003]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MULTIPLAN [1680]|IHC HS [168011]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|59||||59|5.35|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|Self-pay|Self-pay|59||||59|17.7|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59||||59|12.39|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|TRUSTMARK [2030]|STARMARK [203000]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59||||59|28.29|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|UMR [2035]|UMR OPTIONS [203501]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59||||59|4.74|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59||||59|53.1|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|59||||59|3.16|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|59||||59|5.45|54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|59||||59||54.87|3.16
30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|59||||59|29.5|54.87|3.16
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|313||||313|13.66|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|313||||313|8.82|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|313||||313|9.37|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|313||||313|9.37|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|313||||313|156.81|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|313||||313|109.86|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|313||||313|10.67|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|313||||313|133.34|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|313||||313|156.5|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|313||||313|203.45|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|CORESOURCE [1315]|CORESOURCE [131500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|313||||313|13.3|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|313||||313|8.14|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|GEHA [1415]|GEHA [141500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|313||||313|19.46|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HEALTHNET [1495]|HEALTHNET [149500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|313||||313|10.67|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|313||||313|291.09|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|313||||313|187.8|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|313||||313|9.52|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|313||||313|156.5|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|313||||313|9.05|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|313||||313|11.68|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|313||||313|8.82|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MULTIPLAN [1680]|HMA [168003]|313||||313|12.98|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MULTIPLAN [1680]|IHC HS [168011]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|313||||313|9.74|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|313||||313|9.52|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|Self-pay|Self-pay|313||||313|93.9|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|313||||313|65.73|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|313||||313|8.48|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|313||||313|12.63|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|TRUSTMARK [2030]|STARMARK [203000]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|313||||313|150.08|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|UMR [2035]|UMR OPTIONS [203501]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|313||||313|8.62|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|313||||313|281.7|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|313||||313|5.77|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|313||||313|8.14|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|313||||313|8.65|291.09|5.77
30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|313||||313|156.5|291.09|5.77
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|141||||141|10.49|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141||||141|7.19|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141||||141|7.19|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|141||||141|70.64|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141||||141|49.49|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141||||141|8.2|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|141||||141|60.07|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|141||||141|70.5|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141||||141|91.65|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|CORESOURCE [1315]|CORESOURCE [131500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|141||||141|14.6|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|141||||141|8.94|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|GEHA [1415]|GEHA [141500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HEALTHNET [1495]|HEALTHNET [149500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141||||141|8.2|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|141||||141|131.13|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141||||141|84.6|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141||||141|70.5|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141||||141|6.94|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MULTIPLAN [1680]|HMA [168003]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MULTIPLAN [1680]|IHC HS [168011]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|141||||141|7.47|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|Self-pay|Self-pay|141||||141|42.3|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141||||141|29.61|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|TRUSTMARK [2030]|STARMARK [203000]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141||||141|67.61|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|UMR [2035]|UMR OPTIONS [203501]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141||||141|6.61|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141||||141|126.9|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|141||||141|4.43|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|141||||141|8.94|131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|141||||141||131.13|4.43
30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|141||||141|70.5|131.13|4.43
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|AETNA [1015]|AETNA ACO WILCO [101532]|63||||63|10.39|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63||||63|7.92|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63||||63|7.92|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63||||63|31.56|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63||||63|22.11|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63||||63|7.31|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63||||63|26.84|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63||||63|31.5|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63||||63|40.95|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|CORESOURCE [1315]|CORESOURCE [131500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63||||63|8.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63||||63|5.32|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|GEHA [1415]|GEHA [141500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HEALTHNET [1495]|HEALTHNET [149500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63||||63|7.31|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63||||63|58.59|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63||||63|37.8|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63||||63|31.5|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63||||63|7.65|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MULTIPLAN [1680]|HMA [168003]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MULTIPLAN [1680]|IHC HS [168011]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63||||63|8.23|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|Self-pay|Self-pay|63||||63|18.9|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63||||63|13.23|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|TRUSTMARK [2030]|STARMARK [203000]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63||||63|30.21|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|UMR [2035]|UMR OPTIONS [203501]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63||||63|7.29|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63||||63|56.7|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63||||63|4.39|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63||||63|5.32|58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63||||63||58.59|4.39
30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63||||63|31.5|58.59|4.39
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|130||||130|6.75|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130||||130|4.36|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130||||130|4.62|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130||||130|4.62|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|130||||130|65.13|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130||||130|45.63|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130||||130|5.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|130||||130|55.38|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|130||||130|65|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130||||130|84.5|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|130||||130|9.19|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|130||||130|5.63|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|GEHA [1415]|GEHA [141500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|130||||130|9.61|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130||||130|5.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|130||||130|120.9|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130||||130|78|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130||||130|4.7|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130||||130|65|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130||||130|4.46|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130||||130|5.76|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130||||130|4.36|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MULTIPLAN [1680]|HMA [168003]|130||||130|6.41|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MULTIPLAN [1680]|IHC HS [168011]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|130||||130|4.8|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130||||130|4.7|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|Self-pay|Self-pay|130||||130|39|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130||||130|27.3|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|130||||130|4.18|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130||||130|6.23|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|TRUSTMARK [2030]|STARMARK [203000]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130||||130|62.34|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|UMR [2035]|UMR OPTIONS [203501]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130||||130|4.25|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130||||130|117|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|130||||130|2.85|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|130||||130|5.63|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|130||||130|4.27|120.9|2.85
30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|130||||130|65|120.9|2.85
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|AETNA [1015]|AETNA ACO WILCO [101532]|192||||192|8.52|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192||||192|5.5|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192||||192|5.84|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192||||192|5.84|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192||||192|96.19|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192||||192|67.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192||||192|6.65|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192||||192|81.79|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192||||192|96|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192||||192|124.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|CORESOURCE [1315]|CORESOURCE [131500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192||||192|12.94|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192||||192|7.92|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|GEHA [1415]|GEHA [141500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192||||192|12.13|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HEALTHNET [1495]|HEALTHNET [149500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192||||192|6.65|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192||||192|178.56|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192||||192|115.2|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192||||192|5.93|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192||||192|96|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192||||192|5.64|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192||||192|7.28|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192||||192|5.5|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MULTIPLAN [1680]|HMA [168003]|192||||192|8.09|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MULTIPLAN [1680]|IHC HS [168011]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192||||192|6.07|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192||||192|5.93|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|Self-pay|Self-pay|192||||192|57.6|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192||||192|40.32|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192||||192|5.28|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192||||192|7.87|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|TRUSTMARK [2030]|STARMARK [203000]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192||||192|92.06|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|UMR [2035]|UMR OPTIONS [203501]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192||||192|5.37|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192||||192|172.8|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192||||192|3.59|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192||||192|7.92|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192||||192|5.39|178.56|3.59
30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192||||192|96|178.56|3.59
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|AETNA [1015]|AETNA ACO WILCO [101532]|151||||151|9.48|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151||||151|6.49|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151||||151|6.49|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|151||||151|75.65|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151||||151|53|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151||||151|7.4|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|151||||151|64.33|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|151||||151|75.5|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151||||151|98.15|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|CORESOURCE [1315]|CORESOURCE [131500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|151||||151|25.33|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|151||||151|15.51|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|GEHA [1415]|GEHA [141500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HEALTHNET [1495]|HEALTHNET [149500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151||||151|7.4|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|151||||151|140.43|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151||||151|90.6|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151||||151|75.5|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151||||151|6.26|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MULTIPLAN [1680]|HMA [168003]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MULTIPLAN [1680]|IHC HS [168011]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|151||||151|6.75|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|Self-pay|Self-pay|151||||151|45.3|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151||||151|31.71|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|TRUSTMARK [2030]|STARMARK [203000]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151||||151|72.4|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|UMR [2035]|UMR OPTIONS [203501]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151||||151|5.97|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151||||151|135.9|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|151||||151|4|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|151||||151|15.51|140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|151||||151||140.43|4
30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|151||||151|75.5|140.43|4
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|AETNA [1015]|AETNA ACO WILCO [101532]|247||||247|28.4|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247||||247|18.34|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247||||247|19.48|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247||||247|19.48|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|247||||247|123.75|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247||||247|86.7|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247||||247|22.19|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|247||||247|105.22|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|247||||247|123.5|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247||||247|160.55|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|CORESOURCE [1315]|CORESOURCE [131500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|CORVEL CORP [2235]|CORVEL CORP [223500]|247||||247|24.47|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|247||||247|14.4|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|GEHA [1415]|GEHA [141500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|247||||247|40.46|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HEALTHNET [1495]|HEALTHNET [149500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247||||247|22.19|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HEALTHSMART [1505]|HEALTHSMART [150501]|247||||247|229.71|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247||||247|148.2|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247||||247|19.78|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247||||247|123.5|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247||||247|18.82|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247||||247|24.27|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247||||247|18.34|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MULTIPLAN [1680]|HMA [168003]|247||||247|26.97|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MULTIPLAN [1680]|IHC HS [168011]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|247||||247|20.25|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247||||247|19.78|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|Self-pay|Self-pay|247||||247|74.1|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247||||247|51.87|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|247||||247|17.62|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247||||247|26.25|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|TRUSTMARK [2030]|STARMARK [203000]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247||||247|118.44|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|UMR [2035]|UMR OPTIONS [203501]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247||||247|17.92|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247||||247|222.3|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|247||||247|11.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|247||||247|14.4|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|247||||247|17.98|229.71|11.98
30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|247||||247|123.5|229.71|11.98
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|150||||150|8.28|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150||||150|5.94|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150||||150|6.3|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150||||150|6.3|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|150||||150|75.15|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150||||150|52.65|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|150||||150|63.9|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|150||||150|75|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150||||150|97.5|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|150||||150|7.14|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|150||||150|4.37|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|GEHA [1415]|GEHA [141500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|150||||150|13.1|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|150||||150|139.5|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150||||150|90|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150||||150|6.4|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150||||150|75|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150||||150|6.09|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150||||150|7.86|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150||||150|5.94|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MULTIPLAN [1680]|HMA [168003]|150||||150|8.73|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MULTIPLAN [1680]|IHC HS [168011]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|150||||150|6.55|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150||||150|6.4|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|Self-pay|Self-pay|150||||150|45|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150||||150|31.5|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|150||||150|5.7|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150||||150|8.5|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|TRUSTMARK [2030]|STARMARK [203000]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150||||150|71.93|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|UMR [2035]|UMR OPTIONS [203501]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150||||150|5.8|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150||||150|135|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|150||||150|3.49|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|150||||150|4.37|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|150||||150|5.82|139.5|3.49
30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|150||||150|75|139.5|3.49
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|177||||177|6.75|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177||||177|4.36|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177||||177|4.62|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177||||177|4.62|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|177||||177|88.68|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177||||177|62.13|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177||||177|5.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|177||||177|75.4|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|177||||177|88.5|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177||||177|115.05|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|CORESOURCE [1315]|CORESOURCE [131500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|177||||177|10.22|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|177||||177|6.26|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|GEHA [1415]|GEHA [141500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|177||||177|9.61|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HEALTHNET [1495]|HEALTHNET [149500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177||||177|5.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|177||||177|164.61|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177||||177|106.2|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177||||177|4.7|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177||||177|88.5|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177||||177|4.46|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177||||177|5.76|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177||||177|4.36|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MULTIPLAN [1680]|HMA [168003]|177||||177|6.41|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MULTIPLAN [1680]|IHC HS [168011]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|177||||177|4.8|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177||||177|4.7|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|Self-pay|Self-pay|177||||177|53.1|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177||||177|37.17|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|177||||177|4.18|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177||||177|6.23|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|TRUSTMARK [2030]|STARMARK [203000]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177||||177|84.87|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|UMR [2035]|UMR OPTIONS [203501]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177||||177|4.25|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177||||177|159.3|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|177||||177|2.85|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|177||||177|6.26|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|177||||177|4.27|164.61|2.85
30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|177||||177|88.5|164.61|2.85
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|31.19|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|21.39|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|21.39|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|24.37|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|31.61|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|19.35|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|24.37|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|20.66|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MULTIPLAN [1680]|HMA [168003]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|22.23|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|Self-pay|Self-pay|242||||242|72.6|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|19.68|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|13.16|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|19.35|225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242||225.06|13.16
30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|13.16
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|466||||466|41.2|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|466||||466|28.25|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|466||||466|28.25|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|466||||466|233.47|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|466||||466|163.57|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|466||||466|32.18|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|466||||466|198.52|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|466||||466|233|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|466||||466|302.9|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|CORESOURCE [1315]|CORESOURCE [131500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|466||||466|39.47|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|466||||466|24.16|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|GEHA [1415]|GEHA [141500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HEALTHNET [1495]|HEALTHNET [149500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|466||||466|32.18|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|466||||466|433.38|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|466||||466|279.6|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|466||||466|233|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|466||||466|27.29|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MULTIPLAN [1680]|HMA [168003]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MULTIPLAN [1680]|IHC HS [168011]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|466||||466|29.36|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|Self-pay|Self-pay|466||||466|139.8|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|466||||466|97.86|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|TRUSTMARK [2030]|STARMARK [203000]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|466||||466|223.45|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|UMR [2035]|UMR OPTIONS [203501]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|466||||466|25.99|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|466||||466|419.4|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|466||||466|17.38|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|466||||466|24.16|433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|466||||466||433.38|17.38
30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|466||||466|233|433.38|17.38
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|194||||194|30.91|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194||||194|21.2|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194||||194|21.2|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|194||||194|97.19|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194||||194|68.09|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194||||194|24.15|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|194||||194|82.64|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|194||||194|97|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194||||194|126.1|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|194||||194|26.1|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|194||||194|15.63|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|GEHA [1415]|GEHA [141500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194||||194|24.15|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|194||||194|180.42|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194||||194|116.4|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194||||194|97|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194||||194|20.47|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MULTIPLAN [1680]|HMA [168003]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|194||||194|22.03|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|Self-pay|Self-pay|194||||194|58.2|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194||||194|40.74|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194||||194|93.02|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|UMR [2035]|UMR OPTIONS [203501]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194||||194|19.5|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194||||194|174.6|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|194||||194|13.04|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|194||||194|15.63|180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|194||||194||180.42|13.04
30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|194||||194|97|180.42|13.04
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|AETNA [1015]|AETNA ACO WILCO [101532]|444||||444|53.51|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|444||||444|34.54|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|444||||444|36.69|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|444||||444|36.69|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|444||||444|222.44|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|444||||444|155.84|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|444||||444|41.81|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|444||||444|189.14|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|444||||444|222|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|444||||444|288.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|CORESOURCE [1315]|CORESOURCE [131500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|444||||444|234.99|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|444||||444|143.87|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|GEHA [1415]|GEHA [141500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|444||||444|76.19|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HEALTHNET [1495]|HEALTHNET [149500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|444||||444|41.81|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|444||||444|412.92|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|444||||444|266.4|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|444||||444|37.25|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|444||||444|222|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|444||||444|35.44|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|444||||444|45.71|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|444||||444|34.54|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MULTIPLAN [1680]|HMA [168003]|444||||444|50.79|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MULTIPLAN [1680]|IHC HS [168011]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|444||||444|38.13|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|444||||444|37.25|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|Self-pay|Self-pay|444||||444|133.2|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|444||||444|93.24|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|444||||444|33.18|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|444||||444|49.44|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|TRUSTMARK [2030]|STARMARK [203000]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|444||||444|212.9|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|UMR [2035]|UMR OPTIONS [203501]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|444||||444|33.75|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|444||||444|399.6|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|444||||444|22.57|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|444||||444|143.87|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|444||||444|33.86|412.92|22.57
30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|444||||444|222|412.92|22.57
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|141||||141|20.53|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141||||141|15.63|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141||||141|15.63|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|141||||141|70.64|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141||||141|49.49|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141||||141|14.8|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|141||||141|60.07|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|141||||141|70.5|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141||||141|91.65|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|141||||141|20.62|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|141||||141|12.63|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|GEHA [1415]|GEHA [141500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141||||141|14.8|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|141||||141|131.13|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141||||141|84.6|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141||||141|70.5|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141||||141|15.09|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MULTIPLAN [1680]|HMA [168003]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|141||||141|16.25|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|Self-pay|Self-pay|141||||141|42.3|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141||||141|29.61|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141||||141|67.61|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|UMR [2035]|UMR OPTIONS [203501]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141||||141|14.37|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141||||141|126.9|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|141||||141|8.66|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|141||||141|12.63|131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|141||||141||131.13|8.66
30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|141||||141|70.5|131.13|8.66
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|AETNA [1015]|AETNA ACO WILCO [101532]|169||||169|18.95|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169||||169|12.98|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169||||169|12.98|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169||||169|84.67|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169||||169|59.32|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169||||169|14.8|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169||||169|71.99|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169||||169|84.5|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169||||169|109.85|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|CORESOURCE [1315]|CORESOURCE [131500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169||||169|20.62|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169||||169|12.63|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|GEHA [1415]|GEHA [141500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HEALTHNET [1495]|HEALTHNET [149500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169||||169|14.8|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169||||169|157.17|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169||||169|101.4|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169||||169|84.5|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169||||169|12.54|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MULTIPLAN [1680]|HMA [168003]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MULTIPLAN [1680]|IHC HS [168011]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169||||169|13.49|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|Self-pay|Self-pay|169||||169|50.7|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169||||169|35.49|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|TRUSTMARK [2030]|STARMARK [203000]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169||||169|81.04|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|UMR [2035]|UMR OPTIONS [203501]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169||||169|11.94|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169||||169|152.1|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169||||169|7.99|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169||||169|12.63|157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169||||169||157.17|7.99
30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169||||169|84.5|157.17|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|147||||147|18.95|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147||||147|12.22|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147||||147|12.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147||||147|12.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|147||||147|73.65|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147||||147|51.6|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147||||147|14.8|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|147||||147|62.62|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|147||||147|73.5|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147||||147|95.55|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|147||||147|20.62|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|147||||147|12.63|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|GEHA [1415]|GEHA [141500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|147||||147|26.96|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147||||147|14.8|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|147||||147|136.71|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147||||147|88.2|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147||||147|13.18|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147||||147|73.5|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147||||147|12.54|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147||||147|16.17|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147||||147|12.22|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MULTIPLAN [1680]|HMA [168003]|147||||147|17.97|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MULTIPLAN [1680]|IHC HS [168011]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|147||||147|13.49|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147||||147|13.18|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|Self-pay|Self-pay|147||||147|44.1|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147||||147|30.87|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|147||||147|11.74|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147||||147|17.49|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|TRUSTMARK [2030]|STARMARK [203000]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147||||147|70.49|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|UMR [2035]|UMR OPTIONS [203501]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147||||147|11.94|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147||||147|132.3|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|147||||147|7.99|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|147||||147|12.63|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|147||||147|11.98|136.71|7.99
30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|147||||147|73.5|136.71|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|AETNA [1015]|AETNA ACO WILCO [101532]|53||||53|18.95|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53||||53|12.98|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53||||53|12.98|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53||||53|26.55|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53||||53|18.6|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53||||53|14.8|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53||||53|22.58|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53||||53|26.5|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53||||53|34.45|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|CORESOURCE [1315]|CORESOURCE [131500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53||||53|21.12|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53||||53|12.93|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|GEHA [1415]|GEHA [141500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HEALTHNET [1495]|HEALTHNET [149500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53||||53|14.8|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53||||53|49.29|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53||||53|31.8|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53||||53|26.5|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53||||53|12.54|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MULTIPLAN [1680]|HMA [168003]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MULTIPLAN [1680]|IHC HS [168011]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53||||53|13.49|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|Self-pay|Self-pay|53||||53|15.9|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53||||53|11.13|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|TRUSTMARK [2030]|STARMARK [203000]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53||||53|25.41|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|UMR [2035]|UMR OPTIONS [203501]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53||||53|11.94|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53||||53|47.7|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53||||53|7.99|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53||||53|12.93|49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53||||53||49.29|7.99
30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53||||53|26.5|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|AETNA [1015]|AETNA ACO WILCO [101532]|53||||53|18.95|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53||||53|12.98|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53||||53|12.98|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53||||53|26.55|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53||||53|18.6|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53||||53|14.8|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53||||53|22.58|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53||||53|26.5|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53||||53|34.45|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|CORESOURCE [1315]|CORESOURCE [131500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53||||53|20.62|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53||||53|12.63|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|GEHA [1415]|GEHA [141500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HEALTHNET [1495]|HEALTHNET [149500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53||||53|14.8|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53||||53|49.29|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53||||53|31.8|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53||||53|26.5|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53||||53|12.54|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MULTIPLAN [1680]|HMA [168003]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MULTIPLAN [1680]|IHC HS [168011]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53||||53|13.49|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|Self-pay|Self-pay|53||||53|15.9|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53||||53|11.13|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|TRUSTMARK [2030]|STARMARK [203000]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53||||53|25.41|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|UMR [2035]|UMR OPTIONS [203501]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53||||53|11.94|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53||||53|47.7|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53||||53|7.99|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53||||53|12.63|49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53||||53||49.29|7.99
30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53||||53|26.5|49.29|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|AETNA [1015]|AETNA ACO WILCO [101532]|133||||133|18.95|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133||||133|13.28|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133||||133|13.28|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|133||||133|66.63|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133||||133|46.68|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133||||133|14.8|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|133||||133|56.66|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|133||||133|66.5|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133||||133|86.45|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|CORESOURCE [1315]|CORESOURCE [131500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|CORVEL CORP [2235]|CORVEL CORP [223500]|133||||133|21.12|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|133||||133|12.93|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|GEHA [1415]|GEHA [141500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HEALTHNET [1495]|HEALTHNET [149500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133||||133|14.8|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HEALTHSMART [1505]|HEALTHSMART [150501]|133||||133|123.69|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133||||133|79.8|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133||||133|66.5|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133||||133|12.82|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MULTIPLAN [1680]|HMA [168003]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MULTIPLAN [1680]|IHC HS [168011]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|133||||133|13.8|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|Self-pay|Self-pay|133||||133|39.9|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133||||133|27.93|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|TRUSTMARK [2030]|STARMARK [203000]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133||||133|63.77|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|UMR [2035]|UMR OPTIONS [203501]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133||||133|12.21|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133||||133|119.7|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|133||||133|7.99|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|133||||133|12.93|123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|133||||133||123.69|7.99
30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|133||||133|66.5|123.69|7.99
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|AETNA [1015]|AETNA ACO WILCO [101532]|366||||366|22.86|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|366||||366|17.42|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|366||||366|17.42|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|366||||366|183.37|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|366||||366|128.47|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|366||||366|16.07|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|366||||366|155.92|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|366||||366|183|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|366||||366|237.9|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|CORESOURCE [1315]|CORESOURCE [131500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|366||||366|20.62|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|366||||366|12.63|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|GEHA [1415]|GEHA [141500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HEALTHNET [1495]|HEALTHNET [149500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|366||||366|16.07|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|366||||366|340.38|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|366||||366|219.6|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|366||||366|183|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|366||||366|16.82|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MULTIPLAN [1680]|HMA [168003]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MULTIPLAN [1680]|IHC HS [168011]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|366||||366|18.11|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|Self-pay|Self-pay|366||||366|109.8|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|366||||366|76.86|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|TRUSTMARK [2030]|STARMARK [203000]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|366||||366|175.5|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|UMR [2035]|UMR OPTIONS [203501]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|366||||366|16.02|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|366||||366|329.4|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|366||||366|9.64|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|366||||366|12.63|340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|366||||366||340.38|9.64
30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|366||||366|183|340.38|9.64
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|134||||134|22.19|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134||||134|16.9|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134||||134|16.9|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|134||||134|67.13|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134||||134|47.03|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134||||134|15.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|134||||134|57.08|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|134||||134|67|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134||||134|87.1|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|CORESOURCE [1315]|CORESOURCE [131500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|134||||134|20.62|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|134||||134|12.63|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|GEHA [1415]|GEHA [141500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HEALTHNET [1495]|HEALTHNET [149500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134||||134|15.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|134||||134|124.62|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134||||134|80.4|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134||||134|67|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134||||134|16.32|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MULTIPLAN [1680]|HMA [168003]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MULTIPLAN [1680]|IHC HS [168011]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|134||||134|17.57|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|Self-pay|Self-pay|134||||134|40.2|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134||||134|28.14|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|TRUSTMARK [2030]|STARMARK [203000]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134||||134|64.25|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|UMR [2035]|UMR OPTIONS [203501]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134||||134|15.54|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134||||134|120.6|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|134||||134|9.36|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|134||||134|12.63|124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|134||||134||124.62|9.36
30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF LEGIONELLA PNEUMOPHILIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|134||||134|67|124.62|9.36
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|AETNA [1015]|AETNA ACO WILCO [101532]|155||||155|23.37|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|155||||155|17.8|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|155||||155|17.8|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|155||||155|77.66|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|155||||155|54.41|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|155||||155|16.43|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|155||||155|66.03|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|155||||155|77.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|155||||155|100.75|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|CORESOURCE [1315]|CORESOURCE [131500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|155||||155|21.12|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|155||||155|12.93|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|GEHA [1415]|GEHA [141500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HEALTHNET [1495]|HEALTHNET [149500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|155||||155|16.43|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|155||||155|144.15|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|155||||155|93|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|155||||155|77.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|155||||155|17.19|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MULTIPLAN [1680]|HMA [168003]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MULTIPLAN [1680]|IHC HS [168011]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|155||||155|18.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|Self-pay|Self-pay|155||||155|46.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|155||||155|32.55|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|TRUSTMARK [2030]|STARMARK [203000]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|155||||155|74.32|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|UMR [2035]|UMR OPTIONS [203501]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|155||||155|16.37|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|155||||155|139.5|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|155||||155|9.86|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|155||||155|12.93|144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|155||||155||144.15|9.86
30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|155||||155|77.5|144.15|9.86
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|AETNA [1015]|AETNA ACO WILCO [101532]|135||||135|19.08|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135||||135|14.53|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135||||135|14.53|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|135||||135|67.64|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135||||135|47.39|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135||||135|14.8|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|135||||135|57.51|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|135||||135|67.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135||||135|87.75|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|CORESOURCE [1315]|CORESOURCE [131500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|135||||135|20.62|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|135||||135|12.63|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|GEHA [1415]|GEHA [141500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HEALTHNET [1495]|HEALTHNET [149500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135||||135|14.8|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|135||||135|125.55|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135||||135|81|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135||||135|67.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135||||135|14.04|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MULTIPLAN [1680]|HMA [168003]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MULTIPLAN [1680]|IHC HS [168011]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|135||||135|15.1|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|Self-pay|Self-pay|135||||135|40.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135||||135|28.35|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|TRUSTMARK [2030]|STARMARK [203000]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135||||135|64.73|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|UMR [2035]|UMR OPTIONS [203501]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135||||135|13.37|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135||||135|121.5|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|135||||135|8.05|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|135||||135|12.63|125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|135||||135||125.55|8.05
30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|135||||135|67.5|125.55|8.05
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|AETNA [1015]|AETNA ACO WILCO [101532]|118||||118|18.95|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118||||118|12.98|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118||||118|12.98|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118||||118|59.12|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118||||118|41.42|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118||||118|14.8|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118||||118|50.27|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118||||118|59|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118||||118|76.7|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|CORESOURCE [1315]|CORESOURCE [131500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118||||118|21.12|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118||||118|12.93|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|GEHA [1415]|GEHA [141500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HEALTHNET [1495]|HEALTHNET [149500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118||||118|14.8|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118||||118|109.74|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118||||118|70.8|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118||||118|59|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118||||118|12.54|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MULTIPLAN [1680]|HMA [168003]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MULTIPLAN [1680]|IHC HS [168011]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118||||118|13.49|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|Self-pay|Self-pay|118||||118|35.4|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118||||118|24.78|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|TRUSTMARK [2030]|STARMARK [203000]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118||||118|56.58|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|UMR [2035]|UMR OPTIONS [203501]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118||||118|11.94|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118||||118|106.2|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118||||118|7.99|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118||||118|12.93|109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118||||118||109.74|7.99
30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS CARINII AG IF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118||||118|59|109.74|7.99
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|AETNA [1015]|AETNA ACO WILCO [101532]|141||||141|19.08|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141||||141|14.53|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141||||141|14.53|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|141||||141|70.64|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141||||141|49.49|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141||||141|14.8|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|141||||141|60.07|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|141||||141|70.5|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141||||141|91.65|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|CORESOURCE [1315]|CORESOURCE [131500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|CORVEL CORP [2235]|CORVEL CORP [223500]|141||||141|20.62|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|141||||141|12.63|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|GEHA [1415]|GEHA [141500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HEALTHNET [1495]|HEALTHNET [149500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141||||141|14.8|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HEALTHSMART [1505]|HEALTHSMART [150501]|141||||141|131.13|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141||||141|84.6|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141||||141|70.5|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141||||141|14.04|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MULTIPLAN [1680]|HMA [168003]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MULTIPLAN [1680]|IHC HS [168011]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|141||||141|15.1|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|Self-pay|Self-pay|141||||141|42.3|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141||||141|29.61|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|TRUSTMARK [2030]|STARMARK [203000]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141||||141|67.61|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|UMR [2035]|UMR OPTIONS [203501]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141||||141|13.37|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141||||141|126.9|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|141||||141|8.05|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|141||||141|12.63|131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|141||||141||131.13|8.05
30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|141||||141|70.5|131.13|8.05
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|AETNA [1015]|AETNA ACO WILCO [101532]|127||||127|22.9|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127||||127|17.44|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127||||127|17.44|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|127||||127|63.63|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127||||127|44.58|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127||||127|16.1|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|127||||127|54.1|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|127||||127|63.5|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127||||127|82.55|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|CORESOURCE [1315]|CORESOURCE [131500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|127||||127|20.62|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|127||||127|12.63|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|GEHA [1415]|GEHA [141500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HEALTHNET [1495]|HEALTHNET [149500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127||||127|16.1|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|127||||127|118.11|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127||||127|76.2|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127||||127|63.5|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127||||127|16.84|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MULTIPLAN [1680]|HMA [168003]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MULTIPLAN [1680]|IHC HS [168011]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|127||||127|18.13|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|Self-pay|Self-pay|127||||127|38.1|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127||||127|26.67|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|TRUSTMARK [2030]|STARMARK [203000]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127||||127|60.9|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|UMR [2035]|UMR OPTIONS [203501]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127||||127|16.04|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127||||127|114.3|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|127||||127|9.66|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|127||||127|12.63|118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|127||||127||118.11|9.66
30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|127||||127|63.5|118.11|9.66
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|AETNA [1015]|AETNA ACO WILCO [101532]|149||||149|18.95|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149||||149|12.98|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149||||149|12.98|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149||||149|74.65|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149||||149|52.3|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149||||149|14.8|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149||||149|63.47|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149||||149|74.5|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149||||149|96.85|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|CORESOURCE [1315]|CORESOURCE [131500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|149||||149|16.93|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149||||149|10.27|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|GEHA [1415]|GEHA [141500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HEALTHNET [1495]|HEALTHNET [149500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149||||149|14.8|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|149||||149|138.57|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149||||149|89.4|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149||||149|74.5|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149||||149|12.54|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MULTIPLAN [1680]|HMA [168003]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MULTIPLAN [1680]|IHC HS [168011]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|149||||149|13.49|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|Self-pay|Self-pay|149||||149|44.7|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149||||149|31.29|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|TRUSTMARK [2030]|STARMARK [203000]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149||||149|71.45|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|UMR [2035]|UMR OPTIONS [203501]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149||||149|11.94|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149||||149|134.1|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149||||149|7.99|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149||||149|10.27|138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149||||149||138.57|7.99
30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149||||149|74.5|138.57|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|169||||169|18.95|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169||||169|12.98|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169||||169|12.98|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169||||169|84.67|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169||||169|59.32|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169||||169|14.8|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169||||169|71.99|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169||||169|84.5|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169||||169|109.85|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169||||169|20.62|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169||||169|12.63|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|GEHA [1415]|GEHA [141500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169||||169|14.8|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169||||169|157.17|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169||||169|101.4|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169||||169|84.5|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169||||169|12.54|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MULTIPLAN [1680]|HMA [168003]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169||||169|13.49|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|Self-pay|Self-pay|169||||169|50.7|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169||||169|35.49|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169||||169|81.04|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|UMR [2035]|UMR OPTIONS [203501]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169||||169|11.94|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169||||169|152.1|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169||||169|7.99|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169||||169|12.63|157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169||||169||157.17|7.99
30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169||||169|84.5|157.17|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|179||||179|18.95|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179||||179|12.98|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179||||179|12.98|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|179||||179|89.68|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179||||179|62.83|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179||||179|14.8|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|179||||179|76.25|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|179||||179|89.5|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179||||179|116.35|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|179||||179|20.04|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|179||||179|12.27|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|GEHA [1415]|GEHA [141500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179||||179|14.8|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|179||||179|166.47|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179||||179|107.4|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179||||179|89.5|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179||||179|12.54|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MULTIPLAN [1680]|HMA [168003]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MULTIPLAN [1680]|IHC HS [168011]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|179||||179|13.49|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|Self-pay|Self-pay|179||||179|53.7|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179||||179|37.59|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|TRUSTMARK [2030]|STARMARK [203000]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179||||179|85.83|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|UMR [2035]|UMR OPTIONS [203501]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179||||179|11.94|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179||||179|161.1|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|179||||179|7.99|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|179||||179|12.27|166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|179||||179||166.47|7.99
30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|179||||179|89.5|166.47|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|350||||350|18.95|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350||||350|12.22|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350||||350|12.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350||||350|12.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|350||||350|175.35|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350||||350|122.85|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350||||350|14.8|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|350||||350|149.1|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|350||||350|175|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350||||350|227.5|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|CORESOURCE [1315]|CORESOURCE [131500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|350||||350|20.62|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|350||||350|12.63|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|GEHA [1415]|GEHA [141500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|350||||350|26.96|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HEALTHNET [1495]|HEALTHNET [149500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350||||350|14.8|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|350||||350|325.5|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350||||350|210|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350||||350|13.18|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350||||350|175|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350||||350|12.54|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350||||350|16.17|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350||||350|12.22|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MULTIPLAN [1680]|HMA [168003]|350||||350|17.97|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MULTIPLAN [1680]|IHC HS [168011]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|350||||350|13.49|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350||||350|13.18|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|Self-pay|Self-pay|350||||350|105|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350||||350|73.5|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|350||||350|11.74|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350||||350|17.49|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|TRUSTMARK [2030]|STARMARK [203000]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350||||350|167.83|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|UMR [2035]|UMR OPTIONS [203501]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350||||350|11.94|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350||||350|315|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|350||||350|7.99|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|350||||350|12.63|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|350||||350|11.98|325.5|7.99
30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|350||||350|175|325.5|7.99
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|119||||119|19.08|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119||||119|14.53|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119||||119|14.53|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119||||119|59.62|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119||||119|41.77|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119||||119|14.8|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119||||119|50.69|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119||||119|59.5|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119||||119|77.35|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|CORESOURCE [1315]|CORESOURCE [131500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119||||119|21.12|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119||||119|12.93|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|GEHA [1415]|GEHA [141500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HEALTHNET [1495]|HEALTHNET [149500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119||||119|14.8|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119||||119|110.67|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119||||119|71.4|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119||||119|59.5|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119||||119|14.04|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MULTIPLAN [1680]|HMA [168003]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MULTIPLAN [1680]|IHC HS [168011]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119||||119|15.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|Self-pay|Self-pay|119||||119|35.7|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119||||119|24.99|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|TRUSTMARK [2030]|STARMARK [203000]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119||||119|57.06|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|UMR [2035]|UMR OPTIONS [203501]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119||||119|13.37|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119||||119|107.1|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119||||119|8.05|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119||||119|12.93|110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119||||119||110.67|8.05
30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119||||119|59.5|110.67|8.05
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|122||||122|19.66|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122||||122|14.1|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122||||122|14.97|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122||||122|14.97|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|122||||122|61.12|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122||||122|42.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122||||122|14.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|122||||122|51.97|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|122||||122|61|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122||||122|79.3|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|CORESOURCE [1315]|CORESOURCE [131500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|122||||122|20.62|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|122||||122|12.63|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|GEHA [1415]|GEHA [141500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|122||||122|31.1|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HEALTHNET [1495]|HEALTHNET [149500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122||||122|14.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|122||||122|113.46|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122||||122|73.2|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122||||122|15.2|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122||||122|61|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122||||122|14.46|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122||||122|18.66|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122||||122|14.1|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MULTIPLAN [1680]|HMA [168003]|122||||122|20.73|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MULTIPLAN [1680]|IHC HS [168011]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|122||||122|15.56|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122||||122|15.2|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|Self-pay|Self-pay|122||||122|36.6|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122||||122|25.62|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|122||||122|13.54|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122||||122|20.18|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|TRUSTMARK [2030]|STARMARK [203000]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122||||122|58.5|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|UMR [2035]|UMR OPTIONS [203501]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122||||122|13.77|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122||||122|109.8|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|122||||122|8.29|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|122||||122|12.63|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|122||||122|13.82|113.46|8.29
30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA CRYPTOSPORIDIUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|122||||122|61|113.46|8.29
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|158||||158|18.95|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158||||158|12.22|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158||||158|12.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158||||158|12.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158||||158|79.16|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158||||158|55.46|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158||||158|14.8|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158||||158|67.31|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158||||158|79|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158||||158|102.7|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|CORESOURCE [1315]|CORESOURCE [131500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158||||158|19.89|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158||||158|12.18|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|GEHA [1415]|GEHA [141500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158||||158|26.96|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HEALTHNET [1495]|HEALTHNET [149500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158||||158|14.8|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158||||158|146.94|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158||||158|94.8|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158||||158|13.18|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158||||158|79|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158||||158|12.54|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158||||158|16.17|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158||||158|12.22|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MULTIPLAN [1680]|HMA [168003]|158||||158|17.97|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MULTIPLAN [1680]|IHC HS [168011]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158||||158|13.49|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158||||158|13.18|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|Self-pay|Self-pay|158||||158|47.4|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158||||158|33.18|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158||||158|11.74|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158||||158|17.49|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|TRUSTMARK [2030]|STARMARK [203000]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158||||158|75.76|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|UMR [2035]|UMR OPTIONS [203501]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158||||158|11.94|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158||||158|142.2|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158||||158|7.99|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158||||158|12.18|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158||||158|11.98|146.94|7.99
30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158||||158|79|146.94|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|AETNA [1015]|AETNA ACO WILCO [101532]|182||||182|18.95|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182||||182|12.98|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182||||182|12.98|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182||||182|91.18|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182||||182|63.88|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182||||182|14.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182||||182|77.53|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182||||182|91|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182||||182|118.3|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|CORESOURCE [1315]|CORESOURCE [131500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182||||182|21.12|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182||||182|12.93|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|GEHA [1415]|GEHA [141500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HEALTHNET [1495]|HEALTHNET [149500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182||||182|14.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182||||182|169.26|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182||||182|109.2|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182||||182|91|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182||||182|12.54|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MULTIPLAN [1680]|HMA [168003]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MULTIPLAN [1680]|IHC HS [168011]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182||||182|13.49|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|Self-pay|Self-pay|182||||182|54.6|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182||||182|38.22|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|TRUSTMARK [2030]|STARMARK [203000]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182||||182|87.27|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|UMR [2035]|UMR OPTIONS [203501]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182||||182|11.94|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182||||182|163.8|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182||||182|7.99|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182||||182|12.93|169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182||||182||169.26|7.99
30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182||||182|91|169.26|7.99
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|159||||159|22.72|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|159||||159|14.67|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|159||||159|15.58|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|159||||159|15.58|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|159||||159|79.66|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|159||||159|55.81|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|159||||159|17.76|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|159||||159|67.73|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|159||||159|79.5|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|159||||159|103.35|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|CORESOURCE [1315]|CORESOURCE [131500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|159||||159|22.74|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|159||||159|13.92|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|GEHA [1415]|GEHA [141500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|159||||159|32.36|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HEALTHNET [1495]|HEALTHNET [149500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|159||||159|17.76|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|159||||159|147.87|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|159||||159|95.4|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|159||||159|15.82|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|159||||159|79.5|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|159||||159|15.05|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|159||||159|19.41|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|159||||159|14.67|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MULTIPLAN [1680]|HMA [168003]|159||||159|21.57|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MULTIPLAN [1680]|IHC HS [168011]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|159||||159|16.19|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|159||||159|15.82|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|Self-pay|Self-pay|159||||159|47.7|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|159||||159|33.39|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|159||||159|14.09|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|159||||159|20.99|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|TRUSTMARK [2030]|STARMARK [203000]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|159||||159|76.24|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|UMR [2035]|UMR OPTIONS [203501]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|159||||159|14.33|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|159||||159|143.1|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|159||||159|9.59|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|159||||159|13.92|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|159||||159|14.38|147.87|9.59
30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|159||||159|79.5|147.87|9.59
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|AETNA [1015]|AETNA ACO WILCO [101532]|308||||308|16.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|308||||308|10.54|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|308||||308|11.19|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|308||||308|11.19|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|308||||308|154.31|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|308||||308|108.11|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|308||||308|12.75|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|308||||308|131.21|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|308||||308|154|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|308||||308|200.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|CORESOURCE [1315]|CORESOURCE [131500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|308||||308|16.13|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|308||||308|9.87|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|GEHA [1415]|GEHA [141500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|308||||308|23.24|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HEALTHNET [1495]|HEALTHNET [149500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|308||||308|12.75|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|308||||308|286.44|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|308||||308|184.8|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|308||||308|11.36|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|308||||308|154|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|308||||308|10.8|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|308||||308|13.95|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|308||||308|10.54|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MULTIPLAN [1680]|HMA [168003]|308||||308|15.5|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MULTIPLAN [1680]|IHC HS [168011]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|308||||308|11.63|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|308||||308|11.36|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|Self-pay|Self-pay|308||||308|92.4|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|308||||308|64.68|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|308||||308|10.12|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|308||||308|15.08|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|TRUSTMARK [2030]|STARMARK [203000]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|308||||308|147.69|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|UMR [2035]|UMR OPTIONS [203501]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|308||||308|10.29|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|308||||308|277.2|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|308||||308|6.89|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|308||||308|9.87|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|308||||308|10.33|286.44|6.89
30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|308||||308|154|286.44|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|131||||131|16.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131||||131|10.54|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131||||131|11.19|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131||||131|11.19|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131||||131|65.63|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131||||131|45.98|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131||||131|12.75|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131||||131|55.81|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131||||131|65.5|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131||||131|85.15|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|CORESOURCE [1315]|CORESOURCE [131500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|131||||131|16.55|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131||||131|10.13|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|GEHA [1415]|GEHA [141500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131||||131|23.24|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HEALTHNET [1495]|HEALTHNET [149500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131||||131|12.75|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|131||||131|121.83|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131||||131|78.6|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131||||131|11.36|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131||||131|65.5|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131||||131|10.8|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131||||131|13.95|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131||||131|10.54|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MULTIPLAN [1680]|HMA [168003]|131||||131|15.5|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MULTIPLAN [1680]|IHC HS [168011]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|131||||131|11.63|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131||||131|11.36|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|Self-pay|Self-pay|131||||131|39.3|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131||||131|27.51|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131||||131|10.12|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131||||131|15.08|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|TRUSTMARK [2030]|STARMARK [203000]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131||||131|62.81|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|UMR [2035]|UMR OPTIONS [203501]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131||||131|10.29|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131||||131|117.9|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131||||131|6.89|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131||||131|10.13|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131||||131|10.33|121.83|6.89
30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131||||131|65.5|121.83|6.89
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|154||||154|18.22|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154||||154|11.76|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154||||154|12.49|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154||||154|12.49|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|154||||154|77.15|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154||||154|54.05|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154||||154|14.23|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|154||||154|65.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|154||||154|77|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154||||154|100.1|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|154||||154|18.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|154||||154|11.39|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|GEHA [1415]|GEHA [141500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|154||||154|25.94|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154||||154|14.23|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|154||||154|143.22|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154||||154|92.4|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154||||154|12.68|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154||||154|77|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154||||154|12.07|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154||||154|15.57|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154||||154|11.76|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MULTIPLAN [1680]|HMA [168003]|154||||154|17.3|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MULTIPLAN [1680]|IHC HS [168011]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|154||||154|12.98|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154||||154|12.68|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|Self-pay|Self-pay|154||||154|46.2|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154||||154|32.34|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|154||||154|11.3|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154||||154|16.83|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|TRUSTMARK [2030]|STARMARK [203000]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154||||154|73.84|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|UMR [2035]|UMR OPTIONS [203501]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154||||154|11.5|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154||||154|138.6|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|154||||154|7.69|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|154||||154|11.39|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|154||||154|11.53|143.22|7.69
30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|154||||154|77|143.22|7.69
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|531||||531|26.12|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|531||||531|19.89|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|531||||531|19.89|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|531||||531|266.03|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|531||||531|186.38|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|531||||531|20.26|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|531||||531|226.21|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|531||||531|265.5|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|531||||531|345.15|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|531||||531|26.67|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|531||||531|16.33|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|GEHA [1415]|GEHA [141500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|531||||531|20.26|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|531||||531|493.83|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|531||||531|318.6|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|531||||531|265.5|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|531||||531|19.22|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MULTIPLAN [1680]|HMA [168003]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|531||||531|20.67|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|Self-pay|Self-pay|531||||531|159.3|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|531||||531|111.51|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|531||||531|254.61|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|UMR [2035]|UMR OPTIONS [203501]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|531||||531|18.3|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|531||||531|477.9|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|531||||531|11.02|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|531||||531|16.33|493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|531||||531||493.83|11.02
30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|531||||531|265.5|493.83|11.02
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|198||||198|18.95|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198||||198|13.52|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198||||198|14.36|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198||||198|14.36|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198||||198|99.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198||||198|69.5|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198||||198|14.8|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198||||198|84.35|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198||||198|99|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198||||198|128.7|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|CORESOURCE [1315]|CORESOURCE [131500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198||||198|20.6|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198||||198|12.61|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|GEHA [1415]|GEHA [141500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198||||198|29.81|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HEALTHNET [1495]|HEALTHNET [149500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198||||198|14.8|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198||||198|184.14|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198||||198|118.8|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198||||198|14.58|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198||||198|99|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198||||198|13.87|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198||||198|17.89|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198||||198|13.52|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MULTIPLAN [1680]|HMA [168003]|198||||198|19.88|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MULTIPLAN [1680]|IHC HS [168011]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198||||198|14.93|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198||||198|14.58|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|Self-pay|Self-pay|198||||198|59.4|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198||||198|41.58|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198||||198|12.99|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198||||198|19.35|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|TRUSTMARK [2030]|STARMARK [203000]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198||||198|94.94|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|UMR [2035]|UMR OPTIONS [203501]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198||||198|13.21|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198||||198|178.2|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198||||198|7.99|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198||||198|12.61|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198||||198|13.25|184.14|7.99
30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HISTOPLASM CAPSULATUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198||||198|99|184.14|7.99
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|AETNA [1015]|AETNA ACO WILCO [101532]|328||||328|38.05|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|328||||328|24.56|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|328||||328|26.09|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|328||||328|26.09|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|328||||328|164.33|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|328||||328|115.13|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|328||||328|29.73|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|328||||328|139.73|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|328||||328|164|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|328||||328|213.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|CORESOURCE [1315]|CORESOURCE [131500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|328||||328|38.93|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|328||||328|23.83|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|GEHA [1415]|GEHA [141500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|328||||328|54.18|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HEALTHNET [1495]|HEALTHNET [149500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|328||||328|29.73|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|328||||328|305.04|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|328||||328|196.8|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|328||||328|26.49|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|328||||328|164|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|328||||328|25.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|328||||328|32.51|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|328||||328|24.56|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MULTIPLAN [1680]|HMA [168003]|328||||328|36.12|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MULTIPLAN [1680]|IHC HS [168011]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|328||||328|27.12|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|328||||328|26.49|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|Self-pay|Self-pay|328||||328|98.4|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|328||||328|68.88|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|328||||328|23.6|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|328||||328|35.16|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|TRUSTMARK [2030]|STARMARK [203000]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|328||||328|157.28|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|UMR [2035]|UMR OPTIONS [203501]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|328||||328|24|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|328||||328|295.2|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|328||||328|16.05|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|328||||328|23.83|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|328||||328|24.08|305.04|16.05
30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA HIV1/HIV2 AB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|328||||328|164|305.04|16.05
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|AETNA [1015]|AETNA ACO WILCO [101532]|340||||340|34.23|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|340||||340|26.07|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|340||||340|26.07|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|340||||340|170.34|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|340||||340|119.34|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|340||||340|24.06|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|340||||340|144.84|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|340||||340|170|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|340||||340|221|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|CORESOURCE [1315]|CORESOURCE [131500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|340||||340|28.55|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|340||||340|17.48|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|GEHA [1415]|GEHA [141500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HEALTHNET [1495]|HEALTHNET [149500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|340||||340|24.06|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|340||||340|316.2|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|340||||340|204|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|340||||340|170|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|340||||340|25.18|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MULTIPLAN [1680]|HMA [168003]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MULTIPLAN [1680]|IHC HS [168011]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|340||||340|27.1|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|Self-pay|Self-pay|340||||340|102|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|340||||340|71.4|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|TRUSTMARK [2030]|STARMARK [203000]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|340||||340|163.03|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|UMR [2035]|UMR OPTIONS [203501]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|340||||340|23.98|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|340||||340|306|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|340||||340|14.44|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|340||||340|17.48|316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|340||||340||316.2|14.44
30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HIV-1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|340||||340|170|316.2|14.44
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|AETNA [1015]|AETNA ACO WILCO [101532]|133||||133|20.1|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133||||133|15.31|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133||||133|15.31|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|133||||133|66.63|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133||||133|46.68|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133||||133|14.8|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|133||||133|56.66|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|133||||133|66.5|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133||||133|86.45|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|CORESOURCE [1315]|CORESOURCE [131500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|CORVEL CORP [2235]|CORVEL CORP [223500]|133||||133|16.93|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|133||||133|10.36|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|GEHA [1415]|GEHA [141500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HEALTHNET [1495]|HEALTHNET [149500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133||||133|14.8|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HEALTHSMART [1505]|HEALTHSMART [150501]|133||||133|123.69|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133||||133|79.8|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133||||133|66.5|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133||||133|14.79|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MULTIPLAN [1680]|HMA [168003]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MULTIPLAN [1680]|IHC HS [168011]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|133||||133|15.91|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|Self-pay|Self-pay|133||||133|39.9|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133||||133|27.93|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|TRUSTMARK [2030]|STARMARK [203000]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133||||133|63.77|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|UMR [2035]|UMR OPTIONS [203501]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133||||133|14.08|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133||||133|119.7|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|133||||133|8.48|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|133||||133|10.36|123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|133||||133||123.69|8.48
30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|133||||133|66.5|123.69|8.48
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|AETNA [1015]|AETNA ACO WILCO [101532]|149||||149|19.79|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149||||149|15.08|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149||||149|15.08|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149||||149|74.65|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149||||149|52.3|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149||||149|14.8|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149||||149|63.47|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149||||149|74.5|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149||||149|96.85|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|CORESOURCE [1315]|CORESOURCE [131500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|149||||149|20.6|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149||||149|12.61|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|GEHA [1415]|GEHA [141500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HEALTHNET [1495]|HEALTHNET [149500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149||||149|14.8|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|149||||149|138.57|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149||||149|89.4|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149||||149|74.5|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149||||149|14.56|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MULTIPLAN [1680]|HMA [168003]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MULTIPLAN [1680]|IHC HS [168011]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|149||||149|15.67|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|Self-pay|Self-pay|149||||149|44.7|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149||||149|31.29|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|TRUSTMARK [2030]|STARMARK [203000]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149||||149|71.45|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|UMR [2035]|UMR OPTIONS [203501]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149||||149|13.87|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149||||149|134.1|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149||||149|8.35|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149||||149|12.61|138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149||||149||138.57|8.35
30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149||||149|74.5|138.57|8.35
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|161||||161|18.95|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161||||161|12.22|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161||||161|12.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161||||161|12.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|161||||161|80.66|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161||||161|56.51|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161||||161|14.8|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|161||||161|68.59|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|161||||161|80.5|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161||||161|104.65|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|CORESOURCE [1315]|CORESOURCE [131500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|161||||161|20.6|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|161||||161|12.61|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|GEHA [1415]|GEHA [141500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|161||||161|26.96|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HEALTHNET [1495]|HEALTHNET [149500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161||||161|14.8|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|161||||161|149.73|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161||||161|96.6|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161||||161|13.18|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161||||161|80.5|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161||||161|12.54|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161||||161|16.17|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161||||161|12.22|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MULTIPLAN [1680]|HMA [168003]|161||||161|17.97|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MULTIPLAN [1680]|IHC HS [168011]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|161||||161|13.49|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161||||161|13.18|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|Self-pay|Self-pay|161||||161|48.3|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161||||161|33.81|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|161||||161|11.74|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161||||161|17.49|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|TRUSTMARK [2030]|STARMARK [203000]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161||||161|77.2|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|UMR [2035]|UMR OPTIONS [203501]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161||||161|11.94|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161||||161|144.9|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|161||||161|7.99|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|161||||161|12.61|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|161||||161|11.98|149.73|7.99
30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|161||||161|80.5|149.73|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|164||||164|18.95|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|164||||164|12.98|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|164||||164|12.98|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|164||||164|82.16|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|164||||164|57.56|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|164||||164|14.8|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|164||||164|69.86|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|164||||164|82|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|164||||164|106.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|CORESOURCE [1315]|CORESOURCE [131500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|164||||164|21.12|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|164||||164|12.93|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|GEHA [1415]|GEHA [141500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HEALTHNET [1495]|HEALTHNET [149500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|164||||164|14.8|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|164||||164|152.52|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|164||||164|98.4|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|164||||164|82|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|164||||164|12.54|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MULTIPLAN [1680]|HMA [168003]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MULTIPLAN [1680]|IHC HS [168011]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|164||||164|13.49|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|Self-pay|Self-pay|164||||164|49.2|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|164||||164|34.44|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|TRUSTMARK [2030]|STARMARK [203000]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|164||||164|78.64|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|UMR [2035]|UMR OPTIONS [203501]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|164||||164|11.94|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|164||||164|147.6|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|164||||164|7.99|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|164||||164|12.93|152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|164||||164||152.52|7.99
30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|164||||164|82|152.52|7.99
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|AETNA [1015]|AETNA ACO WILCO [101532]|183||||183|23.91|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183||||183|18.21|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183||||183|18.21|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|183||||183|91.68|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183||||183|64.23|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183||||183|16.81|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|183||||183|77.96|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|183||||183|91.5|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183||||183|118.95|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|CORESOURCE [1315]|CORESOURCE [131500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|183||||183|20.6|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|183||||183|12.61|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|GEHA [1415]|GEHA [141500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HEALTHNET [1495]|HEALTHNET [149500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183||||183|16.81|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|183||||183|170.19|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183||||183|109.8|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183||||183|91.5|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183||||183|17.59|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MULTIPLAN [1680]|HMA [168003]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MULTIPLAN [1680]|IHC HS [168011]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|183||||183|18.93|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|Self-pay|Self-pay|183||||183|54.9|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183||||183|38.43|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|TRUSTMARK [2030]|STARMARK [203000]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183||||183|87.75|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|UMR [2035]|UMR OPTIONS [203501]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183||||183|16.76|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183||||183|164.7|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|183||||183|10.09|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|183||||183|12.61|170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|183||||183||170.19|10.09
30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|183||||183|91.5|170.19|10.09
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|752||||752|18.95|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|752||||752|12.22|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|752||||752|12.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|752||||752|12.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|752||||752|376.75|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|752||||752|263.95|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|752||||752|14.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|752||||752|320.35|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|752||||752|376|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|752||||752|488.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|752||||752|20.6|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|752||||752|12.61|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|GEHA [1415]|GEHA [141500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|752||||752|26.96|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|752||||752|14.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|752||||752|699.36|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|752||||752|451.2|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|752||||752|13.18|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|752||||752|376|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|752||||752|12.54|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|752||||752|16.17|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|752||||752|12.22|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MULTIPLAN [1680]|HMA [168003]|752||||752|17.97|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MULTIPLAN [1680]|IHC HS [168011]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|752||||752|13.49|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|752||||752|13.18|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|Self-pay|Self-pay|752||||752|225.6|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|752||||752|157.92|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|752||||752|11.74|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|752||||752|17.49|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|TRUSTMARK [2030]|STARMARK [203000]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|752||||752|360.58|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|UMR [2035]|UMR OPTIONS [203501]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|752||||752|11.94|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|752||||752|676.8|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|752||||752|7.99|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|752||||752|12.61|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|752||||752|11.98|699.36|7.99
30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|752||||752|376|699.36|7.99
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|55.46|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|38.01|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|38.01|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|43.33|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|54.89|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|33.61|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|43.33|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|36.71|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MULTIPLAN [1680]|HMA [168003]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|39.51|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|Self-pay|Self-pay|374||||374|112.2|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|34.97|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|23.39|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|33.61|347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374||347.82|23.39
30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|349||||349|55.46|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349||||349|35.79|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349||||349|38.01|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349||||349|38.01|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349||||349|174.85|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349||||349|122.5|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349||||349|43.33|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349||||349|148.67|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349||||349|174.5|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349||||349|226.85|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|CORESOURCE [1315]|CORESOURCE [131500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349||||349|54.89|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349||||349|33.61|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|GEHA [1415]|GEHA [141500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349||||349|78.95|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HEALTHNET [1495]|HEALTHNET [149500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349||||349|43.33|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349||||349|324.57|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349||||349|209.4|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349||||349|38.6|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349||||349|174.5|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349||||349|36.71|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349||||349|47.37|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349||||349|35.79|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MULTIPLAN [1680]|HMA [168003]|349||||349|52.64|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MULTIPLAN [1680]|IHC HS [168011]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349||||349|39.51|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349||||349|38.6|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|Self-pay|Self-pay|349||||349|104.7|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349||||349|73.29|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349||||349|34.39|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349||||349|51.23|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|TRUSTMARK [2030]|STARMARK [203000]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349||||349|167.35|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|UMR [2035]|UMR OPTIONS [203501]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349||||349|34.97|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349||||349|314.1|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349||||349|23.39|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349||||349|33.61|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349||||349|35.09|324.57|23.39
30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349||||349|174.5|324.57|23.39
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|AETNA [1015]|AETNA ACO WILCO [101532]|213||||213|31.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213||||213|21.73|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213||||213|21.73|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213||||213|106.71|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213||||213|74.76|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213||||213|24.76|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213||||213|90.74|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213||||213|106.5|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213||||213|138.45|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|CORESOURCE [1315]|CORESOURCE [131500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|213||||213|31.59|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213||||213|19.34|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|GEHA [1415]|GEHA [141500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HEALTHNET [1495]|HEALTHNET [149500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213||||213|24.76|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|213||||213|198.09|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213||||213|127.8|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213||||213|106.5|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213||||213|20.99|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MULTIPLAN [1680]|HMA [168003]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MULTIPLAN [1680]|IHC HS [168011]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|213||||213|22.59|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|Self-pay|Self-pay|213||||213|63.9|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213||||213|44.73|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|TRUSTMARK [2030]|STARMARK [203000]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213||||213|102.13|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|UMR [2035]|UMR OPTIONS [203501]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213||||213|19.99|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213||||213|191.7|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213||||213|13.37|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213||||213|19.34|198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213||||213||198.09|13.37
30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213||||213|106.5|198.09|13.37
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|AETNA [1015]|AETNA ACO WILCO [101532]|151||||151|55.46|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151||||151|35.79|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151||||151|38.01|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151||||151|38.01|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|151||||151|75.65|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151||||151|53|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151||||151|43.33|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|151||||151|64.33|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|151||||151|75.5|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151||||151|98.15|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|CORESOURCE [1315]|CORESOURCE [131500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|151||||151|54.89|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|151||||151|33.61|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|GEHA [1415]|GEHA [141500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|151||||151|78.95|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HEALTHNET [1495]|HEALTHNET [149500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151||||151|43.33|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|151||||151|140.43|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151||||151|90.6|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151||||151|38.6|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151||||151|75.5|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151||||151|36.71|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151||||151|47.37|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151||||151|35.79|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MULTIPLAN [1680]|HMA [168003]|151||||151|52.64|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MULTIPLAN [1680]|IHC HS [168011]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|151||||151|39.51|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151||||151|38.6|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|Self-pay|Self-pay|151||||151|45.3|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151||||151|31.71|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|151||||151|34.39|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151||||151|51.23|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|TRUSTMARK [2030]|STARMARK [203000]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151||||151|72.4|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|UMR [2035]|UMR OPTIONS [203501]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151||||151|34.97|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151||||151|135.9|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|151||||151|23.39|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|151||||151|33.61|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|151||||151|35.09|140.43|23.39
30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|151||||151|75.5|140.43|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|628||||628|55.46|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|628||||628|38.01|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|628||||628|38.01|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|628||||628|314.63|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|628||||628|220.43|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|628||||628|43.33|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|628||||628|267.53|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|628||||628|314|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|628||||628|408.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|CORESOURCE [1315]|CORESOURCE [131500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|628||||628|54.89|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|628||||628|33.61|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|GEHA [1415]|GEHA [141500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HEALTHNET [1495]|HEALTHNET [149500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|628||||628|43.33|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|628||||628|584.04|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|628||||628|376.8|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|628||||628|314|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|628||||628|36.71|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MULTIPLAN [1680]|HMA [168003]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MULTIPLAN [1680]|IHC HS [168011]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|628||||628|39.51|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|Self-pay|Self-pay|628||||628|188.4|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|628||||628|131.88|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|TRUSTMARK [2030]|STARMARK [203000]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|628||||628|301.13|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|UMR [2035]|UMR OPTIONS [203501]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|628||||628|34.97|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|628||||628|565.2|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|628||||628|23.39|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|628||||628|33.61|584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|628||||628||584.04|23.39
30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|628||||628|314|584.04|23.39
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|197||||197|32.36|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|197||||197|24.65|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|197||||197|24.65|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|197||||197|98.7|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|197||||197|69.15|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|197||||197|24.76|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|197||||197|83.92|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|197||||197|98.5|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|197||||197|128.05|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|CORESOURCE [1315]|CORESOURCE [131500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|197||||197|31.59|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|197||||197|19.34|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|GEHA [1415]|GEHA [141500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HEALTHNET [1495]|HEALTHNET [149500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|197||||197|24.76|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|197||||197|183.21|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|197||||197|118.2|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|197||||197|98.5|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|197||||197|23.81|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MULTIPLAN [1680]|HMA [168003]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MULTIPLAN [1680]|IHC HS [168011]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|197||||197|25.62|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|Self-pay|Self-pay|197||||197|59.1|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|197||||197|41.37|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|TRUSTMARK [2030]|STARMARK [203000]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|197||||197|94.46|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|UMR [2035]|UMR OPTIONS [203501]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|197||||197|22.68|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|197||||197|177.3|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|197||||197|13.65|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|197||||197|19.34|183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|197||||197||183.21|13.65
30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|197||||197|98.5|183.21|13.65
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|AETNA [1015]|AETNA ACO WILCO [101532]|349||||349|55.46|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349||||349|35.79|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349||||349|38.01|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349||||349|38.01|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349||||349|174.85|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349||||349|122.5|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349||||349|43.33|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349||||349|148.67|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349||||349|174.5|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349||||349|226.85|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|CORESOURCE [1315]|CORESOURCE [131500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349||||349|54.89|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349||||349|33.61|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|GEHA [1415]|GEHA [141500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349||||349|78.95|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HEALTHNET [1495]|HEALTHNET [149500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349||||349|43.33|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349||||349|324.57|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349||||349|209.4|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349||||349|38.6|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349||||349|174.5|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349||||349|36.71|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349||||349|47.37|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349||||349|35.79|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MULTIPLAN [1680]|HMA [168003]|349||||349|52.64|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MULTIPLAN [1680]|IHC HS [168011]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349||||349|39.51|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349||||349|38.6|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|Self-pay|Self-pay|349||||349|104.7|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349||||349|73.29|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349||||349|34.39|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349||||349|51.23|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|TRUSTMARK [2030]|STARMARK [203000]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349||||349|167.35|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|UMR [2035]|UMR OPTIONS [203501]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349||||349|34.97|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349||||349|314.1|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349||||349|23.39|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349||||349|33.61|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349||||349|35.09|324.57|23.39
30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349||||349|174.5|324.57|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|AETNA [1015]|AETNA ACO WILCO [101532]|425||||425|55.46|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|425||||425|38.02|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|425||||425|40.38|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|425||||425|40.38|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|425||||425|212.93|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|425||||425|149.18|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|425||||425|43.33|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|425||||425|181.05|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|425||||425|212.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|425||||425|276.25|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|CORESOURCE [1315]|CORESOURCE [131500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|425||||425|68.18|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|425||||425|41.75|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|GEHA [1415]|GEHA [141500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|425||||425|83.86|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HEALTHNET [1495]|HEALTHNET [149500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|425||||425|43.33|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|425||||425|395.25|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|425||||425|255|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|425||||425|41|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|425||||425|212.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|425||||425|39|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|425||||425|50.31|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|425||||425|38.02|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MULTIPLAN [1680]|HMA [168003]|425||||425|55.91|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MULTIPLAN [1680]|IHC HS [168011]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|425||||425|41.97|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|425||||425|41|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|Self-pay|Self-pay|425||||425|127.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|425||||425|89.25|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|425||||425|36.52|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|425||||425|54.41|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|TRUSTMARK [2030]|STARMARK [203000]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|425||||425|203.79|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|UMR [2035]|UMR OPTIONS [203501]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|425||||425|37.14|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|425||||425|382.5|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|425||||425|23.39|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|425||||425|41.75|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|425||||425|37.27|395.25|23.39
30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|425||||425|212.5|395.25|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|494||||494|55.46|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494||||494|38.01|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494||||494|38.01|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|494||||494|247.49|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494||||494|173.39|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494||||494|43.33|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|494||||494|210.44|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|494||||494|247|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494||||494|321.1|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|494||||494|54.89|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|494||||494|33.61|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|GEHA [1415]|GEHA [141500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494||||494|43.33|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|494||||494|459.42|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494||||494|296.4|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494||||494|247|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494||||494|36.71|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MULTIPLAN [1680]|HMA [168003]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|494||||494|39.51|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|Self-pay|Self-pay|494||||494|148.2|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494||||494|103.74|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494||||494|236.87|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|UMR [2035]|UMR OPTIONS [203501]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494||||494|34.97|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494||||494|444.6|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|494||||494|23.39|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|494||||494|33.61|459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|494||||494||459.42|23.39
30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|494||||494|247|459.42|23.39
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|675||||675|67.7|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|675||||675|43.7|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|675||||675|46.42|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|675||||675|46.42|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|675||||675|338.18|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|675||||675|236.93|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|675||||675|52.88|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|675||||675|287.55|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|675||||675|337.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|675||||675|438.75|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|CORESOURCE [1315]|CORESOURCE [131500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|675||||675|68.82|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|675||||675|42.13|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|GEHA [1415]|GEHA [141500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|675||||675|96.39|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HEALTHNET [1495]|HEALTHNET [149500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|675||||675|52.88|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|675||||675|627.75|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|675||||675|405|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|675||||675|47.12|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|675||||675|337.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|675||||675|44.83|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|675||||675|57.83|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|675||||675|43.7|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MULTIPLAN [1680]|HMA [168003]|675||||675|64.26|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MULTIPLAN [1680]|IHC HS [168011]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|675||||675|48.25|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|675||||675|47.12|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|Self-pay|Self-pay|675||||675|202.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|675||||675|141.75|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|675||||675|41.98|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|675||||675|62.55|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|TRUSTMARK [2030]|STARMARK [203000]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|675||||675|323.66|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|UMR [2035]|UMR OPTIONS [203501]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|675||||675|42.7|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|675||||675|607.5|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|675||||675|28.56|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|675||||675|42.13|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|675||||675|42.84|627.75|28.56
30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|675||||675|337.5|627.75|28.56
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|AETNA [1015]|AETNA ACO WILCO [101532]|494||||494|55.46|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494||||494|35.79|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494||||494|38.01|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494||||494|38.01|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|494||||494|247.49|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494||||494|173.39|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494||||494|43.33|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|494||||494|210.44|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|494||||494|247|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494||||494|321.1|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|CORESOURCE [1315]|CORESOURCE [131500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|494||||494|53.47|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|494||||494|32.74|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|GEHA [1415]|GEHA [141500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|494||||494|78.95|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HEALTHNET [1495]|HEALTHNET [149500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494||||494|43.33|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|494||||494|459.42|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494||||494|296.4|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494||||494|38.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494||||494|247|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494||||494|36.71|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494||||494|47.37|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494||||494|35.79|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MULTIPLAN [1680]|HMA [168003]|494||||494|52.64|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MULTIPLAN [1680]|IHC HS [168011]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|494||||494|39.51|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494||||494|38.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|Self-pay|Self-pay|494||||494|148.2|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494||||494|103.74|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|494||||494|34.39|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494||||494|51.23|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|TRUSTMARK [2030]|STARMARK [203000]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494||||494|236.87|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|UMR [2035]|UMR OPTIONS [203501]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494||||494|34.97|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494||||494|444.6|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|494||||494|23.39|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|494||||494|32.74|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|494||||494|35.09|459.42|23.39
30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|494||||494|247|459.42|23.39
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|41.56|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|31.66|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|31.66|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|29.22|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|31.24|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|19.13|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|29.22|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|45|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|30.58|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|32.91|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|Self-pay|Self-pay|90||||90|27|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|29.12|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|17.53|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|19.13|83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|17.53
30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|17.53
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|AETNA [1015]|AETNA ACO WILCO [101532]|225||||225|202.75|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225||||225|130.86|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225||||225|0|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225||||225|0|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|225||||225|112.73|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225||||225|78.98|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225||||225|158.38|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|225||||225|95.85|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|225||||225|112.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225||||225|146.25|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|CORESOURCE [1315]|CORESOURCE [131500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|225||||225|179.25|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|225||||225|102.76|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|GEHA [1415]|GEHA [141500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|225||||225|225|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HEALTHNET [1495]|HEALTHNET [149500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225||||225|158.38|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|225||||225|209.25|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225||||225|135|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225||||225|141.12|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225||||225|112.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225||||225|0|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225||||225|173.19|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225||||225|130.86|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MULTIPLAN [1680]|HMA [168003]|225||||225|192.44|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MULTIPLAN [1680]|IHC HS [168011]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|225||||225|0|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225||||225|141.12|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|Self-pay|Self-pay|225||||225|67.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225||||225|47.25|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|225||||225|125.72|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225||||225|187.3|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|TRUSTMARK [2030]|STARMARK [203000]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225||||225|107.89|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|UMR [2035]|UMR OPTIONS [203501]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225||||225|0|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225||||225|202.5|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|225||||225|85.52|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|225||||225|102.76|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|225||||225|128.29|225|47.25
30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|225||||225|112.5|225|47.25
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|213||||213|31.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213||||213|21.73|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213||||213|21.73|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213||||213|106.71|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213||||213|74.76|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213||||213|24.76|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213||||213|90.74|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213||||213|106.5|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213||||213|138.45|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|213||||213|31.59|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213||||213|19.34|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|GEHA [1415]|GEHA [141500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213||||213|24.76|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|213||||213|198.09|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213||||213|127.8|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213||||213|106.5|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213||||213|20.99|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MULTIPLAN [1680]|HMA [168003]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MULTIPLAN [1680]|IHC HS [168011]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|213||||213|22.59|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|Self-pay|Self-pay|213||||213|63.9|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213||||213|44.73|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|TRUSTMARK [2030]|STARMARK [203000]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213||||213|102.13|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|UMR [2035]|UMR OPTIONS [203501]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213||||213|19.99|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213||||213|191.7|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213||||213|13.37|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213||||213|19.34|198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213||||213||198.09|13.37
30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213||||213|106.5|198.09|13.37
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|69||||69|66|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69||||69|45.24|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69||||69|45.24|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|69||||69|34.57|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69||||69|24.22|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69||||69|51.55|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|69||||69|29.39|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|69||||69|34.5|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69||||69|44.85|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|69||||69|41.14|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|GEHA [1415]|GEHA [141500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69||||69|51.55|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|69||||69|64.17|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69||||69|41.4|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69||||69|34.5|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69||||69|43.7|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MULTIPLAN [1680]|HMA [168003]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MULTIPLAN [1680]|IHC HS [168011]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|69||||69|47.02|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|Self-pay|Self-pay|69||||69|20.7|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69||||69|14.49|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|TRUSTMARK [2030]|STARMARK [203000]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69||||69|33.09|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|UMR [2035]|UMR OPTIONS [203501]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69||||69|41.62|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69||||69|62.1|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|69||||69|27.84|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|69||||69|41.14|66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|69||||69||66|14.49
30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|69||||69|34.5|66|14.49
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|55.46|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|38.01|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|38.01|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|43.33|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|54.89|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|33.61|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|43.33|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|36.71|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MULTIPLAN [1680]|HMA [168003]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|39.51|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|Self-pay|Self-pay|374||||374|112.2|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|34.97|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|23.39|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|33.61|347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374||347.82|23.39
30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|23.39
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|AETNA [1015]|AETNA ACO WILCO [101532]|548||||548|67.7|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|548||||548|43.7|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|548||||548|46.42|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|548||||548|46.42|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|548||||548|274.55|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|548||||548|192.35|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|548||||548|52.88|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|548||||548|233.45|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|548||||548|274|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|548||||548|356.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|CORESOURCE [1315]|CORESOURCE [131500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|CORVEL CORP [2235]|CORVEL CORP [223500]|548||||548|68.82|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|548||||548|42.13|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|GEHA [1415]|GEHA [141500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|548||||548|96.39|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HEALTHNET [1495]|HEALTHNET [149500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|548||||548|52.88|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HEALTHSMART [1505]|HEALTHSMART [150501]|548||||548|509.64|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|548||||548|328.8|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|548||||548|47.12|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|548||||548|274|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|548||||548|44.83|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|548||||548|57.83|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|548||||548|43.7|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MULTIPLAN [1680]|HMA [168003]|548||||548|64.26|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MULTIPLAN [1680]|IHC HS [168011]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|548||||548|48.25|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|548||||548|47.12|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|Self-pay|Self-pay|548||||548|164.4|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|548||||548|115.08|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|548||||548|41.98|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|548||||548|62.55|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|TRUSTMARK [2030]|STARMARK [203000]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|548||||548|262.77|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|UMR [2035]|UMR OPTIONS [203501]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|548||||548|42.7|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|548||||548|493.2|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|548||||548|28.56|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|548||||548|42.13|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|548||||548|42.84|509.64|28.56
30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|548||||548|274|509.64|28.56
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|55.46|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374|35.79|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|38.01|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|38.01|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|43.33|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|54.89|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|33.61|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374|78.95|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|43.33|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374|38.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|36.71|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374|47.37|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374|35.79|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MULTIPLAN [1680]|HMA [168003]|374||||374|52.64|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|39.51|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374|38.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|Self-pay|Self-pay|374||||374|112.2|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374|34.39|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374|51.23|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|34.97|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|23.39|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|33.61|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374|35.09|347.82|23.39
30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|23.39
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|AETNA [1015]|AETNA ACO WILCO [101532]|1130||||1130|67.7|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1130||||1130|43.7|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1130||||1130|46.42|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1130||||1130|46.42|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1130||||1130|566.13|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1130||||1130|396.63|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1130||||1130|52.88|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1130||||1130|481.38|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1130||||1130|565|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1130||||1130|734.5|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|CORESOURCE [1315]|CORESOURCE [131500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1130||||1130|67.19|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1130||||1130|41.14|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|GEHA [1415]|GEHA [141500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1130||||1130|96.39|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HEALTHNET [1495]|HEALTHNET [149500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1130||||1130|52.88|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1130||||1130|1050.9|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1130||||1130|678|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1130||||1130|47.12|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1130||||1130|565|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1130||||1130|44.83|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1130||||1130|57.83|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1130||||1130|43.7|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MULTIPLAN [1680]|HMA [168003]|1130||||1130|64.26|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MULTIPLAN [1680]|IHC HS [168011]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1130||||1130|48.25|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1130||||1130|47.12|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|Self-pay|Self-pay|1130||||1130|339|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1130||||1130|237.3|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1130||||1130|41.98|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1130||||1130|62.55|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|TRUSTMARK [2030]|STARMARK [203000]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1130||||1130|541.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|UMR [2035]|UMR OPTIONS [203501]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1130||||1130|42.7|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1130||||1130|1017|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1130||||1130|28.56|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1130||||1130|41.14|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1130||||1130|42.84|1050.9|28.56
30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1130||||1130|565|1050.9|28.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|AETNA [1015]|AETNA ACO WILCO [101532]|521||||521|55.84|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521||||521|42.53|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521||||521|42.53|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|521||||521|261.02|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521||||521|182.87|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521||||521|43.33|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|521||||521|221.95|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|521||||521|260.5|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521||||521|338.65|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|CORESOURCE [1315]|CORESOURCE [131500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|521||||521|54.89|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|521||||521|33.61|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|GEHA [1415]|GEHA [141500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HEALTHNET [1495]|HEALTHNET [149500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521||||521|43.33|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|521||||521|484.53|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|521||||521|312.6|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521||||521|260.5|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521||||521|41.08|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MULTIPLAN [1680]|HMA [168003]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MULTIPLAN [1680]|IHC HS [168011]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|521||||521|44.2|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|Self-pay|Self-pay|521||||521|156.3|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521||||521|109.41|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|TRUSTMARK [2030]|STARMARK [203000]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521||||521|249.82|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|UMR [2035]|UMR OPTIONS [203501]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521||||521|39.12|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521||||521|468.9|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|521||||521|23.56|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|521||||521|33.61|484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|521||||521||484.53|23.56
30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|521||||521|260.5|484.53|23.56
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|380||||380|55.46|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|380||||380|35.79|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|380||||380|38.01|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|380||||380|38.01|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|380||||380|190.38|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|380||||380|133.38|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|380||||380|43.33|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|380||||380|161.88|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|380||||380|190|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|380||||380|247|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|CORESOURCE [1315]|CORESOURCE [131500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|380||||380|54.89|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|380||||380|33.61|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|GEHA [1415]|GEHA [141500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|380||||380|78.95|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HEALTHNET [1495]|HEALTHNET [149500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|380||||380|43.33|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|380||||380|353.4|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|380||||380|228|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|380||||380|38.6|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|380||||380|190|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|380||||380|36.71|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|380||||380|47.37|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|380||||380|35.79|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MULTIPLAN [1680]|HMA [168003]|380||||380|52.64|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MULTIPLAN [1680]|IHC HS [168011]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|380||||380|39.51|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|380||||380|38.6|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|Self-pay|Self-pay|380||||380|114|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|380||||380|79.8|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|380||||380|34.39|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|380||||380|51.23|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|TRUSTMARK [2030]|STARMARK [203000]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|380||||380|182.21|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|UMR [2035]|UMR OPTIONS [203501]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|380||||380|34.97|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|380||||380|342|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|380||||380|23.39|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|380||||380|33.61|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|380||||380|35.09|353.4|23.39
30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|380||||380|190|353.4|23.39
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|AETNA [1015]|AETNA ACO WILCO [101532]|185||||185|67.7|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|185||||185|46.42|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|185||||185|46.42|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|185||||185|92.69|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|185||||185|64.94|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|185||||185|52.88|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|185||||185|78.81|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|185||||185|92.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|185||||185|120.25|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|CORESOURCE [1315]|CORESOURCE [131500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|185||||185|68.82|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|185||||185|42.13|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|GEHA [1415]|GEHA [141500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HEALTHNET [1495]|HEALTHNET [149500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|185||||185|52.88|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|185||||185|172.05|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|185||||185|111|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|185||||185|92.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|185||||185|44.83|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MULTIPLAN [1680]|HMA [168003]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MULTIPLAN [1680]|IHC HS [168011]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|185||||185|48.25|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|Self-pay|Self-pay|185||||185|55.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|185||||185|38.85|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|TRUSTMARK [2030]|STARMARK [203000]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|185||||185|88.71|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|UMR [2035]|UMR OPTIONS [203501]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|185||||185|42.7|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|185||||185|166.5|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|185||||185|28.56|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|185||||185|42.13|172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|185||||185||172.05|28.56
30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|185||||185|92.5|172.05|28.56
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|AETNA [1015]|AETNA ACO WILCO [101532]|631||||631|55.46|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|631||||631|35.79|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|631||||631|38.01|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|631||||631|38.01|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|631||||631|316.13|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|631||||631|221.48|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|631||||631|43.33|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|631||||631|268.81|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|631||||631|315.5|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|631||||631|410.15|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|CORESOURCE [1315]|CORESOURCE [131500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|631||||631|54.89|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|631||||631|33.61|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|GEHA [1415]|GEHA [141500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|631||||631|78.95|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HEALTHNET [1495]|HEALTHNET [149500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|631||||631|43.33|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|631||||631|586.83|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|631||||631|378.6|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|631||||631|38.6|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|631||||631|315.5|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|631||||631|36.71|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|631||||631|47.37|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|631||||631|35.79|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MULTIPLAN [1680]|HMA [168003]|631||||631|52.64|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MULTIPLAN [1680]|IHC HS [168011]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|631||||631|39.51|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|631||||631|38.6|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|Self-pay|Self-pay|631||||631|189.3|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|631||||631|132.51|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|631||||631|34.39|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|631||||631|51.23|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|TRUSTMARK [2030]|STARMARK [203000]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|631||||631|302.56|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|UMR [2035]|UMR OPTIONS [203501]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|631||||631|34.97|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|631||||631|567.9|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|631||||631|23.39|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|631||||631|33.61|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|631||||631|35.09|586.83|23.39
30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|631||||631|315.5|586.83|23.39
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|843||||843|134.49|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|843||||843|86.8|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|843||||843|92.2|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|843||||843|92.2|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|843||||843|422.34|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|843||||843|295.89|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|843||||843|105.06|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|843||||843|359.12|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|843||||843|421.5|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|843||||843|547.95|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|CORESOURCE [1315]|CORESOURCE [131500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|843||||843|117.6|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|843||||843|70.31|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|GEHA [1415]|GEHA [141500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|843||||843|191.48|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HEALTHNET [1495]|HEALTHNET [149500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|843||||843|105.06|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|843||||843|783.99|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|843||||843|505.8|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|843||||843|93.61|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|843||||843|421.5|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|843||||843|89.05|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|843||||843|114.89|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|843||||843|86.8|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MULTIPLAN [1680]|HMA [168003]|843||||843|127.65|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MULTIPLAN [1680]|IHC HS [168011]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|843||||843|95.83|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|843||||843|93.61|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|Self-pay|Self-pay|843||||843|252.9|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|843||||843|177.03|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|843||||843|83.4|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|843||||843|124.25|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|TRUSTMARK [2030]|STARMARK [203000]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|843||||843|404.22|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|UMR [2035]|UMR OPTIONS [203501]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|843||||843|84.8|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|843||||843|758.7|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|843||||843|56.73|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|843||||843|70.31|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|843||||843|85.1|783.99|56.73
30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA DETECT NUC ACID HIV-1 QUANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|843||||843|421.5|783.99|56.73
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|AETNA [1015]|AETNA ACO WILCO [101532]|991||||991|83.38|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|991||||991|63.51|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|991||||991|63.51|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|991||||991|496.49|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|991||||991|347.84|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|991||||991|58.62|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|991||||991|422.17|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|991||||991|495.5|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|991||||991|644.15|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|CORESOURCE [1315]|CORESOURCE [131500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|991||||991|68.82|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|991||||991|42.13|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|GEHA [1415]|GEHA [141500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HEALTHNET [1495]|HEALTHNET [149500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|991||||991|58.62|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|991||||991|921.63|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|991||||991|594.6|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|991||||991|495.5|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|991||||991|61.34|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MULTIPLAN [1680]|HMA [168003]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MULTIPLAN [1680]|IHC HS [168011]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|991||||991|66.01|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|Self-pay|Self-pay|991||||991|297.3|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|991||||991|208.11|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|TRUSTMARK [2030]|STARMARK [203000]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|991||||991|475.18|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|UMR [2035]|UMR OPTIONS [203501]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|991||||991|58.41|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|991||||991|891.9|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|991||||991|35.17|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|991||||991|42.13|921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|991||||991||921.63|35.17
30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|991||||991|495.5|921.63|35.17
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|AETNA [1015]|AETNA ACO WILCO [101532]|494||||494|55.46|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494||||494|38.01|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494||||494|38.01|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|494||||494|247.49|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494||||494|173.39|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494||||494|43.33|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|494||||494|210.44|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|494||||494|247|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494||||494|321.1|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|CORESOURCE [1315]|CORESOURCE [131500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|494||||494|54.89|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|494||||494|33.61|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|GEHA [1415]|GEHA [141500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HEALTHNET [1495]|HEALTHNET [149500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494||||494|43.33|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|494||||494|459.42|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494||||494|296.4|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494||||494|247|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494||||494|36.71|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MULTIPLAN [1680]|HMA [168003]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MULTIPLAN [1680]|IHC HS [168011]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|494||||494|39.51|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|Self-pay|Self-pay|494||||494|148.2|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494||||494|103.74|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|TRUSTMARK [2030]|STARMARK [203000]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494||||494|236.87|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|UMR [2035]|UMR OPTIONS [203501]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494||||494|34.97|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494||||494|444.6|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|494||||494|23.39|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|494||||494|33.61|459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|494||||494||459.42|23.39
30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|494||||494|247|459.42|23.39
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|AETNA [1015]|AETNA ACO WILCO [101532]|374||||374|59.28|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374||||374|42.51|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374||||374|45.16|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374||||374|45.16|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|374||||374|187.37|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374||||374|131.27|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374||||374|43.33|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|374||||374|159.32|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|374||||374|187|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374||||374|243.1|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|CORESOURCE [1315]|CORESOURCE [131500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|374||||374|54.89|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|374||||374|33.61|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|GEHA [1415]|GEHA [141500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|374||||374|93.78|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HEALTHNET [1495]|HEALTHNET [149500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374||||374|43.33|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|374||||374|347.82|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374||||374|224.4|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374||||374|45.85|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374||||374|187|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374||||374|43.61|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374||||374|56.27|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374||||374|42.51|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MULTIPLAN [1680]|HMA [168003]|374||||374|62.52|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MULTIPLAN [1680]|IHC HS [168011]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|374||||374|46.94|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374||||374|45.85|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|Self-pay|Self-pay|374||||374|112.2|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374||||374|78.54|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|374||||374|40.85|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374||||374|60.85|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|TRUSTMARK [2030]|STARMARK [203000]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374||||374|179.33|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|UMR [2035]|UMR OPTIONS [203501]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374||||374|41.53|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374||||374|336.6|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|374||||374|25.01|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|374||||374|33.61|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|374||||374|41.68|347.82|25.01
30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|374||||374|187|347.82|25.01
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|517||||517|55.46|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|517||||517|38.01|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|517||||517|38.01|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|517||||517|259.02|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|517||||517|181.47|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|517||||517|43.33|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|517||||517|220.24|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|517||||517|258.5|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517||||517|336.05|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|517||||517|54.89|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|517||||517|33.61|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|GEHA [1415]|GEHA [141500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|517||||517|43.33|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|517||||517|480.81|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|517||||517|310.2|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|517||||517|258.5|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|517||||517|36.71|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MULTIPLAN [1680]|HMA [168003]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|517||||517|39.51|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|Self-pay|Self-pay|517||||517|155.1|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|517||||517|108.57|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|517||||517|247.9|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|UMR [2035]|UMR OPTIONS [203501]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|517||||517|34.97|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|517||||517|465.3|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|517||||517|23.39|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|517||||517|33.61|480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|517||||517||480.81|23.39
30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|517||||517|258.5|480.81|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|AETNA [1015]|AETNA ACO WILCO [101532]|495||||495|55.46|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|495||||495|35.79|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|495||||495|38.01|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|495||||495|38.01|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|495||||495|248|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|495||||495|173.75|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|495||||495|43.33|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|495||||495|210.87|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|495||||495|247.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|495||||495|321.75|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|CORESOURCE [1315]|CORESOURCE [131500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|CORVEL CORP [2235]|CORVEL CORP [223500]|495||||495|54.89|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|495||||495|33.61|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|GEHA [1415]|GEHA [141500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|495||||495|78.95|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HEALTHNET [1495]|HEALTHNET [149500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|495||||495|43.33|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HEALTHSMART [1505]|HEALTHSMART [150501]|495||||495|460.35|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|495||||495|297|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|495||||495|38.6|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|495||||495|247.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|495||||495|36.71|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|495||||495|47.37|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|495||||495|35.79|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MULTIPLAN [1680]|HMA [168003]|495||||495|52.64|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MULTIPLAN [1680]|IHC HS [168011]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|495||||495|39.51|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|495||||495|38.6|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|Self-pay|Self-pay|495||||495|148.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|495||||495|103.95|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|495||||495|34.39|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|495||||495|51.23|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|TRUSTMARK [2030]|STARMARK [203000]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|495||||495|237.35|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|UMR [2035]|UMR OPTIONS [203501]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|495||||495|34.97|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|495||||495|445.5|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|495||||495|23.39|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|495||||495|33.61|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|495||||495|35.09|460.35|23.39
30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|495||||495|247.5|460.35|23.39
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|AETNA [1015]|AETNA ACO WILCO [101532]|189||||189|38.24|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|189||||189|29.13|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|189||||189|29.13|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|189||||189|94.69|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|189||||189|66.34|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|189||||189|26.88|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|189||||189|80.51|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|189||||189|94.5|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|189||||189|122.85|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|CORESOURCE [1315]|CORESOURCE [131500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|189||||189|31.59|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|189||||189|19.34|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|GEHA [1415]|GEHA [141500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HEALTHNET [1495]|HEALTHNET [149500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|189||||189|26.88|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|189||||189|175.77|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|189||||189|113.4|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|189||||189|94.5|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|189||||189|28.14|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MULTIPLAN [1680]|HMA [168003]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MULTIPLAN [1680]|IHC HS [168011]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|189||||189|30.28|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|Self-pay|Self-pay|189||||189|56.7|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|189||||189|39.69|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|TRUSTMARK [2030]|STARMARK [203000]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|189||||189|90.63|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|UMR [2035]|UMR OPTIONS [203501]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|189||||189|26.8|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|189||||189|170.1|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|189||||189|16.13|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|189||||189|19.34|175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|189||||189||175.77|16.13
30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|189||||189|94.5|175.77|16.13
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|AETNA [1015]|AETNA ACO WILCO [101532]|349||||349|55.46|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349||||349|35.79|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349||||349|38.01|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349||||349|38.01|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349||||349|174.85|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349||||349|122.5|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349||||349|43.33|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349||||349|148.67|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349||||349|174.5|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349||||349|226.85|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|CORESOURCE [1315]|CORESOURCE [131500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349||||349|54.89|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349||||349|33.61|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|GEHA [1415]|GEHA [141500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349||||349|78.95|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HEALTHNET [1495]|HEALTHNET [149500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349||||349|43.33|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349||||349|324.57|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349||||349|209.4|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349||||349|38.6|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349||||349|174.5|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349||||349|36.71|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349||||349|47.37|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349||||349|35.79|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MULTIPLAN [1680]|HMA [168003]|349||||349|52.64|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MULTIPLAN [1680]|IHC HS [168011]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349||||349|39.51|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349||||349|38.6|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|Self-pay|Self-pay|349||||349|104.7|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349||||349|73.29|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349||||349|34.39|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349||||349|51.23|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|TRUSTMARK [2030]|STARMARK [203000]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349||||349|167.35|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|UMR [2035]|UMR OPTIONS [203501]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349||||349|34.97|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349||||349|314.1|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349||||349|23.39|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349||||349|33.61|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349||||349|35.09|324.57|23.39
30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349||||349|174.5|324.57|23.39
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|552||||552|202.88|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|552||||552|145.48|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|552||||552|154.53|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|552||||552|154.53|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|552||||552|276.55|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|552||||552|193.75|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|552||||552|158.38|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|552||||552|235.15|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|552||||552|276|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|552||||552|358.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|CORESOURCE [1315]|CORESOURCE [131500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|552||||552|180.77|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|552||||552|102.76|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|GEHA [1415]|GEHA [141500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|552||||552|320.92|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HEALTHNET [1495]|HEALTHNET [149500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|552||||552|158.38|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|552||||552|513.36|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|552||||552|331.2|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|552||||552|156.89|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|552||||552|276|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|552||||552|149.25|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|552||||552|192.55|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|552||||552|145.48|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MULTIPLAN [1680]|HMA [168003]|552||||552|213.95|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MULTIPLAN [1680]|IHC HS [168011]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|552||||552|160.61|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|552||||552|156.89|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|Self-pay|Self-pay|552||||552|165.6|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|552||||552|115.92|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|552||||552|139.78|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|552||||552|208.24|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|TRUSTMARK [2030]|STARMARK [203000]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|552||||552|264.68|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|UMR [2035]|UMR OPTIONS [203501]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|552||||552|142.14|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|552||||552|496.8|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|552||||552|85.58|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|552||||552|102.76|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|552||||552|142.63|513.36|85.58
30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|552||||552|276|513.36|85.58
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|925||||925|337.31|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|925||||925|222.42|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|925||||925|236.26|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|925||||925|236.26|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|925||||925|463.43|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|925||||925|324.68|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|925||||925|263.49|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|925||||925|394.05|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|925||||925|462.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|925||||925|601.25|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|CORESOURCE [1315]|CORESOURCE [131500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|925||||925|300.8|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|925||||925|170.91|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|GEHA [1415]|GEHA [141500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|925||||925|490.64|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HEALTHNET [1495]|HEALTHNET [149500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|925||||925|263.49|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|925||||925|860.25|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|925||||925|555|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|925||||925|239.87|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|925||||925|462.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|925||||925|228.19|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|925||||925|294.38|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|925||||925|222.42|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MULTIPLAN [1680]|HMA [168003]|925||||925|327.09|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MULTIPLAN [1680]|IHC HS [168011]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|925||||925|245.56|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|925||||925|239.87|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|Self-pay|Self-pay|925||||925|277.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|925||||925|194.25|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|925||||925|213.7|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|925||||925|318.37|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|TRUSTMARK [2030]|STARMARK [203000]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|925||||925|443.54|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|UMR [2035]|UMR OPTIONS [203501]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|925||||925|217.32|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|925||||925|832.5|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|925||||925|142.28|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|925||||925|170.91|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|925||||925|218.06|860.25|142.28
30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|925||||925|462.5|860.25|142.28
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|149||||149|110.94|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149||||149|71.6|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149||||149|0|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149||||149|0|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149||||149|74.65|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149||||149|52.3|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149||||149|86.66|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149||||149|63.47|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149||||149|74.5|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149||||149|96.85|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|149||||149|0|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149||||149|56|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|GEHA [1415]|GEHA [141500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149||||149|149|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149||||149|86.66|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|149||||149|138.57|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149||||149|89.4|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149||||149|77.22|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149||||149|74.5|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149||||149|0|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149||||149|94.77|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149||||149|71.6|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MULTIPLAN [1680]|HMA [168003]|149||||149|105.3|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|149||||149|0|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149||||149|77.22|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|Self-pay|Self-pay|149||||149|44.7|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149||||149|31.29|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149||||149|68.8|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149||||149|102.49|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149||||149|71.45|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|UMR [2035]|UMR OPTIONS [203501]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149||||149|0|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149||||149|134.1|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149||||149|46.79|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149||||149|56|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149||||149|70.2|149|31.29
30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149||||149|74.5|149|31.29
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300||||300|145.48|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|300||||300|150.3|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300||||300|105.3|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300||||300|129|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|300||||300|127.8|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|300||||300|150|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300||||300|195|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|CORESOURCE [1315]|CORESOURCE [131500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|GEHA [1415]|GEHA [141500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|300||||300|300|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HEALTHNET [1495]|HEALTHNET [149500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300||||300|129|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|300||||300|279|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300||||300|180|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300||||300|156.89|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300||||300|192.55|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300||||300|145.48|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MULTIPLAN [1680]|HMA [168003]|300||||300|213.95|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MULTIPLAN [1680]|IHC HS [168011]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|300||||300|213.69|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300||||300|156.89|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|Self-pay|Self-pay|300||||300|90|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300||||300|63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|300||||300|139.78|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300||||300|208.24|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|TRUSTMARK [2030]|STARMARK [203000]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|300||||300|143.85|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|UMR [2035]|UMR OPTIONS [203501]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|300||||300|270|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|300||||300|0|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|300||||300|142.63|300|63
30687636|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|300||||300|150|300|63
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|267||||267|55.46|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267||||267|35.79|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267||||267|38.01|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267||||267|38.01|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267||||267|133.77|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267||||267|93.72|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267||||267|43.33|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267||||267|113.74|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267||||267|133.5|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267||||267|173.55|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267||||267|53.47|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267||||267|32.74|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|GEHA [1415]|GEHA [141500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267||||267|78.95|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267||||267|43.33|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267||||267|248.31|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267||||267|160.2|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267||||267|38.6|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267||||267|133.5|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267||||267|36.71|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267||||267|47.37|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267||||267|35.79|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MULTIPLAN [1680]|HMA [168003]|267||||267|52.64|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267||||267|39.51|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267||||267|38.6|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|Self-pay|Self-pay|267||||267|80.1|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267||||267|56.07|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267||||267|34.39|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267||||267|51.23|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267||||267|128.03|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|UMR [2035]|UMR OPTIONS [203501]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267||||267|34.97|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267||||267|240.3|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267||||267|23.39|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267||||267|32.74|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267||||267|35.09|248.31|23.39
30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267||||267|133.5|248.31|23.39
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|AETNA [1015]|AETNA ACO WILCO [101532]|284||||284|31.7|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|284||||284|20.45|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|284||||284|21.73|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|284||||284|21.73|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|284||||284|142.28|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|284||||284|99.68|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|284||||284|24.76|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|284||||284|120.98|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|284||||284|142|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|284||||284|184.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|CORESOURCE [1315]|CORESOURCE [131500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|284||||284|31.59|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|284||||284|19.34|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|GEHA [1415]|GEHA [141500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|284||||284|45.11|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HEALTHNET [1495]|HEALTHNET [149500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|284||||284|24.76|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|284||||284|264.12|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|284||||284|170.4|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|284||||284|22.06|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|284||||284|142|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|284||||284|20.99|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|284||||284|27.07|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|284||||284|20.45|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MULTIPLAN [1680]|HMA [168003]|284||||284|30.08|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MULTIPLAN [1680]|IHC HS [168011]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|284||||284|22.59|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|284||||284|22.06|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|Self-pay|Self-pay|284||||284|85.2|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|284||||284|59.64|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|284||||284|19.65|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|284||||284|29.27|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|TRUSTMARK [2030]|STARMARK [203000]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|284||||284|136.18|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|UMR [2035]|UMR OPTIONS [203501]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|284||||284|19.99|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|284||||284|255.6|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|284||||284|13.37|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|284||||284|19.34|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|284||||284|20.05|264.12|13.37
30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|284||||284|142|264.12|13.37
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|AETNA [1015]|AETNA ACO WILCO [101532]|130||||130|55.46|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130||||130|35.79|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130||||130|38.01|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130||||130|38.01|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|130||||130|65.13|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130||||130|45.63|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130||||130|43.33|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|130||||130|55.38|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|130||||130|65|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130||||130|84.5|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|CORESOURCE [1315]|CORESOURCE [131500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|130||||130|54.89|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|130||||130|33.61|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|GEHA [1415]|GEHA [141500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|130||||130|78.95|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HEALTHNET [1495]|HEALTHNET [149500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130||||130|43.33|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|130||||130|120.9|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130||||130|78|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130||||130|38.6|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130||||130|65|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130||||130|36.71|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130||||130|47.37|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130||||130|35.79|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MULTIPLAN [1680]|HMA [168003]|130||||130|52.64|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MULTIPLAN [1680]|IHC HS [168011]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|130||||130|39.51|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130||||130|38.6|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|Self-pay|Self-pay|130||||130|39|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130||||130|27.3|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|130||||130|34.39|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130||||130|51.23|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|TRUSTMARK [2030]|STARMARK [203000]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130||||130|62.34|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|UMR [2035]|UMR OPTIONS [203501]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130||||130|34.97|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130||||130|117|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|130||||130|23.39|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|130||||130|33.61|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|130||||130|35.09|120.9|23.39
30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|130||||130|65|120.9|23.39
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|87||||87|31.7|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87||||87|21.73|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87||||87|21.73|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87||||87|43.59|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87||||87|30.54|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87||||87|24.76|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87||||87|37.06|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87||||87|43.5|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87||||87|56.55|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|CORESOURCE [1315]|CORESOURCE [131500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87||||87|30.53|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87||||87|18.69|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|GEHA [1415]|GEHA [141500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HEALTHNET [1495]|HEALTHNET [149500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87||||87|24.76|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87||||87|80.91|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87||||87|52.2|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87||||87|43.5|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87||||87|20.99|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MULTIPLAN [1680]|HMA [168003]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MULTIPLAN [1680]|IHC HS [168011]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87||||87|22.59|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|Self-pay|Self-pay|87||||87|26.1|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87||||87|18.27|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|TRUSTMARK [2030]|STARMARK [203000]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87||||87|41.72|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|UMR [2035]|UMR OPTIONS [203501]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87||||87|19.99|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87||||87|78.3|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87||||87|13.37|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87||||87|18.69|80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87||||87||80.91|13.37
30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87||||87|43.5|80.91|13.37
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|AETNA [1015]|AETNA ACO WILCO [101532]|151||||151|55.46|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151||||151|35.79|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151||||151|38.01|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151||||151|38.01|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|151||||151|75.65|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151||||151|53|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151||||151|43.33|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|151||||151|64.33|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|151||||151|75.5|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151||||151|98.15|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|CORESOURCE [1315]|CORESOURCE [131500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|151||||151|49.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|151||||151|28.03|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|GEHA [1415]|GEHA [141500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|151||||151|78.95|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HEALTHNET [1495]|HEALTHNET [149500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151||||151|43.33|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|151||||151|140.43|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151||||151|90.6|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151||||151|38.6|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151||||151|75.5|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151||||151|36.71|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151||||151|47.37|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151||||151|35.79|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MULTIPLAN [1680]|HMA [168003]|151||||151|52.64|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MULTIPLAN [1680]|IHC HS [168011]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|151||||151|39.51|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151||||151|38.6|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|Self-pay|Self-pay|151||||151|45.3|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151||||151|31.71|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|151||||151|34.39|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151||||151|51.23|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|TRUSTMARK [2030]|STARMARK [203000]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151||||151|72.4|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|UMR [2035]|UMR OPTIONS [203501]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151||||151|34.97|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151||||151|135.9|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|151||||151|23.39|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|151||||151|28.03|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|151||||151|35.09|140.43|23.39
30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|151||||151|75.5|140.43|23.39
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|AETNA [1015]|AETNA ACO WILCO [101532]|144||||144|81.11|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144||||144|0|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144||||144|0|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|144||||144|72.14|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144||||144|50.54|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144||||144|63.35|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|144||||144|61.34|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|144||||144|72|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144||||144|93.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|CORESOURCE [1315]|CORESOURCE [131500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|144||||144|0|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|144||||144|40.95|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|GEHA [1415]|GEHA [141500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HEALTHNET [1495]|HEALTHNET [149500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144||||144|63.35|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|144||||144|133.92|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144||||144|86.4|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144||||144|72|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144||||144|0|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MULTIPLAN [1680]|HMA [168003]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MULTIPLAN [1680]|IHC HS [168011]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|144||||144|0|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|Self-pay|Self-pay|144||||144|43.2|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144||||144|30.24|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|TRUSTMARK [2030]|STARMARK [203000]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144||||144|69.05|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|UMR [2035]|UMR OPTIONS [203501]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144||||144|0|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144||||144|129.6|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|144||||144|34.21|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|144||||144|40.95|133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|144||||144||133.92|30.24
30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|144||||144|72|133.92|30.24
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|390||||390|55.46|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390||||390|35.79|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390||||390|38.01|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390||||390|38.01|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|390||||390|195.39|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390||||390|136.89|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390||||390|43.33|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|390||||390|166.14|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|390||||390|195|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390||||390|253.5|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|390||||390|54.89|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|390||||390|33.61|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|GEHA [1415]|GEHA [141500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|390||||390|78.95|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390||||390|43.33|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|390||||390|362.7|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390||||390|234|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390||||390|38.6|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390||||390|195|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390||||390|36.71|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390||||390|47.37|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390||||390|35.79|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MULTIPLAN [1680]|HMA [168003]|390||||390|52.64|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MULTIPLAN [1680]|IHC HS [168011]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|390||||390|39.51|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390||||390|38.6|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|Self-pay|Self-pay|390||||390|117|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390||||390|81.9|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|390||||390|34.39|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390||||390|51.23|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|TRUSTMARK [2030]|STARMARK [203000]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390||||390|187.01|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|UMR [2035]|UMR OPTIONS [203501]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390||||390|34.97|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390||||390|351|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|390||||390|23.39|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|390||||390|33.61|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|390||||390|35.09|362.7|23.39
30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|390||||390|195|362.7|23.39
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|AETNA [1015]|AETNA ACO WILCO [101532]|591||||591|67.7|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|591||||591|43.7|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|591||||591|46.42|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|591||||591|46.42|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|591||||591|296.09|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|591||||591|207.44|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|591||||591|52.88|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|591||||591|251.77|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|591||||591|295.5|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|591||||591|384.15|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|CORESOURCE [1315]|CORESOURCE [131500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|591||||591|68.8|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|591||||591|42.12|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|GEHA [1415]|GEHA [141500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|591||||591|96.39|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HEALTHNET [1495]|HEALTHNET [149500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|591||||591|52.88|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|591||||591|549.63|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|591||||591|354.6|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|591||||591|47.12|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|591||||591|295.5|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|591||||591|44.83|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|591||||591|57.83|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|591||||591|43.7|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MULTIPLAN [1680]|HMA [168003]|591||||591|64.26|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MULTIPLAN [1680]|IHC HS [168011]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|591||||591|48.25|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|591||||591|47.12|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|Self-pay|Self-pay|591||||591|177.3|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|591||||591|124.11|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|591||||591|41.98|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|591||||591|62.55|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|TRUSTMARK [2030]|STARMARK [203000]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|591||||591|283.38|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|UMR [2035]|UMR OPTIONS [203501]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|591||||591|42.7|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|591||||591|531.9|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|591||||591|28.56|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|591||||591|42.12|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|591||||591|42.84|549.63|28.56
30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID NOS QN EA ORGANISM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|591||||591|295.5|549.63|28.56
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|AETNA [1015]|AETNA ACO WILCO [101532]|970||||970|110.94|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|970||||970|71.6|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|970||||970|76.06|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|970||||970|76.06|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|970||||970|485.97|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|970||||970|340.47|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|970||||970|86.66|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|970||||970|413.22|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|970||||970|485|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|970||||970|630.5|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|CORESOURCE [1315]|CORESOURCE [131500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|970||||970|98.95|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|970||||970|60.58|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|GEHA [1415]|GEHA [141500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|970||||970|157.95|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HEALTHNET [1495]|HEALTHNET [149500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|970||||970|86.66|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|970||||970|902.1|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|970||||970|582|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|970||||970|77.22|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|970||||970|485|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|970||||970|73.46|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|970||||970|94.77|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|970||||970|71.6|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MULTIPLAN [1680]|HMA [168003]|970||||970|105.3|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MULTIPLAN [1680]|IHC HS [168011]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|970||||970|79.05|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|970||||970|77.22|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|Self-pay|Self-pay|970||||970|291|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|970||||970|203.7|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|970||||970|68.8|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|970||||970|102.49|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|TRUSTMARK [2030]|STARMARK [203000]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|970||||970|465.12|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|UMR [2035]|UMR OPTIONS [203501]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|970||||970|69.96|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|970||||970|873|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|970||||970|46.79|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|970||||970|60.58|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|970||||970|70.2|902.1|46.79
30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|970||||970|485|902.1|46.79
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|AETNA [1015]|AETNA ACO WILCO [101532]|49||||49|23.54|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49||||49|17.93|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49||||49|17.93|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49||||49|24.55|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49||||49|17.2|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49||||49|16.55|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49||||49|20.87|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49||||49|24.5|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49||||49|31.85|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|CORESOURCE [1315]|CORESOURCE [131500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49||||49|32.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49||||49|19.66|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|GEHA [1415]|GEHA [141500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HEALTHNET [1495]|HEALTHNET [149500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49||||49|16.55|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49||||49|45.57|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49||||49|29.4|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49||||49|24.5|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49||||49|17.32|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MULTIPLAN [1680]|HMA [168003]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MULTIPLAN [1680]|IHC HS [168011]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49||||49|18.64|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|Self-pay|Self-pay|49||||49|14.7|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49||||49|10.29|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|TRUSTMARK [2030]|STARMARK [203000]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49||||49|23.5|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|UMR [2035]|UMR OPTIONS [203501]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49||||49|16.5|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49||||49|44.1|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49||||49|9.93|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49||||49|19.66|45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49||||49||45.57|9.93
30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49||||49|24.5|45.57|9.93
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|AETNA [1015]|AETNA ACO WILCO [101532]|175||||175|23.51|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|175||||175|17.91|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|175||||175|17.91|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|175||||175|87.68|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|175||||175|61.43|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|175||||175|16.53|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|175||||175|74.55|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|175||||175|87.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|175||||175|113.75|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|CORESOURCE [1315]|CORESOURCE [131500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|CORVEL CORP [2235]|CORVEL CORP [223500]|175||||175|20.6|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|175||||175|12.61|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|GEHA [1415]|GEHA [141500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HEALTHNET [1495]|HEALTHNET [149500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|175||||175|16.53|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HEALTHSMART [1505]|HEALTHSMART [150501]|175||||175|162.75|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|175||||175|105|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|175||||175|87.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|175||||175|17.3|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MULTIPLAN [1680]|HMA [168003]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MULTIPLAN [1680]|IHC HS [168011]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|175||||175|18.62|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|Self-pay|Self-pay|175||||175|52.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|175||||175|36.75|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|TRUSTMARK [2030]|STARMARK [203000]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|175||||175|83.91|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|UMR [2035]|UMR OPTIONS [203501]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|175||||175|16.47|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|175||||175|157.5|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|175||||175|9.92|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|175||||175|12.61|162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|175||||175||162.75|9.92
30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|175||||175|87.5|162.75|9.92
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|AETNA [1015]|AETNA ACO WILCO [101532]|119||||119|22.86|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119||||119|16.39|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119||||119|17.42|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119||||119|17.42|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119||||119|59.62|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119||||119|41.77|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119||||119|50.69|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119||||119|59.5|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119||||119|77.35|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|CORESOURCE [1315]|CORESOURCE [131500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119||||119|20.6|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119||||119|12.61|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|GEHA [1415]|GEHA [141500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119||||119|36.16|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HEALTHNET [1495]|HEALTHNET [149500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119||||119|110.67|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119||||119|71.4|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119||||119|17.68|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119||||119|59.5|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119||||119|16.82|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119||||119|21.69|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119||||119|16.39|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MULTIPLAN [1680]|HMA [168003]|119||||119|24.11|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MULTIPLAN [1680]|IHC HS [168011]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119||||119|18.11|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119||||119|17.68|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|Self-pay|Self-pay|119||||119|35.7|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119||||119|24.99|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119||||119|15.75|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119||||119|23.46|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|TRUSTMARK [2030]|STARMARK [203000]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119||||119|57.06|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|UMR [2035]|UMR OPTIONS [203501]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119||||119|16.02|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119||||119|107.1|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119||||119|9.64|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119||||119|12.61|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119||||119|16.07|110.67|9.64
30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119||||119|59.5|110.67|9.64
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|AETNA [1015]|AETNA ACO WILCO [101532]|742||||742|206|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|742||||742|132.96|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|742||||742|141.23|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|742||||742|141.23|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|742||||742|371.74|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|742||||742|260.44|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|742||||742|160.92|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|742||||742|316.09|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|742||||742|371|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|742||||742|482.3|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|CORESOURCE [1315]|CORESOURCE [131500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|742||||742|285.6|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|742||||742|174.86|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|GEHA [1415]|GEHA [141500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|742||||742|293.29|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HEALTHNET [1495]|HEALTHNET [149500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|742||||742|160.92|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|742||||742|690.06|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|742||||742|445.2|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|742||||742|143.39|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|742||||742|371|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|742||||742|136.4|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|742||||742|175.97|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|742||||742|132.96|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MULTIPLAN [1680]|HMA [168003]|742||||742|195.53|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MULTIPLAN [1680]|IHC HS [168011]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|742||||742|146.79|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|742||||742|143.39|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|Self-pay|Self-pay|742||||742|222.6|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|742||||742|155.82|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|742||||742|127.74|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|742||||742|190.31|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|TRUSTMARK [2030]|STARMARK [203000]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|742||||742|355.79|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|UMR [2035]|UMR OPTIONS [203501]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|742||||742|129.9|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|742||||742|667.8|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|742||||742|86.9|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|742||||742|174.86|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|742||||742|130.35|690.06|86.9
30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|742||||742|371|690.06|86.9
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2727||||2727|406.87|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2727||||2727|278.93|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2727||||2727|278.93|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2727||||2727|1366.23|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2727||||2727|957.18|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2727||||2727|317.84|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2727||||2727|1161.7|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2727||||2727|1363.5|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2727||||2727|1772.55|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|CORESOURCE [1315]|CORESOURCE [131500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2727||||2727|448.47|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2727||||2727|274.58|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|GEHA [1415]|GEHA [141500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HEALTHNET [1495]|HEALTHNET [149500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2727||||2727|317.84|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2727||||2727|2536.11|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2727||||2727|1636.2|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2727||||2727|1363.5|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2727||||2727|269.4|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MULTIPLAN [1680]|HMA [168003]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MULTIPLAN [1680]|IHC HS [168011]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2727||||2727|289.91|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|Self-pay|Self-pay|2727||||2727|818.1|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2727||||2727|572.67|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|TRUSTMARK [2030]|STARMARK [203000]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2727||||2727|1307.6|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|UMR [2035]|UMR OPTIONS [203501]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2727||||2727|256.57|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2727||||2727|2454.3|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2727||||2727|171.63|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2727||||2727|274.58|2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2727||||2727||2536.11|171.63
30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2727||||2727|1363.5|2536.11|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|AETNA [1015]|AETNA ACO WILCO [101532]|2548||||2548|406.87|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2548||||2548|262.6|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2548||||2548|278.93|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2548||||2548|278.93|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2548||||2548|1276.55|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2548||||2548|894.35|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2548||||2548|317.84|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2548||||2548|1085.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2548||||2548|1274|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2548||||2548|1656.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|CORESOURCE [1315]|CORESOURCE [131500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2548||||2548|353.49|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2548||||2548|210.41|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|GEHA [1415]|GEHA [141500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2548||||2548|579.26|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HEALTHNET [1495]|HEALTHNET [149500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2548||||2548|317.84|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2548||||2548|2369.64|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2548||||2548|1528.8|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2548||||2548|283.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2548||||2548|1274|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2548||||2548|269.4|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2548||||2548|347.56|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2548||||2548|262.6|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MULTIPLAN [1680]|HMA [168003]|2548||||2548|386.18|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MULTIPLAN [1680]|IHC HS [168011]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2548||||2548|289.91|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2548||||2548|283.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|Self-pay|Self-pay|2548||||2548|764.4|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2548||||2548|535.08|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2548||||2548|252.3|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2548||||2548|375.88|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|TRUSTMARK [2030]|STARMARK [203000]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2548||||2548|1221.77|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|UMR [2035]|UMR OPTIONS [203501]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2548||||2548|256.57|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2548||||2548|2293.2|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2548||||2548|171.63|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2548||||2548|210.41|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2548||||2548|257.45|2369.64|171.63
30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2548||||2548|1274|2369.64|171.63
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|AETNA [1015]|AETNA ACO WILCO [101532]|3524||||3524|772.3|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3524||||3524|529.44|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3524||||3524|529.44|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3524||||3524|1765.52|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3524||||3524|1236.92|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3524||||3524|603.28|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3524||||3524|1501.22|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3524||||3524|1762|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3524||||3524|2290.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|CORESOURCE [1315]|CORESOURCE [131500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3524||||3524|839.86|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3524||||3524|514.2|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|GEHA [1415]|GEHA [141500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HEALTHNET [1495]|HEALTHNET [149500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3524||||3524|603.28|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3524||||3524|3277.32|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3524||||3524|2114.4|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3524||||3524|1762|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3524||||3524|511.35|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MULTIPLAN [1680]|HMA [168003]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MULTIPLAN [1680]|IHC HS [168011]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3524||||3524|550.29|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|Self-pay|Self-pay|3524||||3524|1057.2|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3524||||3524|740.04|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|TRUSTMARK [2030]|STARMARK [203000]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3524||||3524|1689.76|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|UMR [2035]|UMR OPTIONS [203501]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3524||||3524|486.99|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3524||||3524|3171.6|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3524||||3524|325.77|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3524||||3524|514.2|3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3524||||3524||3277.32|325.77
30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3524||||3524|1762|3277.32|325.77
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1107||||1107|406.87|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1107||||1107|262.6|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1107||||1107|278.93|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1107||||1107|278.93|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1107||||1107|554.61|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1107||||1107|388.56|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1107||||1107|317.84|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1107||||1107|471.58|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1107||||1107|553.5|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1107||||1107|719.55|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1107||||1107|362.66|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1107||||1107|206.18|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|GEHA [1415]|GEHA [141500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1107||||1107|579.26|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1107||||1107|317.84|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1107||||1107|1029.51|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1107||||1107|664.2|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1107||||1107|283.2|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1107||||1107|553.5|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1107||||1107|269.4|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1107||||1107|347.56|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1107||||1107|262.6|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MULTIPLAN [1680]|HMA [168003]|1107||||1107|386.18|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MULTIPLAN [1680]|IHC HS [168011]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1107||||1107|289.91|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1107||||1107|283.2|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|Self-pay|Self-pay|1107||||1107|332.1|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1107||||1107|232.47|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1107||||1107|252.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1107||||1107|375.88|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|TRUSTMARK [2030]|STARMARK [203000]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1107||||1107|530.81|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|UMR [2035]|UMR OPTIONS [203501]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1107||||1107|256.57|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1107||||1107|996.3|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1107||||1107|171.63|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1107||||1107|206.18|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1107||||1107|257.45|1029.51|171.63
30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1107||||1107|553.5|1029.51|171.63
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16.21||||16.21|8.12|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.21||||16.21|5.69|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.21||||16.21|6.97|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16.21||||16.21|6.91|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16.21||||16.21|8.11|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.21||||16.21|10.54|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16.21||||16.21|6|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|GEHA [1415]|GEHA [141500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.21||||16.21|6.97|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|16.21||||16.21|15.08|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.21||||16.21|9.73|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|HMA [168003]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|IHC HS [168011]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|Self-pay|Self-pay|16.21||||16.21|4.86|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.21||||16.21|3.4|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|TRUSTMARK [2030]|STARMARK [203000]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.21||||16.21|7.77|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|UMR [2035]|UMR OPTIONS [203501]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.21||||16.21|14.59|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16.21||||16.21|0|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16.21||||16.21|6|15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16.21||||16.21||15.08|3.4
3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16.21||||16.21|8.11|15.08|3.4
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|AETNA [1015]|AETNA ACO WILCO [101532]|147||||147|5.01|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147||||147|3.23|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147||||147|3.43|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147||||147|3.43|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|147||||147|73.65|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147||||147|51.6|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147||||147|3.92|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|147||||147|62.62|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|147||||147|73.5|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147||||147|95.55|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|CORESOURCE [1315]|CORESOURCE [131500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|147||||147|6.2|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|147||||147|3.79|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|GEHA [1415]|GEHA [141500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|147||||147|7.13|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HEALTHNET [1495]|HEALTHNET [149500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147||||147|3.92|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|147||||147|136.71|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147||||147|88.2|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147||||147|3.49|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147||||147|73.5|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147||||147|3.32|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147||||147|4.28|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147||||147|3.23|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MULTIPLAN [1680]|HMA [168003]|147||||147|4.76|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MULTIPLAN [1680]|IHC HS [168011]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|147||||147|3.57|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147||||147|3.49|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|Self-pay|Self-pay|147||||147|44.1|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147||||147|30.87|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|147||||147|3.11|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147||||147|4.63|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|TRUSTMARK [2030]|STARMARK [203000]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147||||147|70.49|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|UMR [2035]|UMR OPTIONS [203501]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147||||147|3.16|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147||||147|132.3|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|147||||147|2.11|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|147||||147|3.79|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|147||||147|3.17|136.71|2.11
30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/MICRO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|147||||147|73.5|136.71|2.11
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|AETNA [1015]|AETNA ACO WILCO [101532]|32||||32|4.95|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32||||32|3.55|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32||||32|3.77|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32||||32|3.77|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32||||32|16.03|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32||||32|11.23|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32||||32|13.63|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32||||32|16|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32||||32|20.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|CORESOURCE [1315]|CORESOURCE [131500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32||||32|4.37|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32||||32|2.67|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|GEHA [1415]|GEHA [141500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32||||32|7.83|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HEALTHNET [1495]|HEALTHNET [149500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32||||32|29.76|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32||||32|19.2|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32||||32|3.83|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32||||32|16|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32||||32|3.65|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32||||32|4.7|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32||||32|3.55|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MULTIPLAN [1680]|HMA [168003]|32||||32|5.22|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MULTIPLAN [1680]|IHC HS [168011]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32||||32|3.92|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32||||32|3.83|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|Self-pay|Self-pay|32||||32|9.6|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32||||32|6.72|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32||||32|3.41|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32||||32|5.08|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|TRUSTMARK [2030]|STARMARK [203000]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32||||32|15.34|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|UMR [2035]|UMR OPTIONS [203501]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32||||32|3.47|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32||||32|28.8|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32||||32|2.09|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32||||32|2.67|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32||||32|3.48|29.76|2.09
30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32||||32|16|29.76|2.09
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|AETNA [1015]|AETNA ACO WILCO [101532]|61||||61|3.54|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61||||61|2.3|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61||||61|2.44|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61||||61|2.44|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61||||61|30.56|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61||||61|21.41|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61||||61|2.77|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61||||61|25.99|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61||||61|30.5|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61||||61|39.65|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|CORESOURCE [1315]|CORESOURCE [131500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61||||61|3.76|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61||||61|2.3|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|GEHA [1415]|GEHA [141500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61||||61|5.06|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HEALTHNET [1495]|HEALTHNET [149500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61||||61|2.77|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61||||61|56.73|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61||||61|36.6|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61||||61|2.48|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61||||61|30.5|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61||||61|2.36|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61||||61|3.04|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61||||61|2.3|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MULTIPLAN [1680]|HMA [168003]|61||||61|3.38|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MULTIPLAN [1680]|IHC HS [168011]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61||||61|2.54|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61||||61|2.48|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|Self-pay|Self-pay|61||||61|18.3|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61||||61|12.81|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61||||61|2.21|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61||||61|3.29|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|TRUSTMARK [2030]|STARMARK [203000]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61||||61|29.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|UMR [2035]|UMR OPTIONS [203501]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61||||61|54.9|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61||||61|1.49|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61||||61|2.3|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61||||61|2.25|56.73|1.49
30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61||||61|30.5|56.73|1.49
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|41||||41|4.83|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41||||41|3.11|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41||||41|3.31|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41||||41|3.31|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41||||41|20.54|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41||||41|14.39|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41||||41|3.76|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41||||41|17.47|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41||||41|20.5|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41||||41|26.65|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41||||41|5|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41||||41|3.06|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|GEHA [1415]|GEHA [141500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41||||41|6.86|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41||||41|3.76|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41||||41|38.13|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41||||41|24.6|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41||||41|3.36|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41||||41|20.5|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41||||41|3.2|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41||||41|4.12|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41||||41|3.11|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MULTIPLAN [1680]|HMA [168003]|41||||41|4.58|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41||||41|3.44|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41||||41|3.36|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|Self-pay|Self-pay|41||||41|12.3|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41||||41|8.61|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41||||41|2.99|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41||||41|4.45|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41||||41|19.66|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|UMR [2035]|UMR OPTIONS [203501]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41||||41|36.9|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41||||41|2.03|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41||||41|3.06|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41||||41|3.05|38.13|2.03
30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41||||41|20.5|38.13|2.03
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|AETNA [1015]|AETNA ACO WILCO [101532]|30||||30|5.17|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30||||30|3.71|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30||||30|3.94|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30||||30|3.94|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30||||30|15.03|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30||||30|10.53|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30||||30|3.71|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30||||30|12.78|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30||||30|15|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30||||30|19.5|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|CORESOURCE [1315]|CORESOURCE [131500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30||||30|26.06|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30||||30|15.96|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|GEHA [1415]|GEHA [141500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30||||30|8.19|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HEALTHNET [1495]|HEALTHNET [149500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30||||30|3.71|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30||||30|27.9|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30||||30|18|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30||||30|4|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30||||30|15|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30||||30|3.81|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30||||30|4.91|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30||||30|3.71|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MULTIPLAN [1680]|HMA [168003]|30||||30|5.46|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MULTIPLAN [1680]|IHC HS [168011]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30||||30|4.1|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30||||30|4|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|Self-pay|Self-pay|30||||30|9|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30||||30|6.3|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30||||30|3.57|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30||||30|5.31|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|TRUSTMARK [2030]|STARMARK [203000]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30||||30|14.39|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|UMR [2035]|UMR OPTIONS [203501]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30||||30|3.63|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30||||30|27|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30||||30|2.18|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30||||30|15.96|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30||||30|3.64|27.9|2.18
30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30||||30|15|27.9|2.18
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
30961|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|AETNA [1015]|AETNA ACO WILCO [101532]|880||||880|259.13|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|880||||880|167.24|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|880||||880|177.64|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|880||||880|177.64|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|880||||880|440.88|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|880||||880|308.88|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|880||||880|202.42|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|880||||880|374.88|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|880||||880|440|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|880||||880|572|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|CORESOURCE [1315]|CORESOURCE [131500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|880||||880|243.57|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|880||||880|149.12|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|GEHA [1415]|GEHA [141500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|880||||880|368.91|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HEALTHNET [1495]|HEALTHNET [149500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|880||||880|202.42|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|880||||880|818.4|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|880||||880|528|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|880||||880|180.36|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|880||||880|440|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|880||||880|171.57|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|880||||880|221.35|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|880||||880|167.24|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MULTIPLAN [1680]|HMA [168003]|880||||880|245.94|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MULTIPLAN [1680]|IHC HS [168011]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|880||||880|184.63|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|880||||880|180.36|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|Self-pay|Self-pay|880||||880|264|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|880||||880|184.8|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|880||||880|160.68|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|880||||880|239.38|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|TRUSTMARK [2030]|STARMARK [203000]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|880||||880|421.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|UMR [2035]|UMR OPTIONS [203501]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|880||||880|163.39|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|880||||880|792|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|880||||880|109.31|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|880||||880|149.12|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|880||||880|163.96|818.4|109.31
31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|880||||880|440|818.4|109.31
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|AETNA [1015]|AETNA ACO WILCO [101532]|527||||527|249.49|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|527||||527|178.91|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|527||||527|190.04|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|527||||527|190.04|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|527||||527|264.03|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|527||||527|184.98|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|527||||527|224.5|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|527||||527|263.5|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|527||||527|342.55|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|CORESOURCE [1315]|CORESOURCE [131500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|527||||527|195.07|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|527||||527|119.43|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|GEHA [1415]|GEHA [141500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|527||||527|394.65|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HEALTHNET [1495]|HEALTHNET [149500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|527||||527|490.11|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|527||||527|316.2|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|527||||527|192.94|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|527||||527|263.5|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|527||||527|183.55|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|527||||527|236.79|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|527||||527|178.91|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MULTIPLAN [1680]|HMA [168003]|527||||527|263.1|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MULTIPLAN [1680]|IHC HS [168011]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|527||||527|197.52|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|527||||527|192.94|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|Self-pay|Self-pay|527||||527|158.1|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|527||||527|110.67|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|527||||527|171.89|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|527||||527|256.08|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|TRUSTMARK [2030]|STARMARK [203000]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|527||||527|252.7|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|UMR [2035]|UMR OPTIONS [203501]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|527||||527|174.81|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|527||||527|474.3|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|527||||527|105.24|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|527||||527|119.43|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|527||||527|175.4|490.11|105.24
31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|527||||527|263.5|490.11|105.24
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|AETNA [1015]|AETNA ACO WILCO [101532]|1812||||1812|709.78|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1812||||1812|0|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1812||||1812|0|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1812||||1812|907.81|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1812||||1812|636.01|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1812||||1812|499|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1812||||1812|771.91|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1812||||1812|906|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1812||||1812|1177.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|CORESOURCE [1315]|CORESOURCE [131500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1812||||1812|557.44|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1812||||1812|341.29|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|GEHA [1415]|GEHA [141500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HEALTHNET [1495]|HEALTHNET [149500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1812||||1812|499|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1812||||1812|1685.16|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1812||||1812|1087.2|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1812||||1812|906|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1812||||1812|0|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MULTIPLAN [1680]|HMA [168003]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MULTIPLAN [1680]|IHC HS [168011]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1812||||1812|0|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|Self-pay|Self-pay|1812||||1812|543.6|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1812||||1812|380.52|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|TRUSTMARK [2030]|STARMARK [203000]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1812||||1812|868.85|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|UMR [2035]|UMR OPTIONS [203501]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1812||||1812|0|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1812||||1812|1630.8|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1812||||1812|299.4|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1812||||1812|341.29|1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1812||||1812||1685.16|299.4
31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1812||||1812|906|1685.16|299.4
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|AETNA [1015]|AETNA ACO WILCO [101532]|1812||||1812|240.03|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1812||||1812|0|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1812||||1812|0|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1812||||1812|907.81|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1812||||1812|636.01|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1812||||1812|168.75|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1812||||1812|771.91|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1812||||1812|906|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1812||||1812|1177.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|CORESOURCE [1315]|CORESOURCE [131500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1812||||1812|188.63|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1812||||1812|115.49|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|GEHA [1415]|GEHA [141500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HEALTHNET [1495]|HEALTHNET [149500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1812||||1812|168.75|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1812||||1812|1685.16|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1812||||1812|1087.2|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1812||||1812|906|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1812||||1812|0|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MULTIPLAN [1680]|HMA [168003]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MULTIPLAN [1680]|IHC HS [168011]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1812||||1812|0|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|Self-pay|Self-pay|1812||||1812|543.6|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1812||||1812|380.52|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|TRUSTMARK [2030]|STARMARK [203000]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1812||||1812|868.85|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|UMR [2035]|UMR OPTIONS [203501]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1812||||1812|0|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1812||||1812|1630.8|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1812||||1812|101.25|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1812||||1812|115.49|1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1812||||1812||1685.16|101.25
31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1812||||1812|906|1685.16|101.25
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|AETNA [1015]|AETNA ACO WILCO [101532]|2325||||2325|414.43|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2325||||2325|315.67|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2325||||2325|315.67|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2325||||2325|1164.83|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2325||||2325|816.08|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2325||||2325|291.36|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2325||||2325|990.45|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2325||||2325|1162.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2325||||2325|1511.25|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|CORESOURCE [1315]|CORESOURCE [131500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2325||||2325|317.75|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2325||||2325|194.54|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|GEHA [1415]|GEHA [141500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HEALTHNET [1495]|HEALTHNET [149500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2325||||2325|291.36|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2325||||2325|2162.25|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2325||||2325|1395|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2325||||2325|1162.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2325||||2325|304.89|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MULTIPLAN [1680]|HMA [168003]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MULTIPLAN [1680]|IHC HS [168011]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2325||||2325|328.1|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|Self-pay|Self-pay|2325||||2325|697.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2325||||2325|488.25|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|TRUSTMARK [2030]|STARMARK [203000]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2325||||2325|1114.84|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|UMR [2035]|UMR OPTIONS [203501]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2325||||2325|290.37|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2325||||2325|2092.5|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2325||||2325|174.82|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2325||||2325|194.54|2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2325||||2325||2162.25|174.82
31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2325||||2325|1162.5|2162.25|174.82
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|AETNA [1015]|AETNA ACO WILCO [101532]|3600||||3600|1649.98|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3600||||3600|0|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3600||||3600|0|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3600||||3600|1803.6|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3600||||3600|1263.6|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3600||||3600|1160|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3600||||3600|1533.6|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3600||||3600|1800|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3600||||3600|2340|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|CORESOURCE [1315]|CORESOURCE [131500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3600||||3600|1295.86|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3600||||3600|793.39|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|GEHA [1415]|GEHA [141500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HEALTHNET [1495]|HEALTHNET [149500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3600||||3600|1160|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3600||||3600|3348|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3600||||3600|2160|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3600||||3600|1800|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3600||||3600|0|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MULTIPLAN [1680]|HMA [168003]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MULTIPLAN [1680]|IHC HS [168011]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3600||||3600|0|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|Self-pay|Self-pay|3600||||3600|1080|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3600||||3600|756|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|TRUSTMARK [2030]|STARMARK [203000]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3600||||3600|1726.2|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|UMR [2035]|UMR OPTIONS [203501]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3600||||3600|0|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3600||||3600|3240|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3600||||3600|696|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3600||||3600|793.39|3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3600||||3600||3348|696
31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3600||||3600|1800|3348|696
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|3856||||3856|461.69|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3856||||3856|331.07|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3856||||3856|351.67|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3856||||3856|351.67|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3856||||3856|1931.86|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3856||||3856|1353.46|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3856||||3856|1642.66|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3856||||3856|1928|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3856||||3856|2506.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3856||||3856|345.65|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3856||||3856|211.62|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|GEHA [1415]|GEHA [141500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3856||||3856|730.31|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3856||||3856|3586.08|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3856||||3856|2313.6|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3856||||3856|357.04|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3856||||3856|1928|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3856||||3856|339.65|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3856||||3856|438.18|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3856||||3856|331.07|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|3856||||3856|486.87|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3856||||3856|365.52|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3856||||3856|357.04|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|Self-pay|Self-pay|3856||||3856|1156.8|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3856||||3856|809.76|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3856||||3856|318.09|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3856||||3856|473.89|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3856||||3856|1848.95|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3856||||3856|323.47|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3856||||3856|3470.4|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3856||||3856|194.75|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3856||||3856|211.62|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3856||||3856|324.58|3586.08|194.75
31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3856||||3856|1928|3586.08|194.75
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|564||||564|93.44|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564||||564|67|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|564||||564|71.17|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|564||||564|71.17|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|564||||564|282.56|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|564||||564|197.96|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|564||||564|240.26|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|564||||564|282|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|564||||564|366.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|564||||564|73.02|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|564||||564|44.7|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|GEHA [1415]|GEHA [141500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|564||||564|147.8|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|564||||564|524.52|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564||||564|338.4|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|564||||564|72.26|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|564||||564|282|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|564||||564|68.75|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|564||||564|88.68|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|564||||564|67|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MULTIPLAN [1680]|HMA [168003]|564||||564|98.54|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MULTIPLAN [1680]|IHC HS [168011]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|564||||564|73.97|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|564||||564|72.26|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|Self-pay|Self-pay|564||||564|169.2|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|564||||564|118.44|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|564||||564|64.38|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|564||||564|95.91|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|TRUSTMARK [2030]|STARMARK [203000]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|564||||564|270.44|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|UMR [2035]|UMR OPTIONS [203501]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|564||||564|65.47|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|564||||564|507.6|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|564||||564|39.41|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|564||||564|44.7|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|564||||564|65.69|524.52|39.41
31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|564||||564|282|524.52|39.41
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|564||||564|104.36|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564||||564|74.84|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|564||||564|79.49|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|564||||564|79.49|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|564||||564|282.56|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|564||||564|197.96|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|564||||564|75.44|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|564||||564|240.26|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|564||||564|282|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|564||||564|366.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|564||||564|90.77|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|564||||564|55.57|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|GEHA [1415]|GEHA [141500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|564||||564|165.08|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564||||564|75.44|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|564||||564|524.52|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564||||564|338.4|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|564||||564|80.71|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|564||||564|282|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|564||||564|76.78|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|564||||564|99.05|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|564||||564|74.84|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MULTIPLAN [1680]|HMA [168003]|564||||564|110.06|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MULTIPLAN [1680]|IHC HS [168011]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|564||||564|82.62|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|564||||564|80.71|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|Self-pay|Self-pay|564||||564|169.2|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|564||||564|118.44|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|564||||564|71.9|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|564||||564|107.12|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|TRUSTMARK [2030]|STARMARK [203000]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|564||||564|270.44|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|UMR [2035]|UMR OPTIONS [203501]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|564||||564|73.12|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|564||||564|507.6|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|564||||564|44.02|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|564||||564|55.57|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|564||||564|73.37|524.52|44.02
31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|564||||564|282|524.52|44.02
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|498||||498|235.42|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|498||||498|168.82|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|498||||498|179.32|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|498||||498|179.32|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|498||||498|249.5|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|498||||498|174.8|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|498||||498|212.15|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|498||||498|249|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|498||||498|323.7|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|498||||498|180.67|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|498||||498|110.61|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|GEHA [1415]|GEHA [141500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|498||||498|372.4|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|498||||498|463.14|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|498||||498|298.8|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|498||||498|182.06|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|498||||498|249|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|498||||498|173.19|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|498||||498|223.44|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|498||||498|168.82|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|498||||498|248.27|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|498||||498|186.38|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|498||||498|182.06|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|Self-pay|Self-pay|498||||498|149.4|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|498||||498|104.58|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|498||||498|162.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|498||||498|241.64|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|498||||498|238.79|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|498||||498|164.94|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|498||||498|448.2|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|498||||498|99.31|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|498||||498|110.61|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|498||||498|165.51|463.14|99.31
31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|498||||498|249|463.14|99.31
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|423||||423|118.06|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|423||||423|0|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|423||||423|0|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|423||||423|211.92|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|423||||423|148.47|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|423||||423|83|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|423||||423|180.2|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|423||||423|211.5|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|423||||423|274.95|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|423||||423|87.05|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|423||||423|53.84|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|GEHA [1415]|GEHA [141500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|423||||423|83|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|423||||423|393.39|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|423||||423|253.8|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|423||||423|211.5|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|423||||423|0|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|423||||423|0|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|Self-pay|Self-pay|423||||423|126.9|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|423||||423|88.83|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|423||||423|202.83|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|423||||423|0|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|423||||423|380.7|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|423||||423|49.8|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|423||||423|53.84|393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|423||||423||393.39|49.8
31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|423||||423|211.5|393.39|49.8
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1249||||1249|73.18|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1249||||1249|0|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1249||||1249|0|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1249||||1249|625.75|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1249||||1249|438.4|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1249||||1249|51.45|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1249||||1249|532.07|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1249||||1249|624.5|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1249||||1249|811.85|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|CORESOURCE [1315]|CORESOURCE [131500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1249||||1249|57.51|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1249||||1249|35.21|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|GEHA [1415]|GEHA [141500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HEALTHNET [1495]|HEALTHNET [149500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1249||||1249|51.45|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1249||||1249|1161.57|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1249||||1249|749.4|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1249||||1249|624.5|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1249||||1249|0|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MULTIPLAN [1680]|HMA [168003]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MULTIPLAN [1680]|IHC HS [168011]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1249||||1249|0|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|Self-pay|Self-pay|1249||||1249|374.7|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1249||||1249|262.29|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|TRUSTMARK [2030]|STARMARK [203000]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1249||||1249|598.9|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|UMR [2035]|UMR OPTIONS [203501]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1249||||1249|0|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1249||||1249|1124.1|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1249||||1249|30.87|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1249||||1249|35.21|1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1249||||1249||1161.57|30.87
31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1249||||1249|624.5|1161.57|30.87
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1065||||1065|103.3|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1065||||1065|66.67|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1065||||1065|70.82|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1065||||1065|70.82|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1065||||1065|533.57|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1065||||1065|373.82|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1065||||1065|80.69|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1065||||1065|453.69|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1065||||1065|532.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1065||||1065|692.25|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|CORESOURCE [1315]|CORESOURCE [131500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1065||||1065|97.14|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1065||||1065|59.48|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|GEHA [1415]|GEHA [141500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1065||||1065|147.06|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HEALTHNET [1495]|HEALTHNET [149500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1065||||1065|80.69|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1065||||1065|990.45|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1065||||1065|639|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1065||||1065|71.9|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1065||||1065|532.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1065||||1065|68.4|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1065||||1065|88.24|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1065||||1065|66.67|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MULTIPLAN [1680]|HMA [168003]|1065||||1065|98.04|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MULTIPLAN [1680]|IHC HS [168011]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1065||||1065|73.61|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1065||||1065|71.9|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|Self-pay|Self-pay|1065||||1065|319.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1065||||1065|223.65|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1065||||1065|64.05|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1065||||1065|95.43|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|TRUSTMARK [2030]|STARMARK [203000]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1065||||1065|510.67|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|UMR [2035]|UMR OPTIONS [203501]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1065||||1065|65.14|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1065||||1065|958.5|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1065||||1065|43.57|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1065||||1065|59.48|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1065||||1065|65.36|990.45|43.57
31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1065||||1065|532.5|990.45|43.57
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|368||||368|55.91|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368||||368|0|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368||||368|0|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|368||||368|184.37|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368||||368|129.17|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368||||368|39.31|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|368||||368|156.77|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|368||||368|184|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368||||368|239.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|CORESOURCE [1315]|CORESOURCE [131500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|368||||368|43.84|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|368||||368|26.84|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|GEHA [1415]|GEHA [141500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HEALTHNET [1495]|HEALTHNET [149500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368||||368|39.31|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|368||||368|342.24|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368||||368|220.8|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368||||368|184|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368||||368|0|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MULTIPLAN [1680]|HMA [168003]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MULTIPLAN [1680]|IHC HS [168011]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|368||||368|0|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|Self-pay|Self-pay|368||||368|110.4|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368||||368|77.28|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|TRUSTMARK [2030]|STARMARK [203000]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368||||368|176.46|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|UMR [2035]|UMR OPTIONS [203501]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368||||368|0|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368||||368|331.2|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|368||||368|23.59|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|368||||368|26.84|342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|368||||368||342.24|23.59
31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|368||||368|184|342.24|23.59
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|3010||||3010|465.46|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3010||||3010|319.1|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3010||||3010|319.1|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3010||||3010|1508.01|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3010||||3010|1056.51|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3010||||3010|363.6|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3010||||3010|1282.26|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3010||||3010|1505|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3010||||3010|1956.5|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|CORESOURCE [1315]|CORESOURCE [131500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3010||||3010|437.47|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3010||||3010|267.84|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|GEHA [1415]|GEHA [141500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HEALTHNET [1495]|HEALTHNET [149500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3010||||3010|363.6|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3010||||3010|2799.3|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3010||||3010|1806|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3010||||3010|1505|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3010||||3010|308.2|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MULTIPLAN [1680]|HMA [168003]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MULTIPLAN [1680]|IHC HS [168011]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3010||||3010|331.66|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|Self-pay|Self-pay|3010||||3010|903|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3010||||3010|632.1|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|TRUSTMARK [2030]|STARMARK [203000]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3010||||3010|1443.3|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|UMR [2035]|UMR OPTIONS [203501]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3010||||3010|293.52|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3010||||3010|2709|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3010||||3010|196.34|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3010||||3010|267.84|2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3010||||3010||2799.3|196.34
31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3010||||3010|1505|2799.3|196.34
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|1509||||1509|144.87|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1509||||1509|93.49|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1509||||1509|99.31|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1509||||1509|99.31|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1509||||1509|756.01|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1509||||1509|529.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1509||||1509|113.17|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1509||||1509|642.83|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1509||||1509|754.5|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1509||||1509|980.85|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|CORESOURCE [1315]|CORESOURCE [131500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1509||||1509|136.06|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1509||||1509|83.3|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|GEHA [1415]|GEHA [141500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1509||||1509|206.24|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HEALTHNET [1495]|HEALTHNET [149500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1509||||1509|113.17|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1509||||1509|1403.37|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1509||||1509|905.4|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1509||||1509|100.83|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1509||||1509|754.5|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1509||||1509|95.91|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1509||||1509|123.74|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1509||||1509|93.49|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MULTIPLAN [1680]|HMA [168003]|1509||||1509|137.49|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MULTIPLAN [1680]|IHC HS [168011]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1509||||1509|103.22|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1509||||1509|100.83|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|Self-pay|Self-pay|1509||||1509|452.7|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1509||||1509|316.89|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1509||||1509|89.83|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1509||||1509|133.82|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|TRUSTMARK [2030]|STARMARK [203000]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1509||||1509|723.57|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|UMR [2035]|UMR OPTIONS [203501]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1509||||1509|91.34|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1509||||1509|1358.1|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1509||||1509|61.11|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1509||||1509|83.3|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1509||||1509|91.66|1403.37|61.11
31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1509||||1509|754.5|1403.37|61.11
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|946||||946|274.88|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|946||||946|197.12|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|946||||946|209.38|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|946||||946|209.38|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|946||||946|473.95|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|946||||946|332.05|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|946||||946|403|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|946||||946|473|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|946||||946|614.9|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|CORESOURCE [1315]|CORESOURCE [131500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|946||||946|214.91|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|946||||946|131.58|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|GEHA [1415]|GEHA [141500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|946||||946|434.81|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HEALTHNET [1495]|HEALTHNET [149500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|946||||946|879.78|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|946||||946|567.6|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|946||||946|212.58|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|946||||946|473|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|946||||946|202.23|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|946||||946|260.89|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|946||||946|197.12|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MULTIPLAN [1680]|HMA [168003]|946||||946|289.88|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MULTIPLAN [1680]|IHC HS [168011]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|946||||946|217.62|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|946||||946|212.58|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|Self-pay|Self-pay|946||||946|283.8|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|946||||946|198.66|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|946||||946|189.39|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|946||||946|282.15|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|TRUSTMARK [2030]|STARMARK [203000]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|946||||946|453.61|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|UMR [2035]|UMR OPTIONS [203501]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|946||||946|192.59|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|946||||946|851.4|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|946||||946|115.95|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|946||||946|131.58|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|946||||946|193.25|879.78|115.95
31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|946||||946|473|879.78|115.95
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1465||||1465|495.79|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1465||||1465|355.53|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1465||||1465|377.65|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1465||||1465|377.65|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1465||||1465|733.97|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1465||||1465|514.22|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1465||||1465|357.48|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1465||||1465|624.09|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1465||||1465|732.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1465||||1465|952.25|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|CORESOURCE [1315]|CORESOURCE [131500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1465||||1465|430.07|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1465||||1465|263.31|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|GEHA [1415]|GEHA [141500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1465||||1465|784.26|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HEALTHNET [1495]|HEALTHNET [149500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1465||||1465|357.48|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1465||||1465|1362.45|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1465||||1465|879|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1465||||1465|383.42|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1465||||1465|732.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1465||||1465|364.75|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1465||||1465|470.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1465||||1465|355.53|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MULTIPLAN [1680]|HMA [168003]|1465||||1465|522.84|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MULTIPLAN [1680]|IHC HS [168011]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1465||||1465|392.52|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1465||||1465|383.42|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|Self-pay|Self-pay|1465||||1465|439.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1465||||1465|307.65|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1465||||1465|341.59|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1465||||1465|508.9|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|TRUSTMARK [2030]|STARMARK [203000]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1465||||1465|702.47|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|UMR [2035]|UMR OPTIONS [203501]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1465||||1465|347.37|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1465||||1465|1318.5|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1465||||1465|209.14|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1465||||1465|263.31|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1465||||1465|348.56|1362.45|209.14
31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1465||||1465|732.5|1362.45|209.14
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|742||||742|350.65|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|742||||742|267.09|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|742||||742|267.09|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|742||||742|371.74|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|742||||742|260.44|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|742||||742|246.52|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|742||||742|316.09|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|742||||742|371|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|742||||742|482.3|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|CORESOURCE [1315]|CORESOURCE [131500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|742||||742|268.86|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|742||||742|164.61|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|GEHA [1415]|GEHA [141500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HEALTHNET [1495]|HEALTHNET [149500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|742||||742|246.52|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|742||||742|690.06|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|742||||742|445.2|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|742||||742|371|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|742||||742|257.96|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MULTIPLAN [1680]|HMA [168003]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MULTIPLAN [1680]|IHC HS [168011]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|742||||742|277.61|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|Self-pay|Self-pay|742||||742|222.6|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|742||||742|155.82|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|TRUSTMARK [2030]|STARMARK [203000]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|742||||742|355.79|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|UMR [2035]|UMR OPTIONS [203501]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|742||||742|245.67|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|742||||742|667.8|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|742||||742|147.91|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|742||||742|164.61|690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|742||||742||690.06|147.91
31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|742||||742|371|690.06|147.91
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|179||||179|68.99|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179||||179|47.29|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179||||179|47.29|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|179||||179|89.68|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179||||179|62.83|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179||||179|53.89|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|179||||179|76.25|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|179||||179|89.5|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179||||179|116.35|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|CORESOURCE [1315]|CORESOURCE [131500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|179||||179|64.84|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|179||||179|39.7|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|GEHA [1415]|GEHA [141500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HEALTHNET [1495]|HEALTHNET [149500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179||||179|53.89|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|179||||179|166.47|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179||||179|107.4|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179||||179|89.5|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179||||179|45.68|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MULTIPLAN [1680]|HMA [168003]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MULTIPLAN [1680]|IHC HS [168011]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|179||||179|49.15|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|Self-pay|Self-pay|179||||179|53.7|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179||||179|37.59|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|TRUSTMARK [2030]|STARMARK [203000]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179||||179|85.83|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|UMR [2035]|UMR OPTIONS [203501]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179||||179|43.5|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179||||179|161.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|179||||179|29.1|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|179||||179|39.7|166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|179||||179||166.47|29.1
31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|179||||179|89.5|166.47|29.1
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|AETNA [1015]|AETNA ACO WILCO [101532]|553||||553|553|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|553||||553|437.26|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|553||||553|437.26|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|553||||553|277.05|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|553||||553|194.1|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|553||||553|403.59|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|553||||553|235.58|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|553||||553|276.5|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|553||||553|359.45|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|CORESOURCE [1315]|CORESOURCE [131500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|553||||553|393.92|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|553||||553|267.56|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|GEHA [1415]|GEHA [141500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HEALTHNET [1495]|HEALTHNET [149500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|553||||553|403.59|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|553||||553|514.29|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|553||||553|331.8|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|553||||553|276.5|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|553||||553|422.33|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MULTIPLAN [1680]|HMA [168003]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MULTIPLAN [1680]|IHC HS [168011]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|553||||553|454.48|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|Self-pay|Self-pay|553||||553|165.9|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|553||||553|116.13|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|TRUSTMARK [2030]|STARMARK [203000]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|553||||553|265.16|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|UMR [2035]|UMR OPTIONS [203501]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|553||||553|402.21|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|553||||553|497.7|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|553||||553|242.15|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|553||||553|267.56|553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|553||||553||553|116.13
31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|553||||553|276.5|553|116.13
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|AETNA [1015]|AETNA ACO WILCO [101532]|438||||438|181.26|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|438||||438|129.98|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|438||||438|138.06|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|438||||438|138.06|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|438||||438|219.44|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|438||||438|153.74|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|438||||438|137.48|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|438||||438|186.59|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|438||||438|219|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|438||||438|284.7|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|CORESOURCE [1315]|CORESOURCE [131500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|438||||438|165.49|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|438||||438|101.32|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|GEHA [1415]|GEHA [141500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|438||||438|286.72|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HEALTHNET [1495]|HEALTHNET [149500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|438||||438|137.48|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|438||||438|407.34|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|438||||438|262.8|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|438||||438|140.17|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|438||||438|219|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|438||||438|133.35|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|438||||438|172.03|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|438||||438|129.98|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MULTIPLAN [1680]|HMA [168003]|438||||438|191.15|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MULTIPLAN [1680]|IHC HS [168011]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|438||||438|143.5|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|438||||438|140.17|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|Self-pay|Self-pay|438||||438|131.4|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|438||||438|91.98|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|438||||438|124.88|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|438||||438|186.05|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|TRUSTMARK [2030]|STARMARK [203000]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|438||||438|210.02|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|UMR [2035]|UMR OPTIONS [203501]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|438||||438|126.99|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|438||||438|394.2|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|438||||438|76.46|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|438||||438|101.32|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|438||||438|127.43|407.34|76.46
31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|438||||438|219|407.34|76.46
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|237||||237|193.17|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237||||237|124.66|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237||||237|132.42|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237||||237|132.42|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|237||||237|118.74|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237||||237|83.19|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237||||237|150.89|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|237||||237|100.96|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|237||||237|118.5|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237||||237|154.05|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|CORESOURCE [1315]|CORESOURCE [131500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|237||||237|181.45|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|237||||237|111.09|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|GEHA [1415]|GEHA [141500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|237||||237|237|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HEALTHNET [1495]|HEALTHNET [149500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237||||237|150.89|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|237||||237|220.41|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237||||237|142.2|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237||||237|134.44|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237||||237|118.5|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237||||237|127.9|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237||||237|165|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237||||237|124.66|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MULTIPLAN [1680]|HMA [168003]|237||||237|183.33|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MULTIPLAN [1680]|IHC HS [168011]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|237||||237|137.63|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237||||237|134.44|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|Self-pay|Self-pay|237||||237|71.1|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237||||237|49.77|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|237||||237|119.78|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237||||237|178.44|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|TRUSTMARK [2030]|STARMARK [203000]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237||||237|113.64|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|UMR [2035]|UMR OPTIONS [203501]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237||||237|121.81|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237||||237|213.3|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|237||||237|81.48|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|237||||237|111.09|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|237||||237|122.22|237|49.77
31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|237||||237|118.5|237|49.77
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|285||||285|145.1|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285||||285|102.65|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285||||285|102.65|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|285||||285|142.79|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285||||285|100.04|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285||||285|113.35|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|285||||285|121.41|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|285||||285|142.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285||||285|185.25|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|CORESOURCE [1315]|CORESOURCE [131500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|285||||285|136.3|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|285||||285|83.45|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|GEHA [1415]|GEHA [141500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HEALTHNET [1495]|HEALTHNET [149500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285||||285|113.35|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|285||||285|265.05|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285||||285|171|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285||||285|142.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285||||285|99.14|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MULTIPLAN [1680]|HMA [168003]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MULTIPLAN [1680]|IHC HS [168011]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|285||||285|106.69|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|Self-pay|Self-pay|285||||285|85.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285||||285|59.85|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|TRUSTMARK [2030]|STARMARK [203000]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285||||285|136.66|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|UMR [2035]|UMR OPTIONS [203501]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285||||285|94.42|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285||||285|256.5|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|285||||285|61.21|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|285||||285|83.45|265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|285||||285||265.05|59.85
31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|285||||285|142.5|265.05|59.85
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305||||1305|280.12|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305||||1305|192.05|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305||||1305|192.05|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305||||1305|653.81|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305||||1305|458.06|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305||||1305|218.83|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305||||1305|555.93|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305||||1305|652.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305||||1305|848.25|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|CORESOURCE [1315]|CORESOURCE [131500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305||||1305|263.02|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305||||1305|161.04|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|GEHA [1415]|GEHA [141500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HEALTHNET [1495]|HEALTHNET [149500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305||||1305|218.83|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305||||1305|1213.65|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1305||||1305|783|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305||||1305|652.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305||||1305|185.48|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MULTIPLAN [1680]|HMA [168003]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MULTIPLAN [1680]|IHC HS [168011]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305||||1305|199.61|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|Self-pay|Self-pay|1305||||1305|391.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305||||1305|274.05|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|TRUSTMARK [2030]|STARMARK [203000]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305||||1305|625.75|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|UMR [2035]|UMR OPTIONS [203501]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305||||1305|176.65|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305||||1305|1174.5|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305||||1305|118.16|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305||||1305|161.04|1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305||||1305||1213.65|118.16
31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305||||1305|652.5|1213.65|118.16
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2025||||2025|195.46|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2025||||2025|134|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2025||||2025|134|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2025||||2025|1014.53|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2025||||2025|710.78|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2025||||2025|152.69|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2025||||2025|862.65|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2025||||2025|1012.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2025||||2025|1316.25|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|CORESOURCE [1315]|CORESOURCE [131500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2025||||2025|183.79|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2025||||2025|112.52|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|GEHA [1415]|GEHA [141500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HEALTHNET [1495]|HEALTHNET [149500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2025||||2025|152.69|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2025||||2025|1883.25|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2025||||2025|1215|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2025||||2025|1012.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2025||||2025|129.43|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MULTIPLAN [1680]|HMA [168003]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MULTIPLAN [1680]|IHC HS [168011]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2025||||2025|139.28|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|Self-pay|Self-pay|2025||||2025|607.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2025||||2025|425.25|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|TRUSTMARK [2030]|STARMARK [203000]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2025||||2025|970.99|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|UMR [2035]|UMR OPTIONS [203501]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2025||||2025|123.26|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2025||||2025|1822.5|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2025||||2025|82.45|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2025||||2025|112.52|1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2025||||2025||1883.25|82.45
31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2025||||2025|1012.5|1883.25|82.45
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|AETNA [1015]|AETNA ACO WILCO [101532]|285||||285|172.48|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285||||285|118.23|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285||||285|118.23|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|285||||285|142.79|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285||||285|100.04|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285||||285|134.73|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|285||||285|121.41|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|285||||285|142.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285||||285|185.25|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|CORESOURCE [1315]|CORESOURCE [131500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|285||||285|161.99|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|285||||285|99.18|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|GEHA [1415]|GEHA [141500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HEALTHNET [1495]|HEALTHNET [149500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285||||285|134.73|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|285||||285|265.05|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285||||285|171|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285||||285|142.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285||||285|114.19|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MULTIPLAN [1680]|HMA [168003]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MULTIPLAN [1680]|IHC HS [168011]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|285||||285|122.89|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|Self-pay|Self-pay|285||||285|85.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285||||285|59.85|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|TRUSTMARK [2030]|STARMARK [203000]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285||||285|136.66|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|UMR [2035]|UMR OPTIONS [203501]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285||||285|108.75|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285||||285|256.5|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|285||||285|72.76|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|285||||285|99.18|265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|285||||285||265.05|59.85
31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|285||||285|142.5|265.05|59.85
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|AETNA [1015]|AETNA ACO WILCO [101532]|630||||630|194.87|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|630||||630|139.74|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|630||||630|148.43|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|630||||630|148.43|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|630||||630|315.63|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|630||||630|221.13|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|630||||630|268.38|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|630||||630|315|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|630||||630|409.5|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|CORESOURCE [1315]|CORESOURCE [131500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|630||||630|153.23|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|630||||630|93.82|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|GEHA [1415]|GEHA [141500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|630||||630|308.25|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HEALTHNET [1495]|HEALTHNET [149500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|630||||630|585.9|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|630||||630|378|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|630||||630|150.7|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|630||||630|315|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|630||||630|164.09|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|630||||630|184.95|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|630||||630|139.74|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MULTIPLAN [1680]|HMA [168003]|630||||630|205.5|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MULTIPLAN [1680]|IHC HS [168011]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|630||||630|154.27|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|630||||630|150.7|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|Self-pay|Self-pay|630||||630|189|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|630||||630|132.3|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|630||||630|134.26|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|630||||630|200.02|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|TRUSTMARK [2030]|STARMARK [203000]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|630||||630|302.09|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|UMR [2035]|UMR OPTIONS [203501]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|630||||630|157.5|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|630||||630|567|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|630||||630|82.2|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|630||||630|93.82|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|630||||630|137|585.9|82.2
31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|630||||630|315|585.9|82.2
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|AETNA [1015]|AETNA ACO WILCO [101532]|1545||||1545|263.42|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1545||||1545|188.9|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1545||||1545|200.66|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1545||||1545|200.66|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1545||||1545|774.05|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1545||||1545|542.3|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1545||||1545|658.17|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1545||||1545|772.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1545||||1545|1004.25|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|CORESOURCE [1315]|CORESOURCE [131500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1545||||1545|206.73|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1545||||1545|126.57|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|GEHA [1415]|GEHA [141500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1545||||1545|416.7|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HEALTHNET [1495]|HEALTHNET [149500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1545||||1545|1436.85|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1545||||1545|927|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1545||||1545|203.72|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1545||||1545|772.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1545||||1545|221.83|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1545||||1545|250.02|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1545||||1545|188.9|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MULTIPLAN [1680]|HMA [168003]|1545||||1545|277.8|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MULTIPLAN [1680]|IHC HS [168011]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1545||||1545|208.56|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1545||||1545|203.72|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|Self-pay|Self-pay|1545||||1545|463.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1545||||1545|324.45|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1545||||1545|181.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1545||||1545|270.39|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|TRUSTMARK [2030]|STARMARK [203000]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1545||||1545|740.83|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|UMR [2035]|UMR OPTIONS [203501]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1545||||1545|211.26|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1545||||1545|1390.5|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1545||||1545|111.12|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1545||||1545|126.57|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1545||||1545|185.2|1436.85|111.12
31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1545||||1545|772.5|1436.85|111.12
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|AETNA [1015]|AETNA ACO WILCO [101532]|5625||||5625|390.91|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5625||||5625|280.33|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5625||||5625|297.76|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5625||||5625|297.76|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5625||||5625|2818.13|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5625||||5625|1974.38|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5625||||5625|2396.25|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5625||||5625|2812.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5625||||5625|3656.25|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|CORESOURCE [1315]|CORESOURCE [131500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5625||||5625|306.87|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5625||||5625|187.88|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|GEHA [1415]|GEHA [141500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5625||||5625|618.37|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HEALTHNET [1495]|HEALTHNET [149500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5625||||5625|5231.25|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5625||||5625|3375|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5625||||5625|302.31|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5625||||5625|2812.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5625||||5625|329.18|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5625||||5625|371.02|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5625||||5625|280.33|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MULTIPLAN [1680]|HMA [168003]|5625||||5625|412.25|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MULTIPLAN [1680]|IHC HS [168011]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5625||||5625|309.48|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5625||||5625|302.31|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|Self-pay|Self-pay|5625||||5625|1687.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5625||||5625|1181.25|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5625||||5625|269.33|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5625||||5625|401.25|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|TRUSTMARK [2030]|STARMARK [203000]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5625||||5625|2697.19|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|UMR [2035]|UMR OPTIONS [203501]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5625||||5625|313.49|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5625||||5625|5062.5|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5625||||5625|164.9|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5625||||5625|187.88|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5625||||5625|274.83|5231.25|164.9
31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5625||||5625|2812.5|5231.25|164.9
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|AETNA [1015]|AETNA ACO WILCO [101532]|8625||||8625|402.37|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8625||||8625|288.54|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8625||||8625|306.49|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8625||||8625|306.49|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8625||||8625|4321.13|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8625||||8625|3027.38|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8625||||8625|3674.25|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8625||||8625|4312.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8625||||8625|5606.25|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|CORESOURCE [1315]|CORESOURCE [131500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8625||||8625|316.12|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8625||||8625|193.54|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|GEHA [1415]|GEHA [141500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8625||||8625|636.48|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HEALTHNET [1495]|HEALTHNET [149500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8625||||8625|8021.25|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8625||||8625|5175|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8625||||8625|311.17|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8625||||8625|4312.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8625||||8625|338.83|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8625||||8625|381.89|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8625||||8625|288.54|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MULTIPLAN [1680]|HMA [168003]|8625||||8625|424.32|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MULTIPLAN [1680]|IHC HS [168011]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8625||||8625|318.56|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8625||||8625|311.17|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|Self-pay|Self-pay|8625||||8625|2587.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8625||||8625|1811.25|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8625||||8625|277.22|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8625||||8625|413|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|TRUSTMARK [2030]|STARMARK [203000]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8625||||8625|4135.69|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|UMR [2035]|UMR OPTIONS [203501]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8625||||8625|322.68|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8625||||8625|7762.5|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8625||||8625|169.73|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8625||||8625|193.54|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8625||||8625|282.88|8021.25|169.73
31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8625||||8625|4312.5|8021.25|169.73
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|180||||180|13.61|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180||||180|9.32|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180||||180|9.32|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|180||||180|90.18|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180||||180|63.18|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180||||180|10.63|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|180||||180|76.68|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|180||||180|90|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180||||180|117|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|CORESOURCE [1315]|CORESOURCE [131500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|180||||180|19.36|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|180||||180|11.85|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|GEHA [1415]|GEHA [141500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HEALTHNET [1495]|HEALTHNET [149500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180||||180|10.63|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|180||||180|167.4|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180||||180|108|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180||||180|90|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180||||180|9|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MULTIPLAN [1680]|HMA [168003]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MULTIPLAN [1680]|IHC HS [168011]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|180||||180|9.69|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|Self-pay|Self-pay|180||||180|54|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180||||180|37.8|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|TRUSTMARK [2030]|STARMARK [203000]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180||||180|86.31|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|UMR [2035]|UMR OPTIONS [203501]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180||||180|8.58|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180||||180|162|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|180||||180|5.74|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|180||||180|11.85|167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|180||||180||167.4|5.74
31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|180||||180|90|167.4|5.74
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|251||||251|19.05|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|251||||251|12.56|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|251||||251|13.34|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|251||||251|13.34|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|251||||251|125.75|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|251||||251|88.1|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|251||||251|14.88|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|251||||251|106.93|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|251||||251|125.5|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|251||||251|163.15|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|251||||251|23.3|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|251||||251|14.26|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|GEHA [1415]|GEHA [141500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|251||||251|27.7|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|251||||251|14.88|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|251||||251|233.43|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|251||||251|150.6|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|251||||251|13.54|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|251||||251|125.5|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|251||||251|12.88|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|251||||251|16.62|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|251||||251|12.56|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|251||||251|18.47|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|251||||251|13.87|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|251||||251|13.54|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|Self-pay|Self-pay|251||||251|75.3|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|251||||251|52.71|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|251||||251|12.06|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|251||||251|17.97|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|251||||251|120.35|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|251||||251|12.26|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|251||||251|225.9|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|251||||251|8.03|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|251||||251|14.26|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|251||||251|12.31|233.43|8.03
31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|251||||251|125.5|233.43|8.03
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|AETNA [1015]|AETNA ACO WILCO [101532]|158||||158|16.87|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158||||158|11.56|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158||||158|11.56|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158||||158|79.16|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158||||158|55.46|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158||||158|13.18|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158||||158|67.31|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158||||158|79|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158||||158|102.7|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|CORESOURCE [1315]|CORESOURCE [131500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158||||158|22.48|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158||||158|13.76|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|GEHA [1415]|GEHA [141500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HEALTHNET [1495]|HEALTHNET [149500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158||||158|13.18|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158||||158|146.94|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158||||158|94.8|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158||||158|79|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158||||158|11.17|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MULTIPLAN [1680]|HMA [168003]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MULTIPLAN [1680]|IHC HS [168011]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158||||158|12.02|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|Self-pay|Self-pay|158||||158|47.4|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158||||158|33.18|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|TRUSTMARK [2030]|STARMARK [203000]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158||||158|75.76|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|UMR [2035]|UMR OPTIONS [203501]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158||||158|10.63|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158||||158|142.2|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158||||158|7.12|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158||||158|13.76|146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158||||158||146.94|7.12
31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158||||158|79|146.94|7.12
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|AETNA [1015]|AETNA ACO WILCO [101532]|371||||371|54.94|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371||||371|32.12|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371||||371|36.91|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371||||371|36.91|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371||||371|31.2|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|371||||371|185.87|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371||||371|130.22|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371||||371|159.53|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|371||||371|158.05|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|371||||371|185.5|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371||||371|241.15|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|CORESOURCE [1315]|CORESOURCE [131500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|371||||371|78.5|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|371||||371|48.06|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|GEHA [1415]|GEHA [141500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|371||||371|70.86|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HEALTHNET [1495]|HEALTHNET [149500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371||||371|159.53|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|371||||371|345.03|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371||||371|222.6|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371||||371|34.32|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371||||371|76.78|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371||||371|38.52|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371||||371|42.52|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371||||371|32.12|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MULTIPLAN [1680]|HMA [168003]|371||||371|47.24|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MULTIPLAN [1680]|IHC HS [168011]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|371||||371|38.36|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371||||371|34.32|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|Self-pay|Self-pay|371||||371|111.3|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371||||371|77.91|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|371||||371|30.86|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371||||371|45.98|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|TRUSTMARK [2030]|STARMARK [203000]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371||||371|177.89|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|UMR [2035]|UMR OPTIONS [203501]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371||||371|36.68|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371||||371|333.9|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|371||||371|19.27|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|371||||371|48.06|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|371||||371|31.49|345.03|19.27
31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|371||||371|185.5|345.03|19.27
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|AETNA [1015]|AETNA ACO WILCO [101532]|552||||552|59.18|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|552||||552|43.82|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|552||||552|43.82|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|552||||552|276.55|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|552||||552|193.75|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|552||||552|237.36|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|552||||552|235.15|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|552||||552|276|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|552||||552|358.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|CORESOURCE [1315]|CORESOURCE [131500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|552||||552|76.51|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|552||||552|46.84|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|GEHA [1415]|GEHA [141500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HEALTHNET [1495]|HEALTHNET [149500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|552||||552|237.36|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|552||||552|513.36|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|552||||552|331.2|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|552||||552|41.04|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|552||||552|43.66|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MULTIPLAN [1680]|HMA [168003]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MULTIPLAN [1680]|IHC HS [168011]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|552||||552|45.55|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|Self-pay|Self-pay|552||||552|165.6|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|552||||552|115.92|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|TRUSTMARK [2030]|STARMARK [203000]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|552||||552|264.68|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|UMR [2035]|UMR OPTIONS [203501]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|552||||552|41.58|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|552||||552|496.8|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|552||||552|10.3|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|552||||552|46.84|513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|552||||552||513.36|10.3
31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|552||||552|276|513.36|10.3
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|AETNA [1015]|AETNA ACO WILCO [101532]|428||||428|50.21|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|428||||428|32.12|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|428||||428|38.16|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|428||||428|38.16|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|428||||428|31.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|428||||428|214.43|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|428||||428|150.23|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|428||||428|184.04|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|428||||428|182.33|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|428||||428|214|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|428||||428|278.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|CORESOURCE [1315]|CORESOURCE [131500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|428||||428|80.64|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|428||||428|49.37|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|GEHA [1415]|GEHA [141500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|428||||428|70.86|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HEALTHNET [1495]|HEALTHNET [149500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|428||||428|184.04|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|428||||428|398.04|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|428||||428|256.8|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|428||||428|34.32|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|428||||428|76.78|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|428||||428|37.83|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|428||||428|42.52|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|428||||428|32.12|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MULTIPLAN [1680]|HMA [168003]|428||||428|47.24|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MULTIPLAN [1680]|IHC HS [168011]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|428||||428|39.66|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|428||||428|34.32|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|Self-pay|Self-pay|428||||428|128.4|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|428||||428|89.88|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|428||||428|30.86|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|428||||428|45.98|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|TRUSTMARK [2030]|STARMARK [203000]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|428||||428|205.23|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|UMR [2035]|UMR OPTIONS [203501]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|428||||428|36.03|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|428||||428|385.2|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|428||||428|19.27|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|428||||428|49.37|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|428||||428|31.49|398.04|19.27
31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|428||||428|214|398.04|19.27
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|AETNA [1015]|AETNA ACO WILCO [101532]|850||||850|51.63|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|850||||850|47.24|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|850||||850|36.91|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|850||||850|36.91|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|850||||850|45.88|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|850||||850|425.85|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|850||||850|298.35|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|850||||850|365.5|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|850||||850|362.1|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|850||||850|425|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|850||||850|552.5|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|CORESOURCE [1315]|CORESOURCE [131500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|850||||850|108.92|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|850||||850|66.68|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|GEHA [1415]|GEHA [141500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|850||||850|104.2|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HEALTHNET [1495]|HEALTHNET [149500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|850||||850|365.5|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|850||||850|790.5|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|850||||850|510|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|850||||850|50.46|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|850||||850|121.87|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|850||||850|37.83|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|850||||850|62.52|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|850||||850|47.24|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MULTIPLAN [1680]|HMA [168003]|850||||850|69.47|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MULTIPLAN [1680]|IHC HS [168011]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|850||||850|38.36|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|850||||850|50.46|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|Self-pay|Self-pay|850||||850|255|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|850||||850|178.5|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|850||||850|45.39|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|850||||850|67.62|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|TRUSTMARK [2030]|STARMARK [203000]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|850||||850|407.58|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|UMR [2035]|UMR OPTIONS [203501]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|850||||850|36.03|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|850||||850|765|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|850||||850|30.59|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|850||||850|66.68|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|850||||850|46.31|790.5|30.59
31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|850||||850|425|790.5|30.59
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|150||||150|32.02|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150||||150|21.95|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150||||150|21.95|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|150||||150|75.15|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150||||150|52.65|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150||||150|25.01|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|150||||150|63.9|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|150||||150|75|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150||||150|97.5|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|150||||150|61.7|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|150||||150|37.78|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|GEHA [1415]|GEHA [141500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150||||150|25.01|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|150||||150|139.5|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150||||150|90|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150||||150|75|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150||||150|21.19|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MULTIPLAN [1680]|HMA [168003]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|150||||150|22.81|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|Self-pay|Self-pay|150||||150|45|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150||||150|31.5|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150||||150|71.93|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150||||150|20.19|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150||||150|135|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|150||||150|13.51|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|150||||150|37.78|139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|150||||150||139.5|13.51
31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|150||||150|75|139.5|13.51
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|AETNA [1015]|AETNA ACO WILCO [101532]|365||||365|59.65|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|365||||365|23.42|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|365||||365|42.57|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|365||||365|42.57|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|365||||365|22.75|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|365||||365|182.87|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|365||||365|128.12|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|365||||365|156.95|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|365||||365|155.49|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|365||||365|182.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|365||||365|237.25|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|CORESOURCE [1315]|CORESOURCE [131500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|365||||365|74.46|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|365||||365|46.84|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|GEHA [1415]|GEHA [141500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|365||||365|51.67|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HEALTHNET [1495]|HEALTHNET [149500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|365||||365|156.95|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|365||||365|339.45|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|365||||365|219|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|365||||365|25.02|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|365||||365|41.04|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|365||||365|43.33|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|365||||365|31|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|365||||365|23.42|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MULTIPLAN [1680]|HMA [168003]|365||||365|34.45|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MULTIPLAN [1680]|IHC HS [168011]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|365||||365|44.25|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|365||||365|25.02|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|Self-pay|Self-pay|365||||365|109.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|365||||365|76.65|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|365||||365|22.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|365||||365|33.53|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|TRUSTMARK [2030]|STARMARK [203000]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|365||||365|175.02|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|UMR [2035]|UMR OPTIONS [203501]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|365||||365|41.26|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|365||||365|328.5|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|365||||365|10.3|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|365||||365|46.84|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|365||||365|22.96|339.45|10.3
31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|365||||365|182.5|339.45|10.3
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|AETNA [1015]|AETNA ACO WILCO [101532]|351||||351|53.98|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351||||351|23.42|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351||||351|42.89|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351||||351|42.89|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351||||351|22.75|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|351||||351|175.85|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351||||351|123.2|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351||||351|150.93|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|351||||351|149.53|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|351||||351|175.5|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351||||351|228.15|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|CORESOURCE [1315]|CORESOURCE [131500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|351||||351|70.39|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|351||||351|43.65|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|GEHA [1415]|GEHA [141500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|351||||351|51.67|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HEALTHNET [1495]|HEALTHNET [149500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351||||351|150.93|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|351||||351|326.43|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351||||351|210.6|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351||||351|25.02|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351||||351|76.78|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351||||351|41.25|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351||||351|31|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351||||351|23.42|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MULTIPLAN [1680]|HMA [168003]|351||||351|34.45|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MULTIPLAN [1680]|IHC HS [168011]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|351||||351|44.58|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351||||351|25.02|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|Self-pay|Self-pay|351||||351|105.3|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351||||351|73.71|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|351||||351|22.5|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351||||351|33.53|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|TRUSTMARK [2030]|STARMARK [203000]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351||||351|168.3|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|UMR [2035]|UMR OPTIONS [203501]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351||||351|39.29|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351||||351|315.9|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|351||||351|19.27|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|351||||351|43.65|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|351||||351|22.96|326.43|19.27
31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|351||||351|175.5|326.43|19.27
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|AETNA [1015]|AETNA ACO WILCO [101532]|526||||526|75.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|526||||526|47.24|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|526||||526|60.59|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|526||||526|60.59|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|526||||526|45.88|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|526||||526|263.53|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|526||||526|184.63|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|526||||526|226.18|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|526||||526|224.08|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|526||||526|263|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|526||||526|341.9|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|CORESOURCE [1315]|CORESOURCE [131500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|526||||526|106.85|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|526||||526|65.42|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|GEHA [1415]|GEHA [141500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|526||||526|104.2|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HEALTHNET [1495]|HEALTHNET [149500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|526||||526|226.18|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|526||||526|489.18|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|526||||526|315.6|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|526||||526|50.46|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|526||||526|121.87|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|526||||526|58.18|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|526||||526|62.52|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|526||||526|47.24|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MULTIPLAN [1680]|HMA [168003]|526||||526|69.47|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MULTIPLAN [1680]|IHC HS [168011]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|526||||526|62.98|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|526||||526|50.46|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|Self-pay|Self-pay|526||||526|157.8|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|526||||526|110.46|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|526||||526|45.39|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|526||||526|67.62|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|TRUSTMARK [2030]|STARMARK [203000]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|526||||526|252.22|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|UMR [2035]|UMR OPTIONS [203501]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|526||||526|55.41|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|526||||526|473.4|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|526||||526|30.59|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|526||||526|65.42|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|526||||526|46.31|489.18|30.59
31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|526||||526|263|489.18|30.59
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|370||||370|26.13|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370||||370|141.6|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370||||370|18.34|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370||||370|18.34|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370||||370|137.52|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|370||||370|185.37|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370||||370|129.87|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370||||370|159.1|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|370||||370|157.62|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|370||||370|185|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370||||370|240.5|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|CORESOURCE [1315]|CORESOURCE [131500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|370||||370|64.06|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|370||||370|39.22|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|GEHA [1415]|GEHA [141500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|370||||370|312.35|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HEALTHNET [1495]|HEALTHNET [149500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370||||370|159.1|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|370||||370|344.1|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370||||370|222|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370||||370|151.27|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370||||370|345.93|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370||||370|18.62|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370||||370|187.41|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370||||370|141.6|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MULTIPLAN [1680]|HMA [168003]|370||||370|208.23|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MULTIPLAN [1680]|IHC HS [168011]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|370||||370|19.06|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370||||370|151.27|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|Self-pay|Self-pay|370||||370|111|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370||||370|77.7|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|370||||370|136.05|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370||||370|202.68|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|TRUSTMARK [2030]|STARMARK [203000]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370||||370|177.42|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|UMR [2035]|UMR OPTIONS [203501]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370||||370|17.73|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370||||370|333|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|370||||370|86.84|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|370||||370|39.22|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|370||||370|138.82|345.93|17.73
31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|370||||370|185|345.93|17.73
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|AETNA [1015]|AETNA ACO WILCO [101532]|858||||858|107.51|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|858||||858|46.71|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|858||||858|79.16|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|858||||858|79.16|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|858||||858|45.88|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|858||||858|429.86|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|858||||858|301.16|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|858||||858|368.94|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|858||||858|365.51|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|858||||858|429|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|858||||858|557.7|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|CORESOURCE [1315]|CORESOURCE [131500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|858||||858|164.1|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|858||||858|102.47|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|GEHA [1415]|GEHA [141500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|858||||858|103.03|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HEALTHNET [1495]|HEALTHNET [149500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|858||||858|368.94|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|858||||858|797.94|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|858||||858|514.8|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|858||||858|46.31|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|858||||858|50.46|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|858||||858|121.87|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|858||||858|79.44|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|858||||858|61.82|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|858||||858|47.24|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MULTIPLAN [1680]|HMA [168003]|858||||858|68.69|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MULTIPLAN [1680]|IHC HS [168011]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|858||||858|82.28|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|858||||858|50.46|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|Self-pay|Self-pay|858||||858|257.4|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|858||||858|180.18|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|858||||858|44.87|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|858||||858|66.85|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|TRUSTMARK [2030]|STARMARK [203000]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|858||||858|411.41|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|UMR [2035]|UMR OPTIONS [203501]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|858||||858|75.66|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|858||||858|772.2|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|858||||858|30.59|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|858||||858|102.47|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|858||||858|45.79|797.94|30.59
31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|858||||858|429|797.94|30.59
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|AETNA [1015]|AETNA ACO WILCO [101532]|248||||248|41.88|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248||||248|27.14|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248||||248|28.83|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248||||248|28.83|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|248||||248|124.25|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248||||248|87.05|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248||||248|32.71|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|248||||248|105.65|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|248||||248|124|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248||||248|161.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|CORESOURCE [1315]|CORESOURCE [131500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|248||||248|139.69|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|248||||248|85.53|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|GEHA [1415]|GEHA [141500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|248||||248|59.87|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HEALTHNET [1495]|HEALTHNET [149500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248||||248|32.71|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|248||||248|230.64|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248||||248|148.8|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248||||248|29.27|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248||||248|124|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248||||248|27.84|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248||||248|35.92|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248||||248|27.14|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MULTIPLAN [1680]|HMA [168003]|248||||248|39.92|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MULTIPLAN [1680]|IHC HS [168011]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|248||||248|29.97|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248||||248|29.27|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|Self-pay|Self-pay|248||||248|74.4|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248||||248|52.08|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|248||||248|26.08|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248||||248|38.85|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|TRUSTMARK [2030]|STARMARK [203000]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248||||248|118.92|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|UMR [2035]|UMR OPTIONS [203501]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248||||248|26.52|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248||||248|223.2|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|248||||248|17.66|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|248||||248|85.53|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|248||||248|26.61|230.64|17.66
31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|248||||248|124|230.64|17.66
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|86||||86|9.44|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86||||86|6.6|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86||||86|6.6|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86||||86|43.09|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86||||86|30.19|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86||||86|36.98|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86||||86|36.64|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86||||86|43|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86||||86|55.9|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|CORESOURCE [1315]|CORESOURCE [131500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86||||86|47.66|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86||||86|29.18|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|GEHA [1415]|GEHA [141500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HEALTHNET [1495]|HEALTHNET [149500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86||||86|36.98|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86||||86|79.98|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86||||86|51.6|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86||||86|43|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86||||86|6.85|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MULTIPLAN [1680]|HMA [168003]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MULTIPLAN [1680]|IHC HS [168011]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86||||86|6.86|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|Self-pay|Self-pay|86||||86|25.8|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86||||86|18.06|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|TRUSTMARK [2030]|STARMARK [203000]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86||||86|41.24|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|UMR [2035]|UMR OPTIONS [203501]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86||||86|6.53|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86||||86|77.4|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86||||86|4.33|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86||||86|29.18|79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86||||86||79.98|4.33
31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86||||86|43|79.98|4.33
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|AETNA [1015]|AETNA ACO WILCO [101532]|710||||710|126.56|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|710||||710|94.04|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|710||||710|94.04|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|710||||710|355.71|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|710||||710|249.21|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|710||||710|305.3|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|710||||710|302.46|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|710||||710|355|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|710||||710|461.5|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|CORESOURCE [1315]|CORESOURCE [131500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|710||||710|125.52|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|710||||710|85.24|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|GEHA [1415]|GEHA [141500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HEALTHNET [1495]|HEALTHNET [149500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|710||||710|305.3|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|710||||710|660.3|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|710||||710|426|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|710||||710|121.87|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|710||||710|95.31|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MULTIPLAN [1680]|HMA [168003]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MULTIPLAN [1680]|IHC HS [168011]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|710||||710|97.74|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|Self-pay|Self-pay|710||||710|213|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|710||||710|149.1|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|TRUSTMARK [2030]|STARMARK [203000]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|710||||710|340.45|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|UMR [2035]|UMR OPTIONS [203501]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|710||||710|90.77|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|710||||710|639|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|710||||710|30.59|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|710||||710|85.24|660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|710||||710||660.3|30.59
31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|710||||710|355|660.3|30.59
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|AETNA [1015]|AETNA ACO WILCO [101532]|317||||317|89.1|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|317||||317|276.49|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|317||||317|65.63|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|317||||317|65.63|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|317||||317|268.52|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|317||||317|158.82|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|317||||317|111.27|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|317||||317|136.31|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|317||||317|135.04|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|317||||317|158.5|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|317||||317|206.05|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|CORESOURCE [1315]|CORESOURCE [131500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|317||||317|89.99|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|317||||317|55.1|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|GEHA [1415]|GEHA [141500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|317||||317|317|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HEALTHNET [1495]|HEALTHNET [149500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|317||||317|136.31|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|317||||317|294.81|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|317||||317|190.2|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|317||||317|295.37|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|317||||317|317|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|317||||317|65.04|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|317||||317|317|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|317||||317|276.49|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MULTIPLAN [1680]|HMA [168003]|317||||317|317|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MULTIPLAN [1680]|IHC HS [168011]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|317||||317|68.21|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|317||||317|295.37|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|Self-pay|Self-pay|317||||317|95.1|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|317||||317|66.57|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|317||||317|265.65|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|317||||317|317|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|TRUSTMARK [2030]|STARMARK [203000]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|317||||317|152|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|UMR [2035]|UMR OPTIONS [203501]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|317||||317|61.94|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|317||||317|285.3|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|317||||317|164.53|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|317||||317|55.1|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|317||||317|271.07|317|55.1
31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|317||||317|158.5|317|55.1
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|AETNA [1015]|AETNA ACO WILCO [101532]|150||||150|32.58|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150||||150|21.71|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150||||150|21.71|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|150||||150|75.15|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150||||150|52.65|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150||||150|64.5|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|150||||150|63.9|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|150||||150|75|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150||||150|97.5|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|CORESOURCE [1315]|CORESOURCE [131500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|150||||150|53.03|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|150||||150|30.78|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|GEHA [1415]|GEHA [141500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HEALTHNET [1495]|HEALTHNET [149500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150||||150|64.5|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|150||||150|139.5|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150||||150|90|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150||||150|75|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150||||150|21.26|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MULTIPLAN [1680]|HMA [168003]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MULTIPLAN [1680]|IHC HS [168011]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|150||||150|22.56|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|Self-pay|Self-pay|150||||150|45|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150||||150|31.5|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|TRUSTMARK [2030]|STARMARK [203000]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150||||150|71.93|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|UMR [2035]|UMR OPTIONS [203501]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150||||150|20.25|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150||||150|135|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|150||||150|14.92|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|150||||150|30.78|139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|150||||150||139.5|14.92
31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADDL MARKER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|150||||150|75|139.5|14.92
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1432||||1432|184.12|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1432||||1432|118.82|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1432||||1432|126.21|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1432||||1432|126.21|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1432||||1432|717.43|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1432||||1432|502.63|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1432||||1432|143.82|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1432||||1432|610.03|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1432||||1432|716|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1432||||1432|930.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|CORESOURCE [1315]|CORESOURCE [131500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1432||||1432|175.81|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1432||||1432|107.64|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|GEHA [1415]|GEHA [141500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1432||||1432|262.1|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HEALTHNET [1495]|HEALTHNET [149500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1432||||1432|143.82|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1432||||1432|1331.76|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1432||||1432|859.2|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1432||||1432|128.14|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1432||||1432|716|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1432||||1432|121.9|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1432||||1432|157.26|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1432||||1432|118.82|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MULTIPLAN [1680]|HMA [168003]|1432||||1432|174.74|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MULTIPLAN [1680]|IHC HS [168011]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1432||||1432|131.18|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1432||||1432|128.14|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|Self-pay|Self-pay|1432||||1432|429.6|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1432||||1432|300.72|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1432||||1432|114.16|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1432||||1432|170.08|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|TRUSTMARK [2030]|STARMARK [203000]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1432||||1432|686.64|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|UMR [2035]|UMR OPTIONS [203501]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1432||||1432|116.09|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1432||||1432|1288.8|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1432||||1432|77.66|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1432||||1432|107.64|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1432||||1432|116.49|1331.76|77.66
31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1432||||1432|716|1331.76|77.66
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1729||||1729|222.41|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1729||||1729|152.48|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1729||||1729|152.48|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1729||||1729|866.23|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1729||||1729|606.88|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1729||||1729|173.74|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1729||||1729|736.55|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1729||||1729|864.5|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1729||||1729|1123.85|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|CORESOURCE [1315]|CORESOURCE [131500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1729||||1729|212.51|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1729||||1729|130.11|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|GEHA [1415]|GEHA [141500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HEALTHNET [1495]|HEALTHNET [149500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1729||||1729|173.74|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1729||||1729|1607.97|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1729||||1729|1037.4|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1729||||1729|864.5|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1729||||1729|147.27|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MULTIPLAN [1680]|HMA [168003]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MULTIPLAN [1680]|IHC HS [168011]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1729||||1729|158.48|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|Self-pay|Self-pay|1729||||1729|518.7|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1729||||1729|363.09|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|TRUSTMARK [2030]|STARMARK [203000]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1729||||1729|829.06|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|UMR [2035]|UMR OPTIONS [203501]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1729||||1729|140.26|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1729||||1729|1556.1|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1729||||1729|93.82|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1729||||1729|130.11|1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1729||||1729||1607.97|93.82
31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1729||||1729|864.5|1607.97|93.82
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1452||||1452|204.47|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1452||||1452|146.63|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1452||||1452|155.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1452||||1452|155.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1452||||1452|727.45|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1452||||1452|509.65|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1452||||1452|155.93|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1452||||1452|618.55|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1452||||1452|726|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1452||||1452|943.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|CORESOURCE [1315]|CORESOURCE [131500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1452||||1452|190.84|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1452||||1452|116.84|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|GEHA [1415]|GEHA [141500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1452||||1452|323.44|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HEALTHNET [1495]|HEALTHNET [149500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1452||||1452|155.93|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1452||||1452|1350.36|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1452||||1452|871.2|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1452||||1452|158.13|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1452||||1452|726|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1452||||1452|150.43|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1452||||1452|194.06|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1452||||1452|146.63|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MULTIPLAN [1680]|HMA [168003]|1452||||1452|215.63|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MULTIPLAN [1680]|IHC HS [168011]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1452||||1452|161.88|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1452||||1452|158.13|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|Self-pay|Self-pay|1452||||1452|435.6|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1452||||1452|304.92|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1452||||1452|140.88|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1452||||1452|209.88|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|TRUSTMARK [2030]|STARMARK [203000]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1452||||1452|696.23|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|UMR [2035]|UMR OPTIONS [203501]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1452||||1452|143.26|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1452||||1452|1306.8|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1452||||1452|86.25|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1452||||1452|116.84|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1452||||1452|143.75|1350.36|86.25
31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISS CUL NEO DISORDERS BONE MARROW/BLOOD CELLS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1452||||1452|726|1350.36|86.25
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|AETNA [1015]|AETNA ACO WILCO [101532]|465||||465|233.15|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|465||||465|150.47|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|465||||465|159.83|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|465||||465|159.83|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|465||||465|232.97|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|465||||465|163.22|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|465||||465|182.12|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|465||||465|198.09|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|465||||465|232.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|465||||465|302.25|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|CORESOURCE [1315]|CORESOURCE [131500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|465||||465|222.79|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|465||||465|136.4|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|GEHA [1415]|GEHA [141500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|465||||465|331.92|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HEALTHNET [1495]|HEALTHNET [149500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|465||||465|182.12|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|465||||465|432.45|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|465||||465|279|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|465||||465|162.27|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|465||||465|232.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|465||||465|154.37|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|465||||465|199.15|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|465||||465|150.47|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MULTIPLAN [1680]|HMA [168003]|465||||465|221.28|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MULTIPLAN [1680]|IHC HS [168011]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|465||||465|166.12|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|465||||465|162.27|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|Self-pay|Self-pay|465||||465|139.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|465||||465|97.65|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|465||||465|144.57|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|465||||465|215.38|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|TRUSTMARK [2030]|STARMARK [203000]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|465||||465|222.97|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|UMR [2035]|UMR OPTIONS [203501]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|465||||465|147.01|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|465||||465|418.5|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|465||||465|98.35|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|465||||465|136.4|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|465||||465|147.52|432.45|97.65
31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|465||||465|232.5|432.45|97.65
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|AETNA [1015]|AETNA ACO WILCO [101532]|2695||||2695|376|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2695||||2695|269.63|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2695||||2695|286.4|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2695||||2695|286.4|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2695||||2695|1350.2|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2695||||2695|945.95|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2695||||2695|1148.07|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2695||||2695|1347.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2695||||2695|1751.75|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|CORESOURCE [1315]|CORESOURCE [131500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2695||||2695|267|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2695||||2695|171.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|GEHA [1415]|GEHA [141500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2695||||2695|594.77|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HEALTHNET [1495]|HEALTHNET [149500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2695||||2695|2506.35|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2695||||2695|1617|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2695||||2695|290.77|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2695||||2695|1347.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2695||||2695|276.62|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2695||||2695|356.86|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2695||||2695|269.63|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MULTIPLAN [1680]|HMA [168003]|2695||||2695|396.51|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MULTIPLAN [1680]|IHC HS [168011]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2695||||2695|297.68|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2695||||2695|290.77|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|Self-pay|Self-pay|2695||||2695|808.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2695||||2695|565.95|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2695||||2695|259.05|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2695||||2695|385.94|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|TRUSTMARK [2030]|STARMARK [203000]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2695||||2695|1292.25|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|UMR [2035]|UMR OPTIONS [203501]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2695||||2695|263.44|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2695||||2695|2425.5|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2695||||2695|158.6|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2695||||2695|171.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2695||||2695|264.34|2506.35|158.6
31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2695||||2695|1347.5|2506.35|158.6
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1533||||1533|196.99|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1533||||1533|128|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1533||||1533|135.96|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1533||||1533|135.96|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1533||||1533|768.03|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1533||||1533|538.08|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1533||||1533|153.88|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1533||||1533|653.06|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1533||||1533|766.5|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1533||||1533|996.45|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|CORESOURCE [1315]|CORESOURCE [131500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1533||||1533|221.68|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1533||||1533|135.72|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|GEHA [1415]|GEHA [141500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1533||||1533|282.35|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HEALTHNET [1495]|HEALTHNET [149500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1533||||1533|153.88|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1533||||1533|1425.69|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1533||||1533|919.8|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1533||||1533|138.04|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1533||||1533|766.5|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1533||||1533|131.32|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1533||||1533|169.41|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1533||||1533|128|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MULTIPLAN [1680]|HMA [168003]|1533||||1533|188.24|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MULTIPLAN [1680]|IHC HS [168011]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1533||||1533|141.31|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1533||||1533|138.04|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|Self-pay|Self-pay|1533||||1533|459.9|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1533||||1533|321.93|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1533||||1533|122.98|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1533||||1533|183.22|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|TRUSTMARK [2030]|STARMARK [203000]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1533||||1533|735.07|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|UMR [2035]|UMR OPTIONS [203501]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1533||||1533|125.06|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1533||||1533|1379.7|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1533||||1533|83.09|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1533||||1533|135.72|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1533||||1533|125.49|1425.69|83.09
31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2 KARYOTYPES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1533||||1533|766.5|1425.69|83.09
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|AETNA [1015]|AETNA ACO WILCO [101532]|982||||982|205.69|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|982||||982|147.5|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|982||||982|156.67|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|982||||982|156.67|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|982||||982|491.98|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|982||||982|344.68|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|982||||982|153.88|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|982||||982|418.33|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|982||||982|491|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|982||||982|638.3|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|CORESOURCE [1315]|CORESOURCE [131500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|982||||982|188.07|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|982||||982|115.15|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|GEHA [1415]|GEHA [141500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|982||||982|325.37|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HEALTHNET [1495]|HEALTHNET [149500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|982||||982|153.88|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|982||||982|913.26|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|982||||982|589.2|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|982||||982|159.07|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|982||||982|491|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|982||||982|151.32|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|982||||982|195.22|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|982||||982|147.5|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MULTIPLAN [1680]|HMA [168003]|982||||982|216.92|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MULTIPLAN [1680]|IHC HS [168011]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|982||||982|162.84|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|982||||982|159.07|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|Self-pay|Self-pay|982||||982|294.6|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|982||||982|206.22|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|982||||982|141.72|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|982||||982|211.13|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|TRUSTMARK [2030]|STARMARK [203000]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|982||||982|470.87|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|UMR [2035]|UMR OPTIONS [203501]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|982||||982|144.11|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|982||||982|883.8|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|982||||982|86.77|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|982||||982|115.15|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|982||||982|144.61|913.26|86.77
31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|982||||982|491|913.26|86.77
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|AETNA [1015]|AETNA ACO WILCO [101532]|2210||||2210|284.12|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2210||||2210|204.31|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2210||||2210|204.31|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2210||||2210|1107.21|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2210||||2210|775.71|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2210||||2210|221.95|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2210||||2210|941.46|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2210||||2210|1105|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2210||||2210|1436.5|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|CORESOURCE [1315]|CORESOURCE [131500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2210||||2210|341.97|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2210||||2210|209.37|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|GEHA [1415]|GEHA [141500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HEALTHNET [1495]|HEALTHNET [149500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2210||||2210|221.95|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2210||||2210|2055.3|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2210||||2210|1326|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2210||||2210|1105|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2210||||2210|197.34|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MULTIPLAN [1680]|HMA [168003]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MULTIPLAN [1680]|IHC HS [168011]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2210||||2210|212.35|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|Self-pay|Self-pay|2210||||2210|663|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2210||||2210|464.1|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|TRUSTMARK [2030]|STARMARK [203000]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2210||||2210|1059.7|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|UMR [2035]|UMR OPTIONS [203501]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2210||||2210|187.93|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2210||||2210|1989|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2210||||2210|119.85|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2210||||2210|209.37|2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2210||||2210||2055.3|119.85
31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2210||||2210|1105|2055.3|119.85
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|AETNA [1015]|AETNA ACO WILCO [101532]|247||||247|33.86|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247||||247|23.2|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247||||247|23.2|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|247||||247|123.75|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247||||247|86.7|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247||||247|26.44|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|247||||247|105.22|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|247||||247|123.5|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247||||247|160.55|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|CORESOURCE [1315]|CORESOURCE [131500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|247||||247|35.23|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|247||||247|21.57|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|GEHA [1415]|GEHA [141500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HEALTHNET [1495]|HEALTHNET [149500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247||||247|26.44|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|247||||247|229.71|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247||||247|148.2|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247||||247|123.5|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247||||247|22.41|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MULTIPLAN [1680]|HMA [168003]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MULTIPLAN [1680]|IHC HS [168011]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|247||||247|24.11|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|Self-pay|Self-pay|247||||247|74.1|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247||||247|51.87|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|TRUSTMARK [2030]|STARMARK [203000]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247||||247|118.44|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|UMR [2035]|UMR OPTIONS [203501]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247||||247|21.34|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247||||247|222.3|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|247||||247|14.28|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|247||||247|21.57|229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|247||||247||229.71|14.28
31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|247||||247|123.5|229.71|14.28
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|AETNA [1015]|AETNA ACO WILCO [101532]|439||||439|57.89|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|439||||439|44.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|439||||439|44.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|439||||439|219.94|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|439||||439|154.09|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|439||||439|40.7|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|439||||439|187.01|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|439||||439|219.5|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|439||||439|285.35|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|CORESOURCE [1315]|CORESOURCE [131500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|439||||439|44.08|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|439||||439|26.99|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|GEHA [1415]|GEHA [141500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HEALTHNET [1495]|HEALTHNET [149500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|439||||439|40.7|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|439||||439|408.27|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|439||||439|263.4|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|439||||439|219.5|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|439||||439|42.6|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MULTIPLAN [1680]|HMA [168003]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MULTIPLAN [1680]|IHC HS [168011]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|439||||439|45.84|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|Self-pay|Self-pay|439||||439|131.7|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|439||||439|92.19|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|TRUSTMARK [2030]|STARMARK [203000]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|439||||439|210.5|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|UMR [2035]|UMR OPTIONS [203501]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|439||||439|40.57|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|439||||439|395.1|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|439||||439|24.42|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|439||||439|26.99|408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|439||||439||408.27|24.42
31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|439||||439|219.5|408.27|24.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|AETNA [1015]|AETNA ACO WILCO [101532]|526||||526|50.78|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|526||||526|37.71|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|526||||526|37.71|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|526||||526|263.53|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|526||||526|184.63|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|526||||526|39.66|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|526||||526|224.08|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|526||||526|263|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|526||||526|341.9|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|CORESOURCE [1315]|CORESOURCE [131500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|CORVEL CORP [2235]|CORVEL CORP [223500]|526||||526|48.56|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|526||||526|29.73|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|GEHA [1415]|GEHA [141500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HEALTHNET [1495]|HEALTHNET [149500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|526||||526|39.66|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HEALTHSMART [1505]|HEALTHSMART [150501]|526||||526|489.18|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|526||||526|315.6|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|526||||526|263|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|526||||526|36.42|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MULTIPLAN [1680]|HMA [168003]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MULTIPLAN [1680]|IHC HS [168011]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|526||||526|39.19|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|Self-pay|Self-pay|526||||526|157.8|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|526||||526|110.46|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|TRUSTMARK [2030]|STARMARK [203000]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|526||||526|252.22|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|UMR [2035]|UMR OPTIONS [203501]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|526||||526|34.68|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|526||||526|473.4|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|526||||526|21.42|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|526||||526|29.73|489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|526||||526||489.18|21.42
31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|526||||526|263|489.18|21.42
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|AETNA [1015]|AETNA ACO WILCO [101532]|569||||569|60.28|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|569||||569|45.92|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|569||||569|45.92|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|569||||569|285.07|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|569||||569|199.72|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|569||||569|42.98|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|569||||569|242.39|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|569||||569|284.5|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|569||||569|369.85|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|CORESOURCE [1315]|CORESOURCE [131500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|569||||569|52.51|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|569||||569|32.15|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|GEHA [1415]|GEHA [141500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HEALTHNET [1495]|HEALTHNET [149500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|569||||569|42.98|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|569||||569|529.17|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|569||||569|341.4|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|569||||569|284.5|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|569||||569|44.35|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MULTIPLAN [1680]|HMA [168003]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MULTIPLAN [1680]|IHC HS [168011]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|569||||569|47.73|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|Self-pay|Self-pay|569||||569|170.7|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|569||||569|119.49|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|TRUSTMARK [2030]|STARMARK [203000]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|569||||569|272.84|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|UMR [2035]|UMR OPTIONS [203501]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|569||||569|42.24|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|569||||569|512.1|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|569||||569|25.43|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|569||||569|32.15|529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|569||||569||529.17|25.43
31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|569||||569|284.5|529.17|25.43
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|AETNA [1015]|AETNA ACO WILCO [101532]|463||||463|72.81|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|463||||463|55.46|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|463||||463|55.46|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|463||||463|231.96|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|463||||463|162.51|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|463||||463|51.19|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|463||||463|197.24|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|463||||463|231.5|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|463||||463|300.95|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|CORESOURCE [1315]|CORESOURCE [131500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|CORVEL CORP [2235]|CORVEL CORP [223500]|463||||463|60.82|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|463||||463|37.24|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|GEHA [1415]|GEHA [141500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HEALTHNET [1495]|HEALTHNET [149500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|463||||463|51.19|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HEALTHSMART [1505]|HEALTHSMART [150501]|463||||463|430.59|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|463||||463|277.8|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|463||||463|231.5|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|463||||463|53.57|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MULTIPLAN [1680]|HMA [168003]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MULTIPLAN [1680]|IHC HS [168011]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|463||||463|57.64|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|Self-pay|Self-pay|463||||463|138.9|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|463||||463|97.23|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|TRUSTMARK [2030]|STARMARK [203000]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|463||||463|222.01|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|UMR [2035]|UMR OPTIONS [203501]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|463||||463|51.01|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|463||||463|416.7|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|463||||463|30.71|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|463||||463|37.24|430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|463||||463||430.59|30.71
31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|463||||463|231.5|430.59|30.71
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|AETNA [1015]|AETNA ACO WILCO [101532]|289||||289|47.61|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289||||289|34.14|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|289||||289|36.26|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|289||||289|36.26|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|289||||289|144.79|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|289||||289|101.44|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|289||||289|123.11|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|289||||289|144.5|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|289||||289|187.85|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|CORESOURCE [1315]|CORESOURCE [131500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|289||||289|52.11|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|289||||289|31.9|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|GEHA [1415]|GEHA [141500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|289||||289|75.31|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HEALTHNET [1495]|HEALTHNET [149500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|289||||289|268.77|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|289||||289|173.4|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|289||||289|36.82|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|289||||289|144.5|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|289||||289|35.02|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|289||||289|45.18|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289||||289|34.14|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MULTIPLAN [1680]|HMA [168003]|289||||289|50.21|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MULTIPLAN [1680]|IHC HS [168011]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|289||||289|37.69|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|289||||289|36.82|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|Self-pay|Self-pay|289||||289|86.7|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|289||||289|60.69|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|289||||289|32.8|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|289||||289|48.87|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|TRUSTMARK [2030]|STARMARK [203000]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289||||289|138.58|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|UMR [2035]|UMR OPTIONS [203501]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|289||||289|33.35|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|289||||289|260.1|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|289||||289|20.08|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|289||||289|31.9|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|289||||289|33.47|268.77|20.08
31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|289||||289|144.5|268.77|20.08
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1033||||1033|108.42|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1033||||1033|69.97|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1033||||1033|74.32|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1033||||1033|74.32|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1033||||1033|517.53|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1033||||1033|362.58|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1033||||1033|84.69|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1033||||1033|440.06|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1033||||1033|516.5|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1033||||1033|671.45|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|CORESOURCE [1315]|CORESOURCE [131500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1033||||1033|103.52|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1033||||1033|63.38|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|GEHA [1415]|GEHA [141500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1033||||1033|154.35|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HEALTHNET [1495]|HEALTHNET [149500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1033||||1033|84.69|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1033||||1033|960.69|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1033||||1033|619.8|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1033||||1033|75.46|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1033||||1033|516.5|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1033||||1033|71.78|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1033||||1033|92.61|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1033||||1033|69.97|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MULTIPLAN [1680]|HMA [168003]|1033||||1033|102.9|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MULTIPLAN [1680]|IHC HS [168011]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1033||||1033|77.25|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1033||||1033|75.46|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|Self-pay|Self-pay|1033||||1033|309.9|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1033||||1033|216.93|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1033||||1033|67.23|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1033||||1033|100.16|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|TRUSTMARK [2030]|STARMARK [203000]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1033||||1033|495.32|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|UMR [2035]|UMR OPTIONS [203501]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1033||||1033|68.36|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1033||||1033|929.7|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1033||||1033|45.73|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1033||||1033|63.38|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1033||||1033|68.6|960.69|45.73
31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1033||||1033|516.5|960.69|45.73
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|310||||310|38.28|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|310||||310|27.45|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|310||||310|29.16|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|310||||310|29.16|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|310||||310|155.31|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|310||||310|108.81|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|310||||310|132.06|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|310||||310|155|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|310||||310|201.5|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|CORESOURCE [1315]|CORESOURCE [131500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|310||||310|35.66|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|310||||310|21.83|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|GEHA [1415]|GEHA [141500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|310||||310|60.55|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HEALTHNET [1495]|HEALTHNET [149500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|310||||310|288.3|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|310||||310|186|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|310||||310|29.6|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|310||||310|155|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|310||||310|28.17|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|310||||310|36.33|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|310||||310|27.45|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MULTIPLAN [1680]|HMA [168003]|310||||310|40.37|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MULTIPLAN [1680]|IHC HS [168011]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|310||||310|30.31|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|310||||310|29.6|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|Self-pay|Self-pay|310||||310|93|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|310||||310|65.1|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|310||||310|26.37|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|310||||310|39.29|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|TRUSTMARK [2030]|STARMARK [203000]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|310||||310|148.65|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|UMR [2035]|UMR OPTIONS [203501]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|310||||310|26.83|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|310||||310|279|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|310||||310|16.15|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|310||||310|21.83|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|310||||310|26.91|288.3|16.15
31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|310||||310|155|288.3|16.15
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|989||||989|468.7|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|989||||989|0|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|989||||989|0|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|989||||989|495.49|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|989||||989|347.14|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|989||||989|329.51|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|989||||989|421.31|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|989||||989|494.5|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|989||||989|642.85|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|CORESOURCE [1315]|CORESOURCE [131500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|989||||989|345.65|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|989||||989|213.44|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|GEHA [1415]|GEHA [141500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HEALTHNET [1495]|HEALTHNET [149500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|989||||989|329.51|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|989||||989|919.77|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|989||||989|593.4|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|989||||989|494.5|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|989||||989|0|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MULTIPLAN [1680]|HMA [168003]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MULTIPLAN [1680]|IHC HS [168011]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|989||||989|0|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|Self-pay|Self-pay|989||||989|296.7|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|989||||989|207.69|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|TRUSTMARK [2030]|STARMARK [203000]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|989||||989|474.23|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|UMR [2035]|UMR OPTIONS [203501]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|989||||989|0|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|989||||989|890.1|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|989||||989|197.71|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|989||||989|213.44|919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|989||||989||919.77|197.71
31281272|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KIT GENE ANAL TARGET SEQUENCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|989||||989|494.5|919.77|197.71
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|592||||592|274.88|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|592||||592|197.12|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|592||||592|0|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|592||||592|0|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|592||||592|296.59|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|592||||592|207.79|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|592||||592|252.19|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|592||||592|296|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|592||||592|384.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|592||||592|207.06|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|592||||592|126.77|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|GEHA [1415]|GEHA [141500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|592||||592|434.81|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|592||||592|550.56|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|592||||592|355.2|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|592||||592|212.58|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|592||||592|296|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|592||||592|0|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|592||||592|260.89|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|592||||592|197.12|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MULTIPLAN [1680]|HMA [168003]|592||||592|289.88|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MULTIPLAN [1680]|IHC HS [168011]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|592||||592|0|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|592||||592|212.58|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|Self-pay|Self-pay|592||||592|177.6|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|592||||592|124.32|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|592||||592|189.39|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|592||||592|282.15|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|TRUSTMARK [2030]|STARMARK [203000]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|592||||592|283.86|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|UMR [2035]|UMR OPTIONS [203501]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|592||||592|0|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|592||||592|532.8|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|592||||592|115.95|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|592||||592|126.77|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|592||||592|193.25|550.56|115.95
31281276|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS GENE ANAL ADDL VARIANT(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|592||||592|296|550.56|115.95
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|AETNA [1015]|AETNA ACO WILCO [101532]|1040||||1040|420.73|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1040||||1040|301.71|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1040||||1040|0|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1040||||1040|0|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1040||||1040|521.04|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1040||||1040|365.04|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1040||||1040|443.04|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1040||||1040|520|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1040||||1040|676|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|CORESOURCE [1315]|CORESOURCE [131500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1040||||1040|310.29|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1040||||1040|191.69|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|GEHA [1415]|GEHA [141500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1040||||1040|665.53|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HEALTHNET [1495]|HEALTHNET [149500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1040||||1040|967.2|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1040||||1040|624|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1040||||1040|325.37|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1040||||1040|520|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1040||||1040|0|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1040||||1040|399.32|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1040||||1040|301.71|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MULTIPLAN [1680]|HMA [168003]|1040||||1040|443.69|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MULTIPLAN [1680]|IHC HS [168011]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1040||||1040|0|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1040||||1040|325.37|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|Self-pay|Self-pay|1040||||1040|312|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1040||||1040|218.4|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1040||||1040|289.87|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1040||||1040|431.85|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|TRUSTMARK [2030]|STARMARK [203000]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1040||||1040|498.68|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|UMR [2035]|UMR OPTIONS [203501]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1040||||1040|0|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1040||||1040|936|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1040||||1040|177.47|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1040||||1040|191.69|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1040||||1040|295.79|967.2|177.47
31281311|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NRAS GENE ANAL EXON 2 AND 3|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1040||||1040|520|967.2|177.47
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|870||||870|318.45|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|870||||870|205.53|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|870||||870|218.31|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|870||||870|218.31|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|870||||870|435.87|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|870||||870|305.37|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|870||||870|248.76|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|870||||870|370.62|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|870||||870|435|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|870||||870|565.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|CORESOURCE [1315]|CORESOURCE [131500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|870||||870|299.22|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|870||||870|183.2|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|GEHA [1415]|GEHA [141500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|870||||870|453.38|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HEALTHNET [1495]|HEALTHNET [149500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|870||||870|248.76|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|870||||870|809.1|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|870||||870|522|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|870||||870|221.65|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|870||||870|435|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|870||||870|210.86|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|870||||870|272.03|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|870||||870|205.53|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MULTIPLAN [1680]|HMA [168003]|870||||870|302.25|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MULTIPLAN [1680]|IHC HS [168011]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|870||||870|226.91|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|870||||870|221.65|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|Self-pay|Self-pay|870||||870|261|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|870||||870|182.7|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|870||||870|197.47|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|870||||870|294.19|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|TRUSTMARK [2030]|STARMARK [203000]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|870||||870|417.17|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|UMR [2035]|UMR OPTIONS [203501]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|870||||870|200.81|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|870||||870|783|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|870||||870|134.33|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|870||||870|183.2|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|870||||870|201.5|809.1|134.33
31281342|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TRG GENE REARRANGEMENT ANAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|870||||870|435|809.1|134.33
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|AETNA [1015]|AETNA ACO WILCO [101532]|128||||128|15.28|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128||||128|23.42|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128||||128|10.48|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128||||128|10.48|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128||||128|22.75|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128||||128|64.13|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128||||128|44.93|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128||||128|55.04|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128||||128|54.53|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128||||128|64|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128||||128|83.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|CORESOURCE [1315]|CORESOURCE [131500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128||||128|23.6|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128||||128|14.45|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|GEHA [1415]|GEHA [141500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128||||128|51.67|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HEALTHNET [1495]|HEALTHNET [149500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128||||128|55.04|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128||||128|119.04|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128||||128|76.8|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128||||128|25.02|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128||||128|41.04|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128||||128|10.74|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128||||128|31|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128||||128|23.42|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MULTIPLAN [1680]|HMA [168003]|128||||128|34.45|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MULTIPLAN [1680]|IHC HS [168011]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128||||128|10.89|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128||||128|25.02|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|Self-pay|Self-pay|128||||128|38.4|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128||||128|26.88|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128||||128|22.5|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128||||128|33.53|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|TRUSTMARK [2030]|STARMARK [203000]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128||||128|61.38|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|UMR [2035]|UMR OPTIONS [203501]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128||||128|10.23|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128||||128|115.2|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128||||128|10.3|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128||||128|14.45|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128||||128|22.96|119.04|10.23
31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128||||128|64|119.04|10.23
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|AETNA [1015]|AETNA ACO WILCO [101532]|274||||274|31.8|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|274||||274|23.42|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|274||||274|23.06|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|274||||274|23.06|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|274||||274|22.75|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|274||||274|137.27|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|274||||274|96.17|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|274||||274|117.82|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|274||||274|116.72|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|274||||274|137|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|274||||274|178.1|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|CORESOURCE [1315]|CORESOURCE [131500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|CORVEL CORP [2235]|CORVEL CORP [223500]|274||||274|51.1|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|274||||274|31.28|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|GEHA [1415]|GEHA [141500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|274||||274|51.67|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HEALTHNET [1495]|HEALTHNET [149500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|274||||274|117.82|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HEALTHSMART [1505]|HEALTHSMART [150501]|274||||274|254.82|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|274||||274|164.4|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|274||||274|25.02|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|274||||274|76.78|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|274||||274|23.08|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|274||||274|31|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|274||||274|23.42|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MULTIPLAN [1680]|HMA [168003]|274||||274|34.45|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MULTIPLAN [1680]|IHC HS [168011]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|274||||274|23.97|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|274||||274|25.02|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|Self-pay|Self-pay|274||||274|82.2|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|274||||274|57.54|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|274||||274|22.5|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|274||||274|33.53|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|TRUSTMARK [2030]|STARMARK [203000]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|274||||274|131.38|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|UMR [2035]|UMR OPTIONS [203501]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|274||||274|21.98|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|274||||274|246.6|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|274||||274|19.27|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|274||||274|31.28|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|274||||274|22.96|254.82|19.27
31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|274||||274|137|254.82|19.27
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|AETNA [1015]|AETNA ACO WILCO [101532]|437||||437|38.4|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|437||||437|47.24|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|437||||437|28.41|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|437||||437|28.41|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|437||||437|45.88|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|437||||437|218.94|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|437||||437|153.39|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|437||||437|187.91|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|437||||437|186.16|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|437||||437|218.5|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|437||||437|284.05|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|CORESOURCE [1315]|CORESOURCE [131500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|CORVEL CORP [2235]|CORVEL CORP [223500]|437||||437|63.52|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|437||||437|38.89|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|GEHA [1415]|GEHA [141500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|437||||437|104.2|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HEALTHNET [1495]|HEALTHNET [149500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|437||||437|187.91|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HEALTHSMART [1505]|HEALTHSMART [150501]|437||||437|406.41|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|437||||437|262.2|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|437||||437|50.46|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|437||||437|121.87|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|437||||437|28.57|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|437||||437|62.52|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|437||||437|47.24|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MULTIPLAN [1680]|HMA [168003]|437||||437|69.47|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MULTIPLAN [1680]|IHC HS [168011]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|437||||437|29.53|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|437||||437|50.46|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|Self-pay|Self-pay|437||||437|131.1|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|437||||437|91.77|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|437||||437|45.39|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|437||||437|67.62|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|TRUSTMARK [2030]|STARMARK [203000]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|437||||437|209.54|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|UMR [2035]|UMR OPTIONS [203501]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|437||||437|27.21|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|437||||437|393.3|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|437||||437|30.59|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|437||||437|38.89|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|437||||437|46.31|406.41|27.21
31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|437||||437|218.5|406.41|27.21
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|AETNA [1015]|AETNA ACO WILCO [101532]|734||||734|40.3|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|734||||734|47.24|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|734||||734|31.25|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|734||||734|31.25|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|734||||734|45.88|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|734||||734|367.73|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|734||||734|257.63|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|734||||734|315.62|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|734||||734|312.68|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|734||||734|367|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|734||||734|477.1|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|CORESOURCE [1315]|CORESOURCE [131500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|734||||734|102.21|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|734||||734|62.58|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|GEHA [1415]|GEHA [141500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|734||||734|104.2|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HEALTHNET [1495]|HEALTHNET [149500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|734||||734|315.62|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|734||||734|682.62|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|734||||734|440.4|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|734||||734|50.46|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|734||||734|121.87|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|734||||734|30.62|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|734||||734|62.52|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|734||||734|47.24|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MULTIPLAN [1680]|HMA [168003]|734||||734|69.47|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MULTIPLAN [1680]|IHC HS [168011]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|734||||734|32.48|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|734||||734|50.46|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|Self-pay|Self-pay|734||||734|220.2|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|734||||734|154.14|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|734||||734|45.39|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|734||||734|67.62|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|TRUSTMARK [2030]|STARMARK [203000]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|734||||734|351.95|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|UMR [2035]|UMR OPTIONS [203501]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|734||||734|29.17|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|734||||734|660.6|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|734||||734|30.59|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|734||||734|62.58|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|734||||734|46.31|682.62|29.17
31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|734||||734|367|682.62|29.17
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|AETNA [1015]|AETNA ACO WILCO [101532]|1506||||1506|244.9|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1506||||1506|276.49|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1506||||1506|190.94|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1506||||1506|190.94|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1506||||1506|268.52|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1506||||1506|754.51|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1506||||1506|528.61|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1506||||1506|647.58|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1506||||1506|641.56|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1506||||1506|753|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1506||||1506|978.9|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|CORESOURCE [1315]|CORESOURCE [131500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1506||||1506|299.83|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1506||||1506|183.57|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|GEHA [1415]|GEHA [141500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1506||||1506|609.91|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HEALTHNET [1495]|HEALTHNET [149500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1506||||1506|647.58|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1506||||1506|1400.58|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1506||||1506|903.6|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1506||||1506|295.37|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1506||||1506|655.46|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1506||||1506|185.51|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1506||||1506|365.95|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1506||||1506|276.49|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MULTIPLAN [1680]|HMA [168003]|1506||||1506|406.61|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MULTIPLAN [1680]|IHC HS [168011]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1506||||1506|198.46|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1506||||1506|295.37|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|Self-pay|Self-pay|1506||||1506|451.8|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1506||||1506|316.26|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1506||||1506|265.65|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1506||||1506|395.76|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|TRUSTMARK [2030]|STARMARK [203000]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1506||||1506|722.13|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|UMR [2035]|UMR OPTIONS [203501]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1506||||1506|176.67|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1506||||1506|1355.4|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1506||||1506|164.53|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1506||||1506|183.57|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1506||||1506|271.07|1400.58|164.53
31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1506||||1506|753|1400.58|164.53
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|AETNA [1015]|AETNA ACO WILCO [101532]|1614||||1614|343.74|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1614||||1614|622.89|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1614||||1614|271.48|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1614||||1614|271.48|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1614||||1614|604.93|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1614||||1614|808.61|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1614||||1614|566.51|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1614||||1614|694.02|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1614||||1614|687.56|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1614||||1614|807|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1614||||1614|1049.1|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|CORESOURCE [1315]|CORESOURCE [131500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1614||||1614|450.48|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1614||||1614|275.8|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|GEHA [1415]|GEHA [141500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1614||||1614|1374.03|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HEALTHNET [1495]|HEALTHNET [149500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1614||||1614|694.02|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1614||||1614|1501.02|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1614||||1614|968.4|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1614||||1614|665.42|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1614||||1614|1334.03|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1614||||1614|261.64|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1614||||1614|824.42|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1614||||1614|622.89|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MULTIPLAN [1680]|HMA [168003]|1614||||1614|916.02|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MULTIPLAN [1680]|IHC HS [168011]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1614||||1614|282.17|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1614||||1614|665.42|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|Self-pay|Self-pay|1614||||1614|484.2|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1614||||1614|338.94|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1614||||1614|598.46|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1614||||1614|891.59|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|TRUSTMARK [2030]|STARMARK [203000]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1614||||1614|773.91|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|UMR [2035]|UMR OPTIONS [203501]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1614||||1614|249.18|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1614||||1614|1452.6|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1614||||1614|334.87|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1614||||1614|275.8|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1614||||1614|610.68|1501.02|249.18
31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1614||||1614|807|1501.02|249.18
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|119||||119|11.97|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119||||119|8.28|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119||||119|8.28|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119||||119|59.62|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119||||119|41.77|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119||||119|51.17|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119||||119|50.69|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119||||119|59.5|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119||||119|77.35|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|CORESOURCE [1315]|CORESOURCE [131500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119||||119|24.12|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119||||119|14.77|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|GEHA [1415]|GEHA [141500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HEALTHNET [1495]|HEALTHNET [149500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119||||119|51.17|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119||||119|110.67|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119||||119|71.4|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119||||119|59.5|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119||||119|8.69|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MULTIPLAN [1680]|HMA [168003]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MULTIPLAN [1680]|IHC HS [168011]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119||||119|8.61|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|Self-pay|Self-pay|119||||119|35.7|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119||||119|24.99|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|TRUSTMARK [2030]|STARMARK [203000]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119||||119|57.06|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|UMR [2035]|UMR OPTIONS [203501]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119||||119|8.27|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119||||119|107.1|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119||||119|5.41|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119||||119|14.77|110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119||||119||110.67|5.41
31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119||||119|59.5|110.67|5.41
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|AETNA [1015]|AETNA ACO WILCO [101532]|491||||491|97.43|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|491||||491|47.24|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|491||||491|79.69|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|491||||491|79.69|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|491||||491|45.88|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|491||||491|245.99|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|491||||491|172.34|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|491||||491|211.13|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|491||||491|209.17|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|491||||491|245.5|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|491||||491|319.15|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|CORESOURCE [1315]|CORESOURCE [131500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|491||||491|100.85|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|491||||491|63.32|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|GEHA [1415]|GEHA [141500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|491||||491|104.2|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HEALTHNET [1495]|HEALTHNET [149500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|491||||491|211.13|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|491||||491|456.63|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|491||||491|294.6|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|491||||491|50.46|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|491||||491|121.87|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|491||||491|75.56|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|491||||491|62.52|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|491||||491|47.24|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MULTIPLAN [1680]|HMA [168003]|491||||491|69.47|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MULTIPLAN [1680]|IHC HS [168011]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|491||||491|82.83|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|491||||491|50.46|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|Self-pay|Self-pay|491||||491|147.3|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|491||||491|103.11|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|491||||491|44.87|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|491||||491|67.62|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|TRUSTMARK [2030]|STARMARK [203000]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|491||||491|235.43|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|UMR [2035]|UMR OPTIONS [203501]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|491||||491|71.96|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|491||||491|441.9|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|491||||491|30.59|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|491||||491|63.32|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|491||||491|46.31|456.63|30.59
31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|491||||491|245.5|456.63|30.59
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|AETNA [1015]|AETNA ACO WILCO [101532]|467||||467|80.43|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|467||||467|32.12|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|467||||467|64.28|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|467||||467|64.28|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|467||||467|31.2|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|467||||467|233.97|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|467||||467|163.92|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|467||||467|200.81|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|467||||467|198.94|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|467||||467|233.5|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|467||||467|303.55|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|CORESOURCE [1315]|CORESOURCE [131500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|CORVEL CORP [2235]|CORVEL CORP [223500]|467||||467|71.02|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|467||||467|45.87|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|GEHA [1415]|GEHA [141500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|467||||467|70.86|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HEALTHNET [1495]|HEALTHNET [149500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|467||||467|200.81|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HEALTHSMART [1505]|HEALTHSMART [150501]|467||||467|434.31|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|467||||467|280.2|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|467||||467|34.32|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|467||||467|76.78|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|467||||467|61.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|467||||467|42.52|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|467||||467|32.12|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MULTIPLAN [1680]|HMA [168003]|467||||467|47.24|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MULTIPLAN [1680]|IHC HS [168011]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|467||||467|66.81|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|467||||467|34.32|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|Self-pay|Self-pay|467||||467|140.1|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|467||||467|98.07|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|467||||467|30.86|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|467||||467|45.98|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|TRUSTMARK [2030]|STARMARK [203000]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|467||||467|223.93|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|UMR [2035]|UMR OPTIONS [203501]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|467||||467|58.56|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|467||||467|420.3|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|467||||467|19.27|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|467||||467|45.87|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|467||||467|31.49|434.31|19.27
31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|467||||467|233.5|434.31|19.27
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|202||||202|92.23|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202||||202|74.03|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202||||202|74.03|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202||||202|101.2|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202||||202|70.9|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202||||202|86.86|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202||||202|86.05|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202||||202|101|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202||||202|131.3|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|CORESOURCE [1315]|CORESOURCE [131500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202||||202|81.83|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202||||202|56.02|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|GEHA [1415]|GEHA [141500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HEALTHNET [1495]|HEALTHNET [149500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202||||202|86.86|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202||||202|187.86|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202||||202|121.2|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202||||202|101|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202||||202|71.78|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MULTIPLAN [1680]|HMA [168003]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MULTIPLAN [1680]|IHC HS [168011]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202||||202|76.94|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|Self-pay|Self-pay|202||||202|60.6|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202||||202|42.42|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|TRUSTMARK [2030]|STARMARK [203000]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202||||202|96.86|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|UMR [2035]|UMR OPTIONS [203501]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202||||202|68.36|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202||||202|181.8|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202||||202|42.17|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202||||202|56.02|187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202||||202||187.86|42.17
31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202||||202|101|187.86|42.17
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|AETNA [1015]|AETNA ACO WILCO [101532]|1832||||1832|93.17|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1832||||1832|622.89|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1832||||1832|95.2|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1832||||1832|95.2|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1832||||1832|604.93|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1832||||1832|917.83|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1832||||1832|643.03|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1832||||1832|787.76|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1832||||1832|780.43|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1832||||1832|916|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1832||||1832|1190.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|CORESOURCE [1315]|CORESOURCE [131500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1832||||1832|97.46|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1832||||1832|59.67|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|GEHA [1415]|GEHA [141500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1832||||1832|1374.03|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HEALTHNET [1495]|HEALTHNET [149500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1832||||1832|787.76|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1832||||1832|1703.76|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1832||||1832|1099.2|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1832||||1832|665.42|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1832||||1832|1334.03|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1832||||1832|81.37|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1832||||1832|824.42|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1832||||1832|622.89|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MULTIPLAN [1680]|HMA [168003]|1832||||1832|916.02|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MULTIPLAN [1680]|IHC HS [168011]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1832||||1832|98.95|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1832||||1832|665.42|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|Self-pay|Self-pay|1832||||1832|549.6|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1832||||1832|384.72|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1832||||1832|598.46|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1832||||1832|891.59|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|TRUSTMARK [2030]|STARMARK [203000]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1832||||1832|878.44|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|UMR [2035]|UMR OPTIONS [203501]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1832||||1832|77.5|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1832||||1832|1648.8|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1832||||1832|334.87|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1832||||1832|59.67|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1832||||1832|610.68|1703.76|59.67
31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1832||||1832|916|1703.76|59.67
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|564||||564|122.19|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564||||564|31.76|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|564||||564|94.28|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|564||||564|94.28|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|564||||564|31.2|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|564||||564|282.56|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|564||||564|197.96|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|564||||564|242.52|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|564||||564|240.26|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|564||||564|282|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|564||||564|366.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|564||||564|105.58|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|564||||564|66.45|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|GEHA [1415]|GEHA [141500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|564||||564|70.06|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564||||564|242.52|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|564||||564|524.52|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564||||564|338.4|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|564||||564|34.32|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|564||||564|76.78|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|564||||564|103.45|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|564||||564|42.04|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|564||||564|31.76|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MULTIPLAN [1680]|HMA [168003]|564||||564|46.71|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MULTIPLAN [1680]|IHC HS [168011]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|564||||564|97.99|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|564||||564|34.32|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|Self-pay|Self-pay|564||||564|169.2|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|564||||564|118.44|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|564||||564|30.52|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|564||||564|45.46|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|TRUSTMARK [2030]|STARMARK [203000]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|564||||564|270.44|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|UMR [2035]|UMR OPTIONS [203501]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|564||||564|98.52|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|564||||564|507.6|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|564||||564|19.27|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|564||||564|66.45|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|564||||564|31.14|524.52|19.27
31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|564||||564|282|524.52|19.27
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|AETNA [1015]|AETNA ACO WILCO [101532]|766||||766|35.57|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|766||||766|47.24|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|766||||766|25.26|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|766||||766|25.26|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|766||||766|45.88|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|766||||766|383.77|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|766||||766|268.87|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|766||||766|329.38|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|766||||766|326.32|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|766||||766|383|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|766||||766|497.9|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|CORESOURCE [1315]|CORESOURCE [131500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|766||||766|141.19|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|766||||766|82.65|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|GEHA [1415]|GEHA [141500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|766||||766|104.2|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HEALTHNET [1495]|HEALTHNET [149500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|766||||766|329.38|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|766||||766|712.38|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|766||||766|459.6|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|766||||766|50.46|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|766||||766|121.87|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|766||||766|25.5|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|766||||766|62.52|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|766||||766|47.24|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MULTIPLAN [1680]|HMA [168003]|766||||766|69.47|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MULTIPLAN [1680]|IHC HS [168011]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|766||||766|26.25|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|766||||766|50.46|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|Self-pay|Self-pay|766||||766|229.8|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|766||||766|160.86|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|766||||766|45.39|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|766||||766|67.62|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|TRUSTMARK [2030]|STARMARK [203000]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|766||||766|367.3|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|UMR [2035]|UMR OPTIONS [203501]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|766||||766|24.28|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|766||||766|689.4|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|766||||766|30.59|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|766||||766|82.65|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|766||||766|46.31|712.38|24.28
31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|766||||766|383|712.38|24.28
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|AETNA [1015]|AETNA ACO WILCO [101532]|182||||182|182|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182||||182|159.72|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182||||182|159.72|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182||||182|91.18|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182||||182|63.88|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182||||182|78.26|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182||||182|77.53|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182||||182|91|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182||||182|118.3|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|CORESOURCE [1315]|CORESOURCE [131500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182||||182|119.82|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|GEHA [1415]|GEHA [141500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HEALTHNET [1495]|HEALTHNET [149500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182||||182|78.26|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182||||182|169.26|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182||||182|109.2|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182||||182|121.87|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182||||182|180.27|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MULTIPLAN [1680]|HMA [168003]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MULTIPLAN [1680]|IHC HS [168011]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182||||182|166.01|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|Self-pay|Self-pay|182||||182|54.6|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182||||182|38.22|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|TRUSTMARK [2030]|STARMARK [203000]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182||||182|87.27|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|UMR [2035]|UMR OPTIONS [203501]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182||||182|171.68|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182||||182|163.8|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182||||182|30.59|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182||||182|119.82|182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182||||182||182|30.59
31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182||||182|91|182|30.59
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|AETNA [1015]|AETNA ACO WILCO [101532]|358||||358|52.48|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|358||||358|32.12|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|358||||358|56.15|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|358||||358|56.15|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|358||||358|31.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|358||||358|179.36|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|358||||358|125.66|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|358||||358|153.94|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|358||||358|152.51|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|358||||358|179|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|358||||358|232.7|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|CORESOURCE [1315]|CORESOURCE [131500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|358||||358|58.57|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|358||||358|35.86|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|GEHA [1415]|GEHA [141500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|358||||358|70.86|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HEALTHNET [1495]|HEALTHNET [149500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|358||||358|153.94|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|358||||358|332.94|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|358||||358|214.8|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|358||||358|34.32|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|358||||358|76.78|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|358||||358|54.42|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|358||||358|42.52|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|358||||358|32.12|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MULTIPLAN [1680]|HMA [168003]|358||||358|47.24|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MULTIPLAN [1680]|IHC HS [168011]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|358||||358|58.36|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|358||||358|34.32|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|Self-pay|Self-pay|358||||358|107.4|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|358||||358|75.18|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|358||||358|30.86|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|358||||358|45.98|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|TRUSTMARK [2030]|STARMARK [203000]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|358||||358|171.66|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|UMR [2035]|UMR OPTIONS [203501]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|358||||358|51.82|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|358||||358|322.2|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|358||||358|19.27|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|358||||358|35.86|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|358||||358|31.49|332.94|19.27
31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|358||||358|179|332.94|19.27
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|AETNA [1015]|AETNA ACO WILCO [101532]|650||||650|44.07|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|650||||650|141.6|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|650||||650|39.1|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|650||||650|39.1|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|650||||650|137.52|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|650||||650|325.65|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|650||||650|228.15|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|650||||650|279.5|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|650||||650|276.9|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|650||||650|325|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|650||||650|422.5|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|CORESOURCE [1315]|CORESOURCE [131500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|650||||650|108.44|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|650||||650|66.39|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|GEHA [1415]|GEHA [141500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|650||||650|312.35|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HEALTHNET [1495]|HEALTHNET [149500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|650||||650|279.5|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|650||||650|604.5|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|650||||650|390|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|650||||650|151.27|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|650||||650|345.93|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|650||||650|33.38|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|650||||650|187.41|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|650||||650|141.6|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MULTIPLAN [1680]|HMA [168003]|650||||650|208.23|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MULTIPLAN [1680]|IHC HS [168011]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|650||||650|40.64|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|650||||650|151.27|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|Self-pay|Self-pay|650||||650|195|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|650||||650|136.5|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|650||||650|136.05|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|650||||650|202.68|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|TRUSTMARK [2030]|STARMARK [203000]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|650||||650|311.68|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|UMR [2035]|UMR OPTIONS [203501]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|650||||650|31.78|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|650||||650|585|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|650||||650|86.84|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|650||||650|66.39|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|650||||650|138.82|604.5|31.78
31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|650||||650|325|604.5|31.78
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|AETNA [1015]|AETNA ACO WILCO [101532]|265||||265|28.96|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|265||||265|22.43|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|265||||265|22.43|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|265||||265|132.77|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|265||||265|93.02|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|265||||265|113.95|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|265||||265|112.89|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|265||||265|132.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|265||||265|172.25|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|CORESOURCE [1315]|CORESOURCE [131500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|265||||265|55.9|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|265||||265|35.24|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|GEHA [1415]|GEHA [141500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HEALTHNET [1495]|HEALTHNET [149500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|265||||265|113.95|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|265||||265|246.45|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|265||||265|159|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|265||||265|132.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|265||||265|22.07|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MULTIPLAN [1680]|HMA [168003]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MULTIPLAN [1680]|IHC HS [168011]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|265||||265|23.31|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|Self-pay|Self-pay|265||||265|79.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|265||||265|55.65|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|TRUSTMARK [2030]|STARMARK [203000]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|265||||265|127.07|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|UMR [2035]|UMR OPTIONS [203501]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|265||||265|21.02|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|265||||265|238.5|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|265||||265|13.19|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|265||||265|35.24|246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|265||||265||246.45|13.19
31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|265||||265|132.5|246.45|13.19
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|AETNA [1015]|AETNA ACO WILCO [101532]|1833||||1833|33.69|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1833||||1833|622.89|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1833||||1833|31.25|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1833||||1833|31.25|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1833||||1833|604.93|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1833||||1833|918.33|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1833||||1833|643.38|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1833||||1833|788.19|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1833||||1833|780.86|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1833||||1833|916.5|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1833||||1833|1191.45|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|CORESOURCE [1315]|CORESOURCE [131500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1833||||1833|117.96|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1833||||1833|72.22|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|GEHA [1415]|GEHA [141500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1833||||1833|1374.03|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HEALTHNET [1495]|HEALTHNET [149500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1833||||1833|788.19|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1833||||1833|1704.69|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1833||||1833|1099.8|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1833||||1833|665.42|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1833||||1833|1334.03|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1833||||1833|25.5|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1833||||1833|824.42|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1833||||1833|622.89|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MULTIPLAN [1680]|HMA [168003]|1833||||1833|916.02|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MULTIPLAN [1680]|IHC HS [168011]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1833||||1833|32.48|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1833||||1833|665.42|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|Self-pay|Self-pay|1833||||1833|549.9|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1833||||1833|384.93|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1833||||1833|598.46|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1833||||1833|891.59|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|TRUSTMARK [2030]|STARMARK [203000]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1833||||1833|878.92|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|UMR [2035]|UMR OPTIONS [203501]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1833||||1833|24.28|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1833||||1833|1649.7|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1833||||1833|334.87|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1833||||1833|72.22|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1833||||1833|610.68|1704.69|24.28
31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1833||||1833|916.5|1704.69|24.28
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|136||||136|22.19|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136||||136|17.93|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136||||136|17.93|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|136||||136|68.14|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136||||136|47.74|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136||||136|58.48|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|136||||136|57.94|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|136||||136|68|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136||||136|88.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|CORESOURCE [1315]|CORESOURCE [131500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|136||||136|68.29|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|136||||136|41.81|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|GEHA [1415]|GEHA [141500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HEALTHNET [1495]|HEALTHNET [149500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136||||136|58.48|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|136||||136|126.48|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136||||136|81.6|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136||||136|68|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136||||136|17.15|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MULTIPLAN [1680]|HMA [168003]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MULTIPLAN [1680]|IHC HS [168011]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|136||||136|18.64|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|Self-pay|Self-pay|136||||136|40.8|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136||||136|28.56|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|TRUSTMARK [2030]|STARMARK [203000]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136||||136|65.21|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|UMR [2035]|UMR OPTIONS [203501]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136||||136|16.33|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136||||136|122.4|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|136||||136|10.16|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|136||||136|41.81|126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|136||||136||126.48|10.16
31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|136||||136|68|126.48|10.16
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|AETNA [1015]|AETNA ACO WILCO [101532]|356||||356|84.52|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356||||356|0|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356||||356|0|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|356||||356|178.36|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356||||356|124.96|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356||||356|153.08|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|356||||356|151.66|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|356||||356|178|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356||||356|231.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|CORESOURCE [1315]|CORESOURCE [131500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|356||||356|95.94|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|356||||356|61.34|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|GEHA [1415]|GEHA [141500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HEALTHNET [1495]|HEALTHNET [149500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356||||356|153.08|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|356||||356|331.08|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356||||356|213.6|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356||||356|178|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356||||356|0|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MULTIPLAN [1680]|HMA [168003]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MULTIPLAN [1680]|IHC HS [168011]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|356||||356|0|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|Self-pay|Self-pay|356||||356|106.8|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356||||356|74.76|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|TRUSTMARK [2030]|STARMARK [203000]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356||||356|170.7|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|UMR [2035]|UMR OPTIONS [203501]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356||||356|0|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356||||356|320.4|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|356||||356|38.71|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|356||||356|61.34|331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|356||||356||331.08|38.71
31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|356||||356|178|331.08|38.71
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|AETNA [1015]|AETNA ACO WILCO [101532]|657||||657|93.64|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|657||||657|141.6|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|657||||657|65.54|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|657||||657|65.54|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|657||||657|137.52|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|657||||657|329.16|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|657||||657|230.61|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|657||||657|282.51|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|657||||657|279.88|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|657||||657|328.5|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|657||||657|427.05|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|CORESOURCE [1315]|CORESOURCE [131500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|657||||657|109.97|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|657||||657|70.42|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|GEHA [1415]|GEHA [141500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|657||||657|312.35|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HEALTHNET [1495]|HEALTHNET [149500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|657||||657|282.51|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|657||||657|611.01|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|657||||657|394.2|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|657||||657|151.27|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|657||||657|345.93|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|657||||657|66.98|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|657||||657|187.41|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|657||||657|141.6|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MULTIPLAN [1680]|HMA [168003]|657||||657|208.23|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MULTIPLAN [1680]|IHC HS [168011]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|657||||657|68.12|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|657||||657|151.27|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|Self-pay|Self-pay|657||||657|197.1|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|657||||657|137.97|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|657||||657|136.05|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|657||||657|202.68|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|TRUSTMARK [2030]|STARMARK [203000]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|657||||657|315.03|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|UMR [2035]|UMR OPTIONS [203501]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|657||||657|63.79|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|657||||657|591.3|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|657||||657|86.84|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|657||||657|70.42|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|657||||657|138.82|611.01|63.79
31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|657||||657|328.5|611.01|63.79
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|814||||814|175.8|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|814||||814|273.37|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|814||||814|129.39|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|814||||814|129.39|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|814||||814|268.52|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|814||||814|407.81|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|814||||814|285.71|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|814||||814|350.02|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|814||||814|346.76|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|814||||814|407|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|814||||814|529.1|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|814||||814|183.06|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|814||||814|115.68|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|GEHA [1415]|GEHA [141500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|814||||814|603.03|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|814||||814|350.02|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|814||||814|757.02|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|814||||814|488.4|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|814||||814|295.37|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|814||||814|655.46|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|814||||814|128.7|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|814||||814|361.82|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|814||||814|273.37|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MULTIPLAN [1680]|HMA [168003]|814||||814|402.02|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MULTIPLAN [1680]|IHC HS [168011]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|814||||814|134.48|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|814||||814|295.37|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|Self-pay|Self-pay|814||||814|244.2|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|814||||814|170.94|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|814||||814|262.65|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|814||||814|391.3|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|TRUSTMARK [2030]|STARMARK [203000]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|814||||814|390.31|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|UMR [2035]|UMR OPTIONS [203501]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|814||||814|122.57|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|814||||814|732.6|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|814||||814|164.53|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|814||||814|115.68|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|814||||814|268.01|757.02|115.68
31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|814||||814|407|757.02|115.68
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|660||||660|97.43|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|660||||660|276.49|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|660||||660|101.39|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|660||||660|101.39|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|660||||660|268.52|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|660||||660|330.66|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|660||||660|231.66|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|660||||660|283.8|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|660||||660|281.16|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|660||||660|330|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|660||||660|429|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|660||||660|109.12|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|660||||660|66.81|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|GEHA [1415]|GEHA [141500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|660||||660|609.91|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|660||||660|283.8|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|660||||660|613.8|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|660||||660|396|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|660||||660|295.37|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|660||||660|655.46|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|660||||660|86.53|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|660||||660|365.95|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|660||||660|276.49|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MULTIPLAN [1680]|HMA [168003]|660||||660|406.61|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MULTIPLAN [1680]|IHC HS [168011]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|660||||660|105.38|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|660||||660|295.37|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|Self-pay|Self-pay|660||||660|198|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|660||||660|138.6|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|660||||660|265.65|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|660||||660|395.76|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|TRUSTMARK [2030]|STARMARK [203000]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|660||||660|316.47|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|UMR [2035]|UMR OPTIONS [203501]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|660||||660|82.4|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|660||||660|594|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|660||||660|164.53|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|660||||660|66.81|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|660||||660|271.07|655.46|66.81
31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR PER SPEC 1ST SINGL AB STAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|660||||660|330|655.46|66.81
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|AETNA [1015]|AETNA ACO WILCO [101532]|4014||||4014|375.7|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4014||||4014|622.89|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4014||||4014|328.18|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4014||||4014|328.18|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4014||||4014|604.93|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4014||||4014|2011.01|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4014||||4014|1408.91|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4014||||4014|1726.02|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4014||||4014|1709.96|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4014||||4014|2007|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4014||||4014|2609.1|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|CORESOURCE [1315]|CORESOURCE [131500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4014||||4014|478.98|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4014||||4014|293.25|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|GEHA [1415]|GEHA [141500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4014||||4014|1374.03|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HEALTHNET [1495]|HEALTHNET [149500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4014||||4014|1726.02|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4014||||4014|3733.02|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4014||||4014|2408.4|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4014||||4014|665.42|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4014||||4014|1334.03|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4014||||4014|299.36|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4014||||4014|824.42|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4014||||4014|622.89|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MULTIPLAN [1680]|HMA [168003]|4014||||4014|916.02|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MULTIPLAN [1680]|IHC HS [168011]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4014||||4014|341.1|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4014||||4014|665.42|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|Self-pay|Self-pay|4014||||4014|1204.2|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4014||||4014|842.94|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4014||||4014|598.46|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4014||||4014|891.59|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|TRUSTMARK [2030]|STARMARK [203000]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4014||||4014|1924.71|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|UMR [2035]|UMR OPTIONS [203501]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4014||||4014|285.1|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4014||||4014|3612.6|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4014||||4014|334.87|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4014||||4014|293.25|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4014||||4014|610.68|3733.02|285.1
31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4014||||4014|2007|3733.02|285.1
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|AETNA [1015]|AETNA ACO WILCO [101532]|132||||132|63.74|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132||||132|0|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132||||132|0|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|132||||132|66.13|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132||||132|46.33|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132||||132|56.76|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|132||||132|56.23|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|132||||132|66|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132||||132|85.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|CORESOURCE [1315]|CORESOURCE [131500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|132||||132|77.13|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|132||||132|47.81|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|GEHA [1415]|GEHA [141500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HEALTHNET [1495]|HEALTHNET [149500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132||||132|56.76|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|132||||132|122.76|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132||||132|79.2|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132||||132|66|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132||||132|0|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MULTIPLAN [1680]|HMA [168003]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MULTIPLAN [1680]|IHC HS [168011]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|132||||132|0|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|Self-pay|Self-pay|132||||132|39.6|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132||||132|27.72|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|TRUSTMARK [2030]|STARMARK [203000]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132||||132|63.29|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|UMR [2035]|UMR OPTIONS [203501]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132||||132|0|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132||||132|118.8|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|132||||132|29.19|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|132||||132|47.81|122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|132||||132||122.76|27.72
31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|132||||132|66|122.76|27.72
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|AETNA [1015]|AETNA ACO WILCO [101532]|538||||538|128.44|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|538||||538|105.77|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|538||||538|105.77|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|538||||538|269.54|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|538||||538|188.84|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|538||||538|231.34|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|538||||538|229.19|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|538||||538|269|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|538||||538|349.7|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|CORESOURCE [1315]|CORESOURCE [131500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|538||||538|235.47|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|538||||538|144.17|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|GEHA [1415]|GEHA [141500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HEALTHNET [1495]|HEALTHNET [149500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|538||||538|231.34|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|538||||538|500.34|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|538||||538|322.8|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|538||||538|121.87|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|538||||538|101.73|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MULTIPLAN [1680]|HMA [168003]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MULTIPLAN [1680]|IHC HS [168011]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|538||||538|109.93|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|Self-pay|Self-pay|538||||538|161.4|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|538||||538|112.98|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|TRUSTMARK [2030]|STARMARK [203000]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|538||||538|257.97|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|UMR [2035]|UMR OPTIONS [203501]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|538||||538|96.88|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|538||||538|484.2|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|538||||538|30.59|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|538||||538|144.17|500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|538||||538||500.34|30.59
31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|538||||538|269|500.34|30.59
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|568||||568|102.14|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|568||||568|83.78|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|568||||568|83.78|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|568||||568|284.57|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|568||||568|199.37|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|568||||568|244.24|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|568||||568|241.97|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|568||||568|284|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|568||||568|369.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|CORESOURCE [1315]|CORESOURCE [131500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|568||||568|104.89|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|568||||568|75.61|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|GEHA [1415]|GEHA [141500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HEALTHNET [1495]|HEALTHNET [149500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|568||||568|244.24|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|568||||568|528.24|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|568||||568|340.8|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|568||||568|568|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|568||||568|79.66|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MULTIPLAN [1680]|HMA [168003]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MULTIPLAN [1680]|IHC HS [168011]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|568||||568|87.08|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|Self-pay|Self-pay|568||||568|170.4|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|568||||568|119.28|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|TRUSTMARK [2030]|STARMARK [203000]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|568||||568|272.36|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|UMR [2035]|UMR OPTIONS [203501]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|568||||568|75.87|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|568||||568|511.2|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|568||||568|164.53|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|568||||568|75.61|568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|568||||568||568|75.61
31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|568||||568|284|568|75.61
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|416||||416|112.06|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|416||||416|141.6|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|416||||416|76.54|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|416||||416|76.54|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|416||||416|137.52|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|416||||416|208.42|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|416||||416|146.02|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|416||||416|178.88|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|416||||416|177.22|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|416||||416|208|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|416||||416|270.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|CORESOURCE [1315]|CORESOURCE [131500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|416||||416|148.2|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|416||||416|90.73|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|GEHA [1415]|GEHA [141500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|416||||416|312.35|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HEALTHNET [1495]|HEALTHNET [149500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|416||||416|178.88|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|416||||416|386.88|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|416||||416|249.6|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|416||||416|151.27|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|416||||416|345.93|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|416||||416|79.33|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|416||||416|187.41|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|416||||416|141.6|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MULTIPLAN [1680]|HMA [168003]|416||||416|208.23|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MULTIPLAN [1680]|IHC HS [168011]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|416||||416|79.55|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|416||||416|151.27|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|Self-pay|Self-pay|416||||416|124.8|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|416||||416|87.36|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|416||||416|136.05|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|416||||416|202.68|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|TRUSTMARK [2030]|STARMARK [203000]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|416||||416|199.47|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|UMR [2035]|UMR OPTIONS [203501]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|416||||416|75.55|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|416||||416|374.4|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|416||||416|86.84|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|416||||416|90.73|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|416||||416|138.82|386.88|75.55
31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|416||||416|208|386.88|75.55
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|AETNA [1015]|AETNA ACO WILCO [101532]|1100||||1100|113.48|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1100||||1100|276.49|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1100||||1100|74.67|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1100||||1100|74.67|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1100||||1100|268.52|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1100||||1100|551.1|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1100||||1100|386.1|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1100||||1100|473|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1100||||1100|468.6|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1100||||1100|550|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1100||||1100|715|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|CORESOURCE [1315]|CORESOURCE [131500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1100||||1100|170.91|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1100||||1100|104.64|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|GEHA [1415]|GEHA [141500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1100||||1100|609.91|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HEALTHNET [1495]|HEALTHNET [149500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1100||||1100|473|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1100||||1100|1023|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1100||||1100|660|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1100||||1100|295.37|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1100||||1100|655.46|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1100||||1100|78.64|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1100||||1100|365.95|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1100||||1100|276.49|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MULTIPLAN [1680]|HMA [168003]|1100||||1100|406.61|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MULTIPLAN [1680]|IHC HS [168011]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1100||||1100|77.61|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1100||||1100|295.37|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|Self-pay|Self-pay|1100||||1100|330|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1100||||1100|231|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1100||||1100|265.65|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1100||||1100|395.76|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|TRUSTMARK [2030]|STARMARK [203000]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1100||||1100|527.45|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|UMR [2035]|UMR OPTIONS [203501]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1100||||1100|74.89|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1100||||1100|990|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1100||||1100|164.53|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1100||||1100|104.64|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1100||||1100|271.07|1023|74.67
31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1100||||1100|550|1023|74.67
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|AETNA [1015]|AETNA ACO WILCO [101532]|107||||107|28.74|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107||||107|22.36|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107||||107|22.36|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107||||107|53.61|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107||||107|37.56|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107||||107|46.01|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107||||107|45.58|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107||||107|53.5|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107||||107|69.55|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|CORESOURCE [1315]|CORESOURCE [131500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107||||107|33.83|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107||||107|20.71|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|GEHA [1415]|GEHA [141500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HEALTHNET [1495]|HEALTHNET [149500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107||||107|46.01|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107||||107|99.51|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107||||107|64.2|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107||||107|41.04|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107||||107|24.35|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MULTIPLAN [1680]|HMA [168003]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MULTIPLAN [1680]|IHC HS [168011]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107||||107|23.24|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|Self-pay|Self-pay|107||||107|32.1|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107||||107|22.47|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|TRUSTMARK [2030]|STARMARK [203000]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107||||107|51.31|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|UMR [2035]|UMR OPTIONS [203501]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107||||107|23.19|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107||||107|96.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107||||107|10.3|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107||||107|20.71|99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107||||107||99.51|10.3
31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107||||107|53.5|99.51|10.3
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|370||||370|129.06|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370||||370|0|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370||||370|0|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|370||||370|185.37|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370||||370|129.87|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370||||370|159.1|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|370||||370|157.62|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|370||||370|185|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370||||370|240.5|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|370||||370|140.61|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|370||||370|87.46|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|GEHA [1415]|GEHA [141500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370||||370|159.1|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|370||||370|344.1|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370||||370|222|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370||||370|185|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370||||370|0|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MULTIPLAN [1680]|HMA [168003]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MULTIPLAN [1680]|IHC HS [168011]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|370||||370|0|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|Self-pay|Self-pay|370||||370|111|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370||||370|77.7|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|TRUSTMARK [2030]|STARMARK [203000]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370||||370|177.42|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|UMR [2035]|UMR OPTIONS [203501]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370||||370|0|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370||||370|333|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|370||||370|59.03|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|370||||370|87.46|344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|370||||370||344.1|59.03
31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|370||||370|185|344.1|59.03
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|469||||469|175.8|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469||||469|141.6|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469||||469|131.37|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469||||469|131.37|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469||||469|137.52|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|469||||469|234.97|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469||||469|164.62|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469||||469|201.67|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|469||||469|199.79|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|469||||469|234.5|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469||||469|304.85|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|469||||469|182.23|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|469||||469|116|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|GEHA [1415]|GEHA [141500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|469||||469|312.35|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469||||469|201.67|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|469||||469|436.17|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469||||469|281.4|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469||||469|151.27|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469||||469|345.93|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469||||469|131.56|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469||||469|187.41|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469||||469|141.6|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MULTIPLAN [1680]|HMA [168003]|469||||469|208.23|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MULTIPLAN [1680]|IHC HS [168011]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|469||||469|136.54|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469||||469|151.27|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|Self-pay|Self-pay|469||||469|140.7|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469||||469|98.49|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|469||||469|134.51|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469||||469|202.68|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|TRUSTMARK [2030]|STARMARK [203000]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469||||469|224.89|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|UMR [2035]|UMR OPTIONS [203501]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469||||469|125.29|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469||||469|422.1|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|469||||469|86.84|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|469||||469|116|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|469||||469|138.82|436.17|86.84
31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH PER SPECIMEN 1ST PROBE STAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|469||||469|234.5|436.17|86.84
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|AETNA [1015]|AETNA ACO WILCO [101532]|1568||||1568|98.37|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1568||||1568|76.23|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1568||||1568|76.23|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1568||||1568|785.57|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1568||||1568|550.37|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1568||||1568|674.24|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1568||||1568|667.97|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1568||||1568|784|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1568||||1568|1019.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|CORESOURCE [1315]|CORESOURCE [131500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1568||||1568|283.73|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1568||||1568|173.71|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|GEHA [1415]|GEHA [141500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HEALTHNET [1495]|HEALTHNET [149500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1568||||1568|674.24|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1568||||1568|1458.24|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1568||||1568|940.8|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1568||||1568|655.46|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1568||||1568|75.56|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MULTIPLAN [1680]|HMA [168003]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MULTIPLAN [1680]|IHC HS [168011]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1568||||1568|79.23|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|Self-pay|Self-pay|1568||||1568|470.4|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1568||||1568|329.28|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|TRUSTMARK [2030]|STARMARK [203000]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1568||||1568|751.86|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|UMR [2035]|UMR OPTIONS [203501]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1568||||1568|71.96|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1568||||1568|1411.2|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1568||||1568|164.53|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1568||||1568|173.71|1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1568||||1568||1458.24|71.96
31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1568||||1568|784|1458.24|71.96
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|AETNA [1015]|AETNA ACO WILCO [101532]|931||||931|112.54|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|931||||931|88.91|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|931||||931|88.91|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|931||||931|466.43|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|931||||931|326.78|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|931||||931|400.33|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|931||||931|396.61|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|931||||931|465.5|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|931||||931|605.15|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|CORESOURCE [1315]|CORESOURCE [131500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|931||||931|250.28|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|931||||931|153.23|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|GEHA [1415]|GEHA [141500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HEALTHNET [1495]|HEALTHNET [149500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|931||||931|400.33|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|931||||931|865.83|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|931||||931|558.6|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|931||||931|655.46|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|931||||931|86.3|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MULTIPLAN [1680]|HMA [168003]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MULTIPLAN [1680]|IHC HS [168011]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|931||||931|92.41|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|Self-pay|Self-pay|931||||931|279.3|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|931||||931|195.51|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|TRUSTMARK [2030]|STARMARK [203000]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|931||||931|446.41|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|UMR [2035]|UMR OPTIONS [203501]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|931||||931|82.19|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|931||||931|837.9|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|931||||931|164.53|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|931||||931|153.23|865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|931||||931||865.83|82.19
31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|931||||931|465.5|865.83|82.19
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|AETNA [1015]|AETNA ACO WILCO [101532]|1458||||1458|373.14|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1458||||1458|141.6|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1458||||1458|286.39|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1458||||1458|286.39|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1458||||1458|137.52|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1458||||1458|730.46|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1458||||1458|511.76|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1458||||1458|626.94|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1458||||1458|621.11|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1458||||1458|729|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1458||||1458|947.7|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|CORESOURCE [1315]|CORESOURCE [131500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1458||||1458|361.36|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1458||||1458|227.64|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|GEHA [1415]|GEHA [141500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1458||||1458|312.35|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HEALTHNET [1495]|HEALTHNET [149500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1458||||1458|626.94|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1458||||1458|1355.94|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1458||||1458|874.8|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1458||||1458|151.27|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1458||||1458|345.93|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1458||||1458|287.14|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1458||||1458|187.41|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1458||||1458|141.6|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MULTIPLAN [1680]|HMA [168003]|1458||||1458|208.23|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MULTIPLAN [1680]|IHC HS [168011]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1458||||1458|297.67|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1458||||1458|151.27|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|Self-pay|Self-pay|1458||||1458|437.4|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1458||||1458|306.18|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1458||||1458|136.05|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1458||||1458|202.68|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|TRUSTMARK [2030]|STARMARK [203000]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1458||||1458|699.11|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|UMR [2035]|UMR OPTIONS [203501]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1458||||1458|273.46|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1458||||1458|1312.2|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1458||||1458|86.84|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1458||||1458|227.64|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1458||||1458|138.82|1355.94|86.84
31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1458||||1458|729|1355.94|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1236||||1236|428.55|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1236||||1236|141.6|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1236||||1236|334.62|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1236||||1236|334.62|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1236||||1236|137.52|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1236||||1236|619.24|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1236||||1236|433.84|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1236||||1236|531.48|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1236||||1236|526.54|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1236||||1236|618|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1236||||1236|803.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|CORESOURCE [1315]|CORESOURCE [131500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1236||||1236|431.19|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1236||||1236|270.55|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|GEHA [1415]|GEHA [141500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1236||||1236|312.35|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HEALTHNET [1495]|HEALTHNET [149500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1236||||1236|531.48|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1236||||1236|1149.48|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1236||||1236|741.6|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1236||||1236|151.27|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1236||||1236|345.93|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1236||||1236|327.37|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1236||||1236|187.41|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1236||||1236|141.6|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MULTIPLAN [1680]|HMA [168003]|1236||||1236|208.23|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MULTIPLAN [1680]|IHC HS [168011]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1236||||1236|347.8|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1236||||1236|151.27|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|Self-pay|Self-pay|1236||||1236|370.8|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1236||||1236|259.56|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1236||||1236|136.05|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1236||||1236|202.68|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|TRUSTMARK [2030]|STARMARK [203000]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1236||||1236|592.66|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|UMR [2035]|UMR OPTIONS [203501]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1236||||1236|311.77|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1236||||1236|1112.4|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1236||||1236|86.84|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1236||||1236|270.55|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1236||||1236|138.82|1149.48|86.84
31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1236||||1236|618|1149.48|86.84
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1342||||1342|170.77|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1342||||1342|0|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1342||||1342|0|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1342||||1342|672.34|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1342||||1342|471.04|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1342||||1342|577.06|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1342||||1342|571.69|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1342||||1342|671|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1342||||1342|872.3|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1342||||1342|181.45|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1342||||1342|111.09|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|GEHA [1415]|GEHA [141500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1342||||1342|577.06|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1342||||1342|1248.06|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1342||||1342|805.2|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1342||||1342|671|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1342||||1342|0|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MULTIPLAN [1680]|HMA [168003]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MULTIPLAN [1680]|IHC HS [168011]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1342||||1342|0|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|Self-pay|Self-pay|1342||||1342|402.6|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1342||||1342|281.82|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|TRUSTMARK [2030]|STARMARK [203000]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1342||||1342|643.49|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|UMR [2035]|UMR OPTIONS [203501]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1342||||1342|0|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1342||||1342|1207.8|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1342||||1342|78.06|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1342||||1342|111.09|1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1342||||1342||1248.06|78.06
31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1342||||1342|671|1248.06|78.06
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|869||||869|255.18|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|869||||869|276.49|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|869||||869|388.05|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|869||||869|388.05|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|869||||869|268.52|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|869||||869|435.37|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|869||||869|305.02|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|869||||869|373.67|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|869||||869|370.19|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|869||||869|434.5|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|869||||869|564.85|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|CORESOURCE [1315]|CORESOURCE [131500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|869||||869|0|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|869||||869|0|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|GEHA [1415]|GEHA [141500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|869||||869|609.91|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HEALTHNET [1495]|HEALTHNET [149500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|869||||869|373.67|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|869||||869|808.17|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|869||||869|521.4|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|869||||869|295.37|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|869||||869|655.46|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|869||||869|374.79|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|869||||869|365.95|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|869||||869|276.49|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MULTIPLAN [1680]|HMA [168003]|869||||869|406.61|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MULTIPLAN [1680]|IHC HS [168011]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|869||||869|403.33|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|869||||869|295.37|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|Self-pay|Self-pay|869||||869|260.7|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|869||||869|182.49|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|869||||869|265.65|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|869||||869|395.76|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|TRUSTMARK [2030]|STARMARK [203000]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|869||||869|416.69|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|UMR [2035]|UMR OPTIONS [203501]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|869||||869|356.93|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|869||||869|782.1|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|869||||869|164.53|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|869||||869|0|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|869||||869|271.07|808.17|164.53
31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PATH GROSS & MICRO PROSTATE NDL BX ANY METHOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|869||||869|434.5|808.17|164.53
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|121.75||||121.75|61|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|121.75||||121.75|42.73|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|121.75||||121.75|52.35|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|121.75||||121.75|51.87|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|121.75||||121.75|60.88|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|121.75||||121.75|79.14|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|CORESOURCE [1315]|CORESOURCE [131500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|121.75||||121.75|45.05|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|GEHA [1415]|GEHA [141500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HEALTHNET [1495]|HEALTHNET [149500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|121.75||||121.75|52.35|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|121.75||||121.75|113.23|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|121.75||||121.75|73.05|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MULTIPLAN [1680]|HMA [168003]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MULTIPLAN [1680]|IHC HS [168011]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|Self-pay|Self-pay|121.75||||121.75|36.52|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|121.75||||121.75|25.57|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|TRUSTMARK [2030]|STARMARK [203000]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|121.75||||121.75|58.38|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|UMR [2035]|UMR OPTIONS [203501]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|121.75||||121.75|109.58|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|121.75||||121.75|0|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|121.75||||121.75|45.05|113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|121.75||||121.75||113.23|25.57
3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|121.75||||121.75|60.88|113.23|25.57
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|AETNA [1015]|AETNA ACO WILCO [101532]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|137.14||||137.14|68.71|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137.14||||137.14|48.14|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137.14||||137.14|58.97|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|137.14||||137.14|58.42|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|137.14||||137.14|68.57|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137.14||||137.14|89.14|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|CORESOURCE [1315]|CORESOURCE [131500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|CORVEL CORP [2235]|CORVEL CORP [223500]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|137.14||||137.14|50.74|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|GEHA [1415]|GEHA [141500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HEALTHNET [1495]|HEALTHNET [149500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137.14||||137.14|58.97|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HEALTHSMART [1505]|HEALTHSMART [150501]|137.14||||137.14|127.54|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.14||||137.14|82.28|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MULTIPLAN [1680]|HMA [168003]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MULTIPLAN [1680]|IHC HS [168011]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|Self-pay|Self-pay|137.14||||137.14|41.14|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137.14||||137.14|28.8|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|TRUSTMARK [2030]|STARMARK [203000]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137.14||||137.14|65.76|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|UMR [2035]|UMR OPTIONS [203501]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137.14||||137.14|123.43|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|137.14||||137.14|0|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|137.14||||137.14|50.74|127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|137.14||||137.14||127.54|28.8
3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|15 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|137.14||||137.14|68.57|127.54|28.8
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123.72||||123.72|61.98|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.72||||123.72|43.43|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.72||||123.72|53.2|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123.72||||123.72|52.7|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123.72||||123.72|61.86|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.72||||123.72|80.42|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|123.72||||123.72|11.27|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123.72||||123.72|45.78|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|GEHA [1415]|GEHA [141500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.72||||123.72|53.2|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|123.72||||123.72|115.06|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.72||||123.72|74.23|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MULTIPLAN [1680]|HMA [168003]|123.72||||123.72|43.3|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MULTIPLAN [1680]|IHC HS [168011]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|Self-pay|Self-pay|123.72||||123.72|37.12|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.72||||123.72|25.98|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.72||||123.72|10.97|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|TRUSTMARK [2030]|STARMARK [203000]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.72||||123.72|59.32|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UMR [2035]|UMR OPTIONS [203501]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.72||||123.72|111.35|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123.72||||123.72|0|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123.72||||123.72|45.78|115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123.72||||123.72||115.06|10.97
31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123.72||||123.72|61.86|115.06|10.97
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA ACO WILCO [101532]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|451.54||||451.54|226.22|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|451.54||||451.54|158.49|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|451.54||||451.54|194.16|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|451.54||||451.54|192.36|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|451.54||||451.54|225.77|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|451.54||||451.54|293.5|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|CORESOURCE [1315]|CORESOURCE [131500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|CORVEL CORP [2235]|CORVEL CORP [223500]|451.54||||451.54|105.08|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|451.54||||451.54|167.07|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|GEHA [1415]|GEHA [141500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHNET [1495]|HEALTHNET [149500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|451.54||||451.54|194.16|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART [150501]|451.54||||451.54|419.93|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|451.54||||451.54|270.92|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|HMA [168003]|451.54||||451.54|158.04|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|IHC HS [168011]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|Self-pay|Self-pay|451.54||||451.54|135.46|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|451.54||||451.54|94.82|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|451.54||||451.54|69.54|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|TRUSTMARK [2030]|STARMARK [203000]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|451.54||||451.54|216.51|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|UMR [2035]|UMR OPTIONS [203501]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|451.54||||451.54|406.39|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|451.54||||451.54|0|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|451.54||||451.54|167.07|419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|451.54||||451.54||419.93|69.54
31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|1 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|451.54||||451.54|225.77|419.93|69.54
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|469||||469|36.28|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469||||469|76.8|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469||||469|78.28|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469||||469|78.28|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469||||469|74.59|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|469||||469|234.97|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469||||469|164.62|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469||||469|201.67|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|469||||469|199.79|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|469||||469|234.5|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469||||469|304.85|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|CORESOURCE [1315]|CORESOURCE [131500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|469||||469|32.89|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|469||||469|20.71|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|GEHA [1415]|GEHA [141500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|469||||469|169.41|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HEALTHNET [1495]|HEALTHNET [149500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469||||469|201.67|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|469||||469|436.17|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469||||469|281.4|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469||||469|82.04|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469||||469|148.92|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469||||469|75.61|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469||||469|101.65|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469||||469|76.8|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MULTIPLAN [1680]|HMA [168003]|469||||469|112.94|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MULTIPLAN [1680]|IHC HS [168011]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|469||||469|81.36|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469||||469|82.04|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|Self-pay|Self-pay|469||||469|140.7|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469||||469|98.49|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|469||||469|73.79|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469||||469|109.93|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|TRUSTMARK [2030]|STARMARK [203000]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469||||469|224.89|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|UMR [2035]|UMR OPTIONS [203501]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469||||469|72.01|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469||||469|422.1|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|469||||469|0|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|469||||469|20.71|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|469||||469|75.29|436.17|20.71
32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|469||||469|234.5|436.17|20.71
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|694||||694|43.62|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|694||||694|75.93|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|694||||694|78.28|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|694||||694|78.28|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|694||||694|74.59|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|694||||694|347.69|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|694||||694|243.59|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|694||||694|298.42|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|694||||694|295.64|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|694||||694|347|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|694||||694|451.1|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|694||||694|37.84|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|694||||694|24.2|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|GEHA [1415]|GEHA [141500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|694||||694|167.5|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|694||||694|298.42|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|694||||694|645.42|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|694||||694|416.4|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|694||||694|82.04|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|694||||694|148.92|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|694||||694|75.61|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|694||||694|100.5|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|694||||694|75.93|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|694||||694|111.67|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|694||||694|81.36|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|694||||694|82.04|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|Self-pay|Self-pay|694||||694|208.2|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|694||||694|145.74|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|694||||694|72.96|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|694||||694|108.69|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|694||||694|332.77|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|694||||694|72.01|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|694||||694|624.6|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|694||||694|0|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|694||||694|24.2|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|694||||694|74.45|645.42|24.2
32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|694||||694|347|645.42|24.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|736||||736|47.28|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|736||||736|102.28|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|736||||736|125.3|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|736||||736|125.3|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|736||||736|100.46|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|736||||736|368.74|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|736||||736|258.34|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|736||||736|316.48|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|736||||736|313.54|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|736||||736|368|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|736||||736|478.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|736||||736|43.7|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|736||||736|28.2|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|736||||736|225.62|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|736||||736|316.48|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|736||||736|684.48|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|736||||736|441.6|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|736||||736|110.51|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|736||||736|268.93|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|736||||736|121.01|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|736||||736|135.37|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|736||||736|102.28|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|736||||736|150.41|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|736||||736|130.23|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|736||||736|110.51|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|Self-pay|Self-pay|736||||736|220.8|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|736||||736|154.56|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|736||||736|98.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|736||||736|148.07|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|736||||736|352.91|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|736||||736|115.25|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|736||||736|662.4|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|736||||736|0|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|736||||736|28.2|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|736||||736|100.27|684.48|28.2
32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|736||||736|368|684.48|28.2
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|516||||516|35.06|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|516||||516|76.8|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|516||||516|78.28|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|516||||516|78.28|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|516||||516|74.59|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|516||||516|258.52|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|516||||516|181.12|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|516||||516|221.88|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|516||||516|219.82|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|516||||516|258|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|516||||516|335.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|516||||516|34.84|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|516||||516|21.46|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|GEHA [1415]|GEHA [141500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|516||||516|169.41|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|516||||516|221.88|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|516||||516|479.88|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|516||||516|309.6|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|516||||516|82.04|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|516||||516|148.92|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|516||||516|75.61|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|516||||516|101.65|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|516||||516|76.8|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|516||||516|112.94|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|516||||516|81.36|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|516||||516|82.04|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|Self-pay|Self-pay|516||||516|154.8|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|516||||516|108.36|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|516||||516|73.79|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|516||||516|108.69|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|516||||516|247.42|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|516||||516|72.01|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|516||||516|464.4|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|516||||516|0|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|516||||516|21.46|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|516||||516|75.29|479.88|21.46
32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|516||||516|258|479.88|21.46
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|695||||695|52.17|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|695||||695|102.28|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|695||||695|125.3|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|695||||695|125.3|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|695||||695|100.46|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|695||||695|348.2|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|695||||695|243.95|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|695||||695|298.85|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|695||||695|296.07|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|695||||695|347.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|695||||695|451.75|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|695||||695|47.6|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|695||||695|30.69|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|695||||695|225.62|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|695||||695|298.85|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|695||||695|646.35|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|695||||695|417|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|695||||695|110.51|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|695||||695|268.93|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|695||||695|121.01|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|695||||695|135.37|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|695||||695|102.28|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|695||||695|150.41|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|695||||695|130.23|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|695||||695|110.51|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|Self-pay|Self-pay|695||||695|208.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|695||||695|145.95|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|695||||695|98.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|695||||695|146.4|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|695||||695|333.25|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|695||||695|115.25|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|695||||695|625.5|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|695||||695|0|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|695||||695|30.69|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|695||||695|100.27|646.35|30.69
32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|695||||695|347.5|646.35|30.69
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|513||||513|44.23|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|513||||513|75.93|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|513||||513|78.28|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|513||||513|78.28|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|513||||513|74.59|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|513||||513|257.01|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|513||||513|180.06|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|513||||513|220.59|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|513||||513|218.54|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|513||||513|256.5|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|513||||513|333.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|513||||513|37.48|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|513||||513|24.2|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|513||||513|167.5|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|513||||513|220.59|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|513||||513|477.09|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|513||||513|307.8|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|513||||513|82.04|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|513||||513|148.92|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|513||||513|75.61|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|513||||513|100.5|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|513||||513|75.93|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|513||||513|111.67|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|513||||513|81.36|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|513||||513|82.04|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|513||||513|153.9|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|513||||513|107.73|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|513||||513|72.96|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|513||||513|108.69|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|513||||513|245.98|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|513||||513|72.01|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|513||||513|461.7|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|513||||513|0|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|513||||513|24.2|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|513||||513|74.45|477.09|24.2
32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|513||||513|256.5|477.09|24.2
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|761||||761|51.56|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|761||||761|102.28|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|761||||761|125.3|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|761||||761|125.3|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|761||||761|100.46|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|761||||761|381.26|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|761||||761|267.11|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|761||||761|327.23|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|761||||761|324.19|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|761||||761|380.5|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|761||||761|494.65|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|761||||761|48.42|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|761||||761|30.95|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|761||||761|225.62|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|761||||761|327.23|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|761||||761|707.73|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|761||||761|456.6|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|761||||761|110.51|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|761||||761|268.93|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|761||||761|121.01|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|761||||761|135.37|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|761||||761|102.28|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|761||||761|150.41|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|761||||761|130.23|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|761||||761|110.51|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|Self-pay|Self-pay|761||||761|228.3|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|761||||761|159.81|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|761||||761|98.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|761||||761|146.4|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|761||||761|364.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|761||||761|115.25|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|761||||761|684.9|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|761||||761|0|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|761||||761|30.95|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|761||||761|100.27|707.73|30.95
32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|761||||761|380.5|707.73|30.95
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|451||||451|39.34|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|451||||451|76.8|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|451||||451|78.28|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|451||||451|78.28|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|451||||451|74.59|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|451||||451|225.95|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|451||||451|158.3|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|451||||451|193.93|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|451||||451|192.13|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|451||||451|225.5|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|451||||451|293.15|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|451||||451|34.17|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|451||||451|22.2|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|GEHA [1415]|GEHA [141500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|451||||451|169.41|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|451||||451|193.93|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|451||||451|419.43|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|451||||451|270.6|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|451||||451|82.04|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|451||||451|148.92|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|451||||451|75.61|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|451||||451|101.65|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|451||||451|76.8|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|451||||451|112.94|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|451||||451|81.36|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|451||||451|82.04|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|Self-pay|Self-pay|451||||451|135.3|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|451||||451|94.71|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|451||||451|73.79|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|451||||451|109.93|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|451||||451|216.25|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|451||||451|72.01|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|451||||451|405.9|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|451||||451|0|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|451||||451|22.2|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|451||||451|75.29|419.43|22.2
32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|451||||451|225.5|419.43|22.2
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|750||||750|45.44|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|750||||750|76.8|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|750||||750|125.3|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|750||||750|125.3|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|750||||750|74.59|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|750||||750|375.75|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|750||||750|263.25|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|750||||750|322.5|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|750||||750|319.5|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|750||||750|375|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|750||||750|487.5|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|750||||750|44.96|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|750||||750|27.53|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|750||||750|169.41|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|750||||750|322.5|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|750||||750|697.5|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|750||||750|450|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|750||||750|82.04|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|750||||750|148.92|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|750||||750|121.01|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|750||||750|101.65|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|750||||750|76.8|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|750||||750|112.94|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|750||||750|130.23|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|750||||750|82.04|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|750||||750|225|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|750||||750|157.5|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|750||||750|73.79|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|750||||750|109.93|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|750||||750|359.63|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|750||||750|115.25|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|750||||750|675|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|750||||750|0|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|750||||750|27.53|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|750||||750|75.29|697.5|27.53
32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|750||||750|375|697.5|27.53
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|667||||667|43.62|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|667||||667|102.28|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|667||||667|125.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|667||||667|125.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|667||||667|100.46|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|667||||667|334.17|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|667||||667|234.12|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|667||||667|286.81|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|667||||667|284.14|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|667||||667|333.5|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|667||||667|433.55|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|667||||667|41.51|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|667||||667|26.7|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|GEHA [1415]|GEHA [141500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|667||||667|225.62|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|667||||667|286.81|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|667||||667|620.31|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|667||||667|400.2|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|667||||667|110.51|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|667||||667|268.93|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|667||||667|121.01|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|667||||667|135.37|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|667||||667|102.28|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|667||||667|150.41|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|667||||667|130.23|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|667||||667|110.51|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|Self-pay|Self-pay|667||||667|200.1|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|667||||667|140.07|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|667||||667|98.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|667||||667|146.4|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|667||||667|319.83|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|667||||667|115.25|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|667||||667|600.3|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|667||||667|0|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|667||||667|26.7|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|667||||667|100.27|620.31|26.7
32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|667||||667|333.5|620.31|26.7
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|839||||839|51.56|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|839||||839|103.45|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|839||||839|125.3|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|839||||839|125.3|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|839||||839|100.46|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|839||||839|420.34|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|839||||839|294.49|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|839||||839|360.77|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|839||||839|357.41|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|839||||839|419.5|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|839||||839|545.35|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|839||||839|53.98|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|839||||839|33.59|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|839||||839|228.19|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|839||||839|360.77|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|839||||839|780.27|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|839||||839|503.4|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|839||||839|110.51|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|839||||839|268.93|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|839||||839|121.01|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|839||||839|136.91|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|839||||839|103.45|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|839||||839|152.13|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|839||||839|130.23|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|839||||839|110.51|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|Self-pay|Self-pay|839||||839|251.7|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|839||||839|176.19|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|839||||839|99.39|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|839||||839|148.07|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|839||||839|402.3|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|839||||839|115.25|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|839||||839|755.1|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|839||||839|0|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|839||||839|33.59|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|839||||839|101.42|780.27|33.59
32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|839||||839|419.5|780.27|33.59
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|543||||543|38.73|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|543||||543|76.8|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|543||||543|78.28|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|543||||543|78.28|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|543||||543|74.59|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|543||||543|272.04|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|543||||543|190.59|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|543||||543|233.49|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|543||||543|231.32|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|543||||543|271.5|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|543||||543|352.95|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|543||||543|34.99|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|543||||543|22.2|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|GEHA [1415]|GEHA [141500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|543||||543|169.41|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|543||||543|233.49|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|543||||543|504.99|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|543||||543|325.8|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|543||||543|82.04|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|543||||543|148.92|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|543||||543|75.61|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|543||||543|101.65|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|543||||543|76.8|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MULTIPLAN [1680]|HMA [168003]|543||||543|112.94|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MULTIPLAN [1680]|IHC HS [168011]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|543||||543|81.36|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|543||||543|82.04|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|Self-pay|Self-pay|543||||543|162.9|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|543||||543|114.03|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|543||||543|73.79|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|543||||543|109.93|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|TRUSTMARK [2030]|STARMARK [203000]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|543||||543|260.37|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|UMR [2035]|UMR OPTIONS [203501]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|543||||543|72.01|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|543||||543|488.7|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|543||||543|0|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|543||||543|22.2|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|543||||543|75.29|504.99|22.2
32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|543||||543|271.5|504.99|22.2
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|871||||871|63.79|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|871||||871|76.8|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|871||||871|78.28|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|871||||871|78.28|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|871||||871|74.59|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|871||||871|436.37|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|871||||871|305.72|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|871||||871|374.53|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|871||||871|371.05|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|871||||871|435.5|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|871||||871|566.15|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|871||||871|55.33|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|871||||871|34.68|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|GEHA [1415]|GEHA [141500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|871||||871|169.41|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|871||||871|374.53|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|871||||871|810.03|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|871||||871|522.6|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|871||||871|82.04|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|871||||871|148.92|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|871||||871|75.61|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|871||||871|101.65|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|871||||871|76.8|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MULTIPLAN [1680]|HMA [168003]|871||||871|112.94|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|871||||871|81.36|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|871||||871|82.04|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|Self-pay|Self-pay|871||||871|261.3|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|871||||871|182.91|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|871||||871|73.79|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|871||||871|109.93|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|871||||871|417.64|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|UMR [2035]|UMR OPTIONS [203501]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|871||||871|72.01|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|871||||871|783.9|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|871||||871|0|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|871||||871|34.68|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|871||||871|75.29|810.03|34.68
32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|871||||871|435.5|810.03|34.68
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|AETNA [1015]|AETNA ACO WILCO [101532]|565||||565|37.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|565||||565|75.93|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|565||||565|78.28|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|565||||565|78.28|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|565||||565|74.59|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|565||||565|283.07|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|565||||565|198.32|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|565||||565|242.95|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|565||||565|240.69|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|565||||565|282.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|565||||565|367.25|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|CORESOURCE [1315]|CORESOURCE [131500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|565||||565|32.24|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|565||||565|21.2|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|GEHA [1415]|GEHA [141500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|565||||565|167.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HEALTHNET [1495]|HEALTHNET [149500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|565||||565|242.95|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|565||||565|525.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|565||||565|339|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|565||||565|75.29|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|565||||565|82.04|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|565||||565|148.92|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|565||||565|75.61|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|565||||565|100.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|565||||565|75.93|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MULTIPLAN [1680]|HMA [168003]|565||||565|111.67|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MULTIPLAN [1680]|IHC HS [168011]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|565||||565|81.36|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|565||||565|82.04|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|Self-pay|Self-pay|565||||565|169.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|565||||565|118.65|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|565||||565|72.96|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|565||||565|109.93|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|TRUSTMARK [2030]|STARMARK [203000]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|565||||565|270.92|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|UMR [2035]|UMR OPTIONS [203501]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|565||||565|72.01|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|565||||565|508.5|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|565||||565|0|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|565||||565|21.2|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|565||||565|74.45|525.45|21.2
32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|565||||565|282.5|525.45|21.2
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|AETNA [1015]|AETNA ACO WILCO [101532]|330||||330|27.12|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|330||||330|76.8|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|330||||330|81.94|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|330||||330|81.94|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|330||||330|74.59|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|330||||330|165.33|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|330||||330|115.83|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|330||||330|141.9|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|330||||330|140.58|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|330||||330|165|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|330||||330|214.5|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|CORESOURCE [1315]|CORESOURCE [131500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|330||||330|0|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|330||||330|16.92|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|GEHA [1415]|GEHA [141500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|330||||330|169.41|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HEALTHNET [1495]|HEALTHNET [149500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|330||||330|141.9|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|330||||330|306.9|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|330||||330|198|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|330||||330|82.04|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|330||||330|148.92|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|330||||330|79.14|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|330||||330|100.5|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|330||||330|75.93|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MULTIPLAN [1680]|HMA [168003]|330||||330|112.94|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MULTIPLAN [1680]|IHC HS [168011]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|330||||330|85.17|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|330||||330|82.04|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|Self-pay|Self-pay|330||||330|99|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|330||||330|69.3|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|330||||330|73.79|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|330||||330|109.93|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|TRUSTMARK [2030]|STARMARK [203000]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|330||||330|158.24|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|UMR [2035]|UMR OPTIONS [203501]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|330||||330|0|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|330||||330|297|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|330||||330|0|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|330||||330|16.92|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|330||||330|75.29|306.9|16.92
32071045|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST SINGLE VIEW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|330||||330|165|306.9|16.92
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|440||||440|35.67|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|440||||440|76.8|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|440||||440|81.94|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|440||||440|81.94|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|440||||440|74.59|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|440||||440|220.44|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|440||||440|154.44|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|440||||440|189.2|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|440||||440|187.44|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|440||||440|220|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|440||||440|286|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|440||||440|0|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|440||||440|23.55|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|GEHA [1415]|GEHA [141500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|440||||440|169.41|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|440||||440|189.2|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|440||||440|409.2|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|440||||440|264|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|440||||440|82.04|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|440||||440|148.92|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|440||||440|79.14|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|440||||440|101.65|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|440||||440|75.93|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|440||||440|112.94|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|440||||440|85.17|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|440||||440|82.04|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|Self-pay|Self-pay|440||||440|132|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|440||||440|92.4|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|440||||440|73.79|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|440||||440|109.93|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|440||||440|210.98|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|440||||440|0|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|440||||440|396|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|440||||440|0|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|440||||440|74.45|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|440||||440|23.55|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|440||||440|75.29|409.2|23.55
32071046|EAP|0324 - RADIOLOGY-DIAGNOSTIC-CHEST X-RAY|HC CHEST 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|440||||440|220|409.2|23.55
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|696||||696|39.95|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|696||||696|76.8|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|696||||696|78.28|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|696||||696|78.28|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|696||||696|74.59|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|696||||696|348.7|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|696||||696|244.3|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|696||||696|299.28|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|696||||696|296.5|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|696||||696|348|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|696||||696|452.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|696||||696|38.13|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|696||||696|24.2|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|GEHA [1415]|GEHA [141500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|696||||696|169.41|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|696||||696|299.28|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|696||||696|647.28|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|696||||696|417.6|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|696||||696|74.45|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|696||||696|82.04|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|696||||696|148.92|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|696||||696|75.61|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|696||||696|100.5|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|696||||696|75.93|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|696||||696|112.94|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|696||||696|81.36|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|696||||696|82.04|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|Self-pay|Self-pay|696||||696|208.8|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|696||||696|146.16|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|696||||696|73.79|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|696||||696|109.93|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|696||||696|333.73|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|696||||696|72.01|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|696||||696|626.4|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|696||||696|0|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|696||||696|24.2|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|696||||696|75.29|647.28|24.2
32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|696||||696|348|647.28|24.2
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|AETNA [1015]|AETNA ACO WILCO [101532]|766||||766|44.23|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|766||||766|103.45|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|766||||766|125.3|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|766||||766|125.3|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|766||||766|100.46|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|766||||766|383.77|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|766||||766|268.87|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|766||||766|329.38|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|766||||766|326.32|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|766||||766|383|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|766||||766|497.9|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|CORESOURCE [1315]|CORESOURCE [131500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|766||||766|44.65|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|766||||766|27.69|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|GEHA [1415]|GEHA [141500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|766||||766|228.19|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HEALTHNET [1495]|HEALTHNET [149500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|766||||766|329.38|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|766||||766|712.38|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|766||||766|459.6|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|766||||766|110.51|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|766||||766|268.93|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|766||||766|121.01|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|766||||766|136.91|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|766||||766|103.45|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MULTIPLAN [1680]|HMA [168003]|766||||766|152.13|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MULTIPLAN [1680]|IHC HS [168011]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|766||||766|130.23|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|766||||766|110.51|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|Self-pay|Self-pay|766||||766|229.8|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|766||||766|160.86|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|766||||766|99.39|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|766||||766|148.07|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|TRUSTMARK [2030]|STARMARK [203000]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|766||||766|367.3|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|UMR [2035]|UMR OPTIONS [203501]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|766||||766|115.25|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|766||||766|689.4|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|766||||766|0|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|766||||766|27.69|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|766||||766|101.42|712.38|27.69
32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|766||||766|383|712.38|27.69
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|721||||721|45.44|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|721||||721|103.45|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|721||||721|125.3|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|721||||721|125.3|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|721||||721|100.46|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|721||||721|361.22|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|721||||721|253.07|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|721||||721|310.03|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|721||||721|307.15|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|721||||721|360.5|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|721||||721|468.65|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|721||||721|47.19|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|721||||721|29.04|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|GEHA [1415]|GEHA [141500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|721||||721|228.19|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|721||||721|310.03|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|721||||721|670.53|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|721||||721|432.6|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|721||||721|110.51|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|721||||721|268.93|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|721||||721|121.01|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|721||||721|136.91|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|721||||721|103.45|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|721||||721|152.13|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|721||||721|130.23|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|721||||721|110.51|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|Self-pay|Self-pay|721||||721|216.3|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|721||||721|151.41|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|721||||721|99.39|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|721||||721|148.07|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|721||||721|345.72|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|721||||721|115.25|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|721||||721|648.9|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|721||||721|0|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|721||||721|29.04|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|721||||721|101.42|670.53|29.04
32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|721||||721|360.5|670.53|29.04
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1168||||1168|55.84|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1168||||1168|103.45|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1168||||1168|125.3|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1168||||1168|125.3|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1168||||1168|100.46|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1168||||1168|585.17|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1168||||1168|409.97|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1168||||1168|502.24|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1168||||1168|497.57|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1168||||1168|584|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1168||||1168|759.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1168||||1168|58.08|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1168||||1168|35.56|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1168||||1168|228.19|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1168||||1168|502.24|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1168||||1168|1086.24|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1168||||1168|700.8|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1168||||1168|110.51|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1168||||1168|268.93|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1168||||1168|121.01|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1168||||1168|136.91|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1168||||1168|103.45|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|1168||||1168|152.13|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1168||||1168|130.23|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1168||||1168|110.51|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|Self-pay|Self-pay|1168||||1168|350.4|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1168||||1168|245.28|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1168||||1168|99.39|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1168||||1168|148.07|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1168||||1168|560.06|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1168||||1168|115.25|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1168||||1168|1051.2|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1168||||1168|0|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1168||||1168|35.56|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1168||||1168|101.42|1086.24|35.56
32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1168||||1168|584|1086.24|35.56
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|609||||609|36.28|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|609||||609|76.8|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|609||||609|78.28|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|609||||609|78.28|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|609||||609|74.59|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|609||||609|305.11|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|609||||609|213.76|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|609||||609|261.87|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|609||||609|259.43|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|609||||609|304.5|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|609||||609|395.85|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|609||||609|37.53|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|609||||609|22.98|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|609||||609|169.41|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|609||||609|261.87|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|609||||609|566.37|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|609||||609|365.4|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|609||||609|82.04|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|609||||609|148.92|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|609||||609|75.61|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|609||||609|101.65|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|609||||609|76.8|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|609||||609|112.94|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|609||||609|81.36|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|609||||609|82.04|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|Self-pay|Self-pay|609||||609|182.7|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|609||||609|127.89|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|609||||609|73.79|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|609||||609|109.93|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|609||||609|292.02|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|609||||609|72.01|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|609||||609|548.1|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|609||||609|0|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|609||||609|22.98|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|609||||609|75.29|566.37|22.98
32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|609||||609|304.5|566.37|22.98
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|532||||532|45.44|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|532||||532|76.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|532||||532|78.28|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|532||||532|78.28|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|532||||532|74.59|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|532||||532|266.53|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|532||||532|186.73|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|532||||532|228.76|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|532||||532|226.63|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|532||||532|266|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|532||||532|345.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|532||||532|41.88|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|532||||532|26.2|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|532||||532|169.41|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|532||||532|228.76|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|532||||532|494.76|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|532||||532|319.2|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|532||||532|82.04|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|532||||532|148.92|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|532||||532|75.61|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|532||||532|101.65|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|532||||532|76.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|532||||532|112.94|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|532||||532|81.36|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|532||||532|82.04|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|Self-pay|Self-pay|532||||532|159.6|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|532||||532|111.72|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|532||||532|73.79|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|532||||532|109.93|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|532||||532|255.09|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|532||||532|72.01|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|532||||532|478.8|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|532||||532|0|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|532||||532|26.2|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|532||||532|75.29|494.76|26.2
32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|532||||532|266|494.76|26.2
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|493||||493|26.51|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|493||||493|76.8|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|493||||493|78.28|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|493||||493|78.28|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|493||||493|74.59|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|493||||493|246.99|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|493||||493|173.04|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|493||||493|211.99|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|493||||493|210.02|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|493||||493|246.5|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|493||||493|320.45|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|CORESOURCE [1315]|CORESOURCE [131500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|493||||493|26.82|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|493||||493|16.42|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|GEHA [1415]|GEHA [141500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|493||||493|169.41|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HEALTHNET [1495]|HEALTHNET [149500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|493||||493|211.99|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|493||||493|458.49|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|493||||493|295.8|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|493||||493|82.04|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|493||||493|148.92|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|493||||493|75.61|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|493||||493|101.65|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|493||||493|76.8|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MULTIPLAN [1680]|HMA [168003]|493||||493|112.94|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MULTIPLAN [1680]|IHC HS [168011]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|493||||493|81.36|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|493||||493|82.04|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|Self-pay|Self-pay|493||||493|147.9|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|493||||493|103.53|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|493||||493|73.79|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|493||||493|109.93|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|TRUSTMARK [2030]|STARMARK [203000]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|493||||493|236.39|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|UMR [2035]|UMR OPTIONS [203501]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|493||||493|72.01|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|493||||493|443.7|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|493||||493|0|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|493||||493|16.42|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|493||||493|75.29|458.49|16.42
32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|493||||493|246.5|458.49|16.42
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|679||||679|75.29|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|679||||679|43.62|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|679||||679|76.8|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|679||||679|125.3|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|679||||679|125.3|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|679||||679|74.59|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|679||||679|340.18|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|679||||679|238.33|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|679||||679|291.97|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|679||||679|289.25|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|679||||679|339.5|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|679||||679|441.35|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|679||||679|75.29|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|679||||679|43.27|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|679||||679|26.49|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|GEHA [1415]|GEHA [141500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|679||||679|167.5|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|679||||679|291.97|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|679||||679|631.47|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|679||||679|407.4|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|679||||679|75.29|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|679||||679|82.04|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|679||||679|148.92|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|679||||679|121.01|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|679||||679|101.65|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|679||||679|75.93|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|679||||679|111.67|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|679||||679|130.23|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|679||||679|82.04|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|Self-pay|Self-pay|679||||679|203.7|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|679||||679|142.59|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|679||||679|73.79|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|679||||679|108.69|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|679||||679|325.58|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|679||||679|115.25|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|679||||679|611.1|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|679||||679|0|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|679||||679|26.49|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|679||||679|74.45|631.47|26.49
32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|679||||679|339.5|631.47|26.49
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|877||||877|59.51|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|877||||877|103.45|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|877||||877|125.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|877||||877|125.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|877||||877|100.46|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|877||||877|439.38|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|877||||877|307.83|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|877||||877|377.11|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|877||||877|373.6|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|877||||877|438.5|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|877||||877|570.05|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|877||||877|57.87|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|877||||877|35.43|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|GEHA [1415]|GEHA [141500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|877||||877|228.19|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|877||||877|377.11|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|877||||877|815.61|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|877||||877|526.2|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|877||||877|110.51|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|877||||877|268.93|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|877||||877|121.01|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|877||||877|136.91|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|877||||877|103.45|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|877||||877|152.13|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|877||||877|130.23|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|877||||877|110.51|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|Self-pay|Self-pay|877||||877|263.1|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|877||||877|184.17|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|877||||877|98.27|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|877||||877|146.4|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|877||||877|420.52|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|877||||877|115.25|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|877||||877|789.3|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|877||||877|0|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|877||||877|35.43|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|877||||877|101.42|815.61|35.43
32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|877||||877|438.5|815.61|35.43
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|954||||954|71.73|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|954||||954|103.45|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|954||||954|125.3|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|954||||954|125.3|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|954||||954|100.46|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|954||||954|477.95|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|954||||954|334.85|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|954||||954|410.22|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|954||||954|406.4|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|954||||954|477|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|954||||954|620.1|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|954||||954|72.86|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|954||||954|44.61|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|GEHA [1415]|GEHA [141500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|954||||954|228.19|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|954||||954|410.22|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|954||||954|887.22|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|954||||954|572.4|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|954||||954|110.51|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|954||||954|268.93|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|954||||954|121.01|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|954||||954|136.91|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|954||||954|103.45|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|954||||954|152.13|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|954||||954|130.23|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|954||||954|110.51|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|Self-pay|Self-pay|954||||954|286.2|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|954||||954|200.34|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|954||||954|99.39|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|954||||954|148.07|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|954||||954|457.44|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|954||||954|115.25|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|954||||954|858.6|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|954||||954|0|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|954||||954|44.61|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|954||||954|101.42|887.22|44.61
32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|954||||954|477|887.22|44.61
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|697||||697|39.34|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|697||||697|103.45|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|697||||697|125.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|697||||697|125.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|697||||697|100.46|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|697||||697|349.2|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|697||||697|244.65|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|697||||697|299.71|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|697||||697|296.92|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|697||||697|348.5|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|697||||697|453.05|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|697||||697|39.05|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|697||||697|23.95|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|GEHA [1415]|GEHA [141500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|697||||697|228.19|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|697||||697|299.71|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|697||||697|648.21|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|697||||697|418.2|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|697||||697|110.51|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|697||||697|268.93|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|697||||697|121.01|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|697||||697|136.91|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|697||||697|103.45|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|697||||697|152.13|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|697||||697|130.23|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|697||||697|110.51|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|Self-pay|Self-pay|697||||697|209.1|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|697||||697|146.37|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|697||||697|99.39|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|697||||697|148.07|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|697||||697|334.21|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|697||||697|115.25|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|697||||697|627.3|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|697||||697|0|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|697||||697|23.95|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|697||||697|101.42|648.21|23.95
32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|697||||697|348.5|648.21|23.95
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|761||||761|43.62|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|761||||761|102.28|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|761||||761|125.3|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|761||||761|125.3|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|761||||761|100.46|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|761||||761|381.26|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|761||||761|267.11|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|761||||761|327.23|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|761||||761|324.19|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|761||||761|380.5|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|761||||761|494.65|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|761||||761|44.09|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|761||||761|26.99|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|GEHA [1415]|GEHA [141500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|761||||761|225.62|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|761||||761|327.23|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|761||||761|707.73|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|761||||761|456.6|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|761||||761|110.51|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|761||||761|268.93|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|761||||761|121.01|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|761||||761|135.37|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|761||||761|102.28|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|761||||761|150.41|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|761||||761|130.23|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|761||||761|110.51|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|Self-pay|Self-pay|761||||761|228.3|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|761||||761|159.81|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|761||||761|98.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|761||||761|146.4|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|761||||761|364.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|761||||761|115.25|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|761||||761|684.9|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|761||||761|0|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|761||||761|26.99|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|761||||761|100.27|707.73|26.99
32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|761||||761|380.5|707.73|26.99
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|774||||774|49.72|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|774||||774|102.28|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|774||||774|125.3|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|774||||774|125.3|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|774||||774|100.46|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|774||||774|387.77|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|774||||774|271.67|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|774||||774|332.82|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|774||||774|329.72|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|774||||774|387|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|774||||774|503.1|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|774||||774|51.19|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|774||||774|31.34|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|774||||774|225.62|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|774||||774|332.82|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|774||||774|719.82|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|774||||774|464.4|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|774||||774|110.51|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|774||||774|268.93|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|774||||774|121.01|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|774||||774|135.37|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|774||||774|102.28|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|774||||774|150.41|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|774||||774|130.23|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|774||||774|110.51|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|Self-pay|Self-pay|774||||774|232.2|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|774||||774|162.54|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|774||||774|98.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|774||||774|146.4|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|774||||774|371.13|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|774||||774|115.25|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|774||||774|696.6|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|774||||774|0|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|774||||774|31.34|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|774||||774|100.27|719.82|31.34
32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|774||||774|387|719.82|31.34
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|510||||510|38.73|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|510||||510|76.8|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|510||||510|78.28|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|510||||510|78.28|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|510||||510|74.59|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|510||||510|255.51|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|510||||510|179.01|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|510||||510|219.3|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|510||||510|217.26|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|510||||510|255|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|510||||510|331.5|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|510||||510|40.9|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|510||||510|25.04|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|510||||510|169.41|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|510||||510|219.3|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|510||||510|474.3|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|510||||510|306|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|510||||510|82.04|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|510||||510|148.92|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|510||||510|75.61|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|510||||510|101.65|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|510||||510|76.8|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|510||||510|112.94|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|510||||510|81.36|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|510||||510|82.04|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|Self-pay|Self-pay|510||||510|153|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|510||||510|107.1|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|510||||510|73.79|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|510||||510|109.93|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|510||||510|244.55|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|510||||510|72.01|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|510||||510|459|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|510||||510|0|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|510||||510|25.04|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|510||||510|75.29|474.3|25.04
32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|510||||510|255|474.3|25.04
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|AETNA [1015]|AETNA ACO WILCO [101532]|633||||633|46.05|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|633||||633|76.8|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|633||||633|80.21|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|633||||633|80.21|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|633||||633|74.59|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|633||||633|317.13|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|633||||633|222.18|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|633||||633|272.19|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|633||||633|269.66|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|633||||633|316.5|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|633||||633|411.45|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|CORESOURCE [1315]|CORESOURCE [131500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|633||||633|46.66|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|633||||633|29.99|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|GEHA [1415]|GEHA [141500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|633||||633|169.41|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HEALTHNET [1495]|HEALTHNET [149500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|633||||633|272.19|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|633||||633|588.69|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|633||||633|379.8|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|633||||633|82.04|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|633||||633|148.92|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|633||||633|77.47|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|633||||633|101.65|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|633||||633|76.8|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MULTIPLAN [1680]|HMA [168003]|633||||633|112.94|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MULTIPLAN [1680]|IHC HS [168011]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|633||||633|83.37|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|633||||633|82.04|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|Self-pay|Self-pay|633||||633|189.9|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|633||||633|132.93|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|633||||633|73.79|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|633||||633|109.93|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|TRUSTMARK [2030]|STARMARK [203000]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|633||||633|303.52|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|UMR [2035]|UMR OPTIONS [203501]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|633||||633|73.78|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|633||||633|569.7|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|633||||633|0|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|633||||633|29.99|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|633||||633|75.29|588.69|29.99
32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|633||||633|316.5|588.69|29.99
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|695||||695|83.96|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|695||||695|103.45|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|695||||695|132.84|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|695||||695|132.84|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|695||||695|100.46|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|695||||695|348.2|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|695||||695|243.95|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|695||||695|298.85|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|695||||695|296.07|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|695||||695|347.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|695||||695|451.75|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|695||||695|75.19|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|695||||695|48.11|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|GEHA [1415]|GEHA [141500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|695||||695|228.19|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|695||||695|298.85|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|695||||695|646.35|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|695||||695|417|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|695||||695|110.51|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|695||||695|268.93|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|695||||695|128.3|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|695||||695|136.91|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|695||||695|103.45|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|695||||695|152.13|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|695||||695|138.07|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|695||||695|110.51|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|Self-pay|Self-pay|695||||695|208.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|695||||695|145.95|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|695||||695|99.39|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|695||||695|148.07|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|695||||695|333.25|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|695||||695|122.19|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|695||||695|625.5|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|695||||695|0|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|695||||695|48.11|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|695||||695|101.42|646.35|48.11
32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|695||||695|347.5|646.35|48.11
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|640||||640|43.62|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|640||||640|103.45|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|640||||640|125.3|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|640||||640|125.3|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|640||||640|100.46|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|640||||640|320.64|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|640||||640|224.64|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|640||||640|275.2|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|640||||640|272.64|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|640||||640|320|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|640||||640|416|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|640||||640|41.41|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|640||||640|25.7|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|GEHA [1415]|GEHA [141500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|640||||640|225.62|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|640||||640|275.2|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|640||||640|595.2|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|640||||640|384|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|640||||640|110.51|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|640||||640|101.42|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|640||||640|268.93|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|640||||640|121.01|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|640||||640|135.37|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|640||||640|102.28|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|640||||640|150.41|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|640||||640|130.23|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|640||||640|110.51|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|Self-pay|Self-pay|640||||640|192|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|640||||640|134.4|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|640||||640|99.39|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|640||||640|146.4|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|640||||640|306.88|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|640||||640|115.25|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|640||||640|576|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|640||||640|0|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|640||||640|25.7|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|640||||640|100.27|595.2|25.7
32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|640||||640|320|595.2|25.7
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|986||||986|60.73|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|986||||986|103.45|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|986||||986|125.3|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|986||||986|125.3|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|986||||986|100.46|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|986||||986|493.99|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|986||||986|346.09|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|986||||986|423.98|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|986||||986|420.04|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|986||||986|493|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|986||||986|640.9|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|986||||986|59.04|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|986||||986|36.15|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|986||||986|228.19|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|986||||986|423.98|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|986||||986|916.98|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|986||||986|591.6|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|986||||986|110.51|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|986||||986|268.93|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|986||||986|121.01|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|986||||986|135.37|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|986||||986|102.28|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|986||||986|152.13|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|986||||986|130.23|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|986||||986|110.51|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|Self-pay|Self-pay|986||||986|295.8|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|986||||986|207.06|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|986||||986|98.27|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|986||||986|148.07|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|986||||986|472.79|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|986||||986|115.25|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|986||||986|887.4|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|986||||986|0|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|986||||986|36.15|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|986||||986|101.42|916.98|36.15
32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|986||||986|493|916.98|36.15
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1063||||1063|71.73|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1063||||1063|103.45|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1063||||1063|125.3|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1063||||1063|125.3|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1063||||1063|100.46|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1063||||1063|532.56|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1063||||1063|373.11|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1063||||1063|457.09|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1063||||1063|452.84|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1063||||1063|531.5|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1063||||1063|690.95|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1063||||1063|74.72|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1063||||1063|45.75|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|GEHA [1415]|GEHA [141500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1063||||1063|228.19|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1063||||1063|457.09|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1063||||1063|988.59|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1063||||1063|637.8|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1063||||1063|110.51|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1063||||1063|268.93|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1063||||1063|121.01|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1063||||1063|136.91|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1063||||1063|103.45|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|1063||||1063|152.13|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1063||||1063|130.23|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1063||||1063|110.51|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|Self-pay|Self-pay|1063||||1063|318.9|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1063||||1063|223.23|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1063||||1063|99.39|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1063||||1063|148.07|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1063||||1063|509.71|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1063||||1063|115.25|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1063||||1063|956.7|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1063||||1063|0|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1063||||1063|45.75|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1063||||1063|101.42|988.59|45.75
32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1063||||1063|531.5|988.59|45.75
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|953||||953|54.62|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|953||||953|103.45|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|953||||953|125.3|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|953||||953|125.3|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|953||||953|100.46|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|953||||953|477.45|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|953||||953|334.5|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|953||||953|409.79|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|953||||953|405.98|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|953||||953|476.5|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|953||||953|619.45|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|953||||953|51.89|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|953||||953|31.77|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|GEHA [1415]|GEHA [141500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|953||||953|228.19|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|953||||953|409.79|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|953||||953|886.29|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|953||||953|571.8|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|953||||953|110.51|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|953||||953|268.93|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|953||||953|121.01|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|953||||953|136.91|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|953||||953|103.45|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|953||||953|152.13|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|953||||953|130.23|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|953||||953|110.51|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|Self-pay|Self-pay|953||||953|285.9|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|953||||953|200.13|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|953||||953|99.39|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|953||||953|148.07|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|953||||953|456.96|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|953||||953|115.25|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|953||||953|857.7|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|953||||953|0|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|953||||953|31.77|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|953||||953|101.42|886.29|31.77
32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-S SPINE BENDING ONLY 2 OR 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|953||||953|476.5|886.29|31.77
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|468||||468|41.77|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|468||||468|103.45|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|468||||468|125.3|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|468||||468|125.3|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|468||||468|100.46|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|468||||468|234.47|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|468||||468|164.27|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|468||||468|201.24|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|468||||468|199.37|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|468||||468|234|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|468||||468|304.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|468||||468|36.61|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|468||||468|23.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|GEHA [1415]|GEHA [141500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|468||||468|228.19|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|468||||468|201.24|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|468||||468|435.24|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|468||||468|280.8|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|468||||468|110.51|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|468||||468|268.93|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|468||||468|121.01|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|468||||468|135.37|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|468||||468|102.28|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|468||||468|152.13|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|468||||468|130.23|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|468||||468|110.51|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|Self-pay|Self-pay|468||||468|140.4|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|468||||468|98.28|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|468||||468|99.39|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|468||||468|148.07|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|468||||468|224.41|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|468||||468|115.25|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|468||||468|421.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|468||||468|0|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|468||||468|23.2|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|468||||468|101.42|435.24|23.2
32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|468||||468|234|435.24|23.2
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|539||||539|49.72|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|539||||539|103.45|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|539||||539|125.3|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|539||||539|125.3|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|539||||539|100.46|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|539||||539|270.04|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|539||||539|189.19|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|539||||539|231.77|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|539||||539|229.61|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|539||||539|269.5|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|539||||539|350.35|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|539||||539|46.3|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|539||||539|28.35|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|539||||539|228.19|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|539||||539|231.77|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|539||||539|501.27|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|539||||539|323.4|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|539||||539|110.51|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|539||||539|268.93|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|539||||539|121.01|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|539||||539|136.91|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|539||||539|103.45|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|539||||539|152.13|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|539||||539|130.23|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|539||||539|110.51|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|539||||539|161.7|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|539||||539|113.19|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|539||||539|99.39|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|539||||539|148.07|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|539||||539|258.45|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|539||||539|115.25|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|539||||539|485.1|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|539||||539|0|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|539||||539|28.35|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|539||||539|101.42|501.27|28.35
32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|539||||539|269.5|501.27|28.35
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|547||||547|43.62|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|547||||547|102.28|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|547||||547|125.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|547||||547|125.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|547||||547|100.46|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|547||||547|274.05|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|547||||547|192|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|547||||547|235.21|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|547||||547|233.02|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|547||||547|273.5|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|547||||547|355.55|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|547||||547|39.06|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|547||||547|24.45|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|547||||547|225.62|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|547||||547|235.21|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|547||||547|508.71|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|547||||547|328.2|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|547||||547|110.51|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|547||||547|268.93|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|547||||547|121.01|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|547||||547|135.37|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|547||||547|102.28|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|547||||547|150.41|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|547||||547|130.23|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|547||||547|110.51|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|Self-pay|Self-pay|547||||547|164.1|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|547||||547|114.87|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|547||||547|98.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|547||||547|146.4|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|547||||547|262.29|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|547||||547|115.25|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|547||||547|492.3|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|547||||547|0|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|547||||547|24.45|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|547||||547|100.27|508.71|24.45
32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|547||||547|273.5|508.71|24.45
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|541||||541|37.5|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|541||||541|76.8|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|541||||541|78.28|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|541||||541|78.28|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|541||||541|74.59|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|541||||541|271.04|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|541||||541|189.89|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|541||||541|232.63|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|541||||541|230.47|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|541||||541|270.5|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|541||||541|351.65|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|541||||541|33.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|541||||541|21.46|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|541||||541|169.41|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|541||||541|232.63|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|541||||541|503.13|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|541||||541|324.6|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|541||||541|82.04|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|541||||541|148.92|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|541||||541|75.61|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|541||||541|100.5|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|541||||541|75.93|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|541||||541|112.94|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|541||||541|81.36|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|541||||541|82.04|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|Self-pay|Self-pay|541||||541|162.3|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|541||||541|113.61|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|541||||541|72.96|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|541||||541|109.93|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|541||||541|259.41|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|541||||541|72.01|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|541||||541|486.9|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|541||||541|0|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|541||||541|21.46|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|541||||541|75.29|503.13|21.46
32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|541||||541|270.5|503.13|21.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|549||||549|35.67|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|549||||549|76.8|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|549||||549|78.28|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|549||||549|78.28|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|549||||549|74.59|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|549||||549|275.05|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|549||||549|192.7|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|549||||549|236.07|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|549||||549|233.87|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|549||||549|274.5|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|549||||549|356.85|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|549||||549|31.83|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|549||||549|20.46|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|GEHA [1415]|GEHA [141500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|549||||549|169.41|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|549||||549|236.07|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|549||||549|510.57|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|549||||549|329.4|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|549||||549|82.04|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|549||||549|148.92|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|549||||549|75.61|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|549||||549|101.65|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|549||||549|76.8|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|549||||549|112.94|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|549||||549|81.36|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|549||||549|82.04|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|Self-pay|Self-pay|549||||549|164.7|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|549||||549|115.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|549||||549|73.79|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|549||||549|109.93|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|549||||549|263.25|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|549||||549|72.01|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|549||||549|494.1|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|549||||549|0|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|549||||549|20.46|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|549||||549|75.29|510.57|20.46
32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|549||||549|274.5|510.57|20.46
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|520||||520|39.34|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|520||||520|103.45|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|520||||520|78.28|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|520||||520|78.28|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|520||||520|100.46|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|520||||520|260.52|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|520||||520|182.52|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|520||||520|223.6|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|520||||520|221.52|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|520||||520|260|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|520||||520|338|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|520||||520|34.66|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|520||||520|22.45|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|GEHA [1415]|GEHA [141500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|520||||520|228.19|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|520||||520|223.6|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|520||||520|483.6|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|520||||520|312|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|520||||520|110.51|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|520||||520|268.93|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|520||||520|75.61|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|520||||520|136.91|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|520||||520|103.45|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|520||||520|152.13|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|520||||520|81.36|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|520||||520|110.51|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|Self-pay|Self-pay|520||||520|156|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|520||||520|109.2|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|520||||520|99.39|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|520||||520|148.07|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|520||||520|249.34|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|520||||520|72.01|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|520||||520|468|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|520||||520|0|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|520||||520|22.45|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|520||||520|101.42|483.6|22.45
32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|520||||520|260|483.6|22.45
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|AETNA [1015]|AETNA ACO WILCO [101532]|435||||435|27.12|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435||||435|75.93|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435||||435|78.28|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435||||435|78.28|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435||||435|74.59|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|435||||435|217.94|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435||||435|152.69|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435||||435|187.05|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|435||||435|185.31|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|435||||435|217.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435||||435|282.75|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|CORESOURCE [1315]|CORESOURCE [131500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|435||||435|27.07|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|435||||435|16.71|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|GEHA [1415]|GEHA [141500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|435||||435|167.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HEALTHNET [1495]|HEALTHNET [149500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435||||435|187.05|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|435||||435|404.55|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435||||435|261|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435||||435|75.29|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435||||435|82.04|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435||||435|148.92|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435||||435|75.61|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435||||435|100.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435||||435|75.93|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MULTIPLAN [1680]|HMA [168003]|435||||435|111.67|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MULTIPLAN [1680]|IHC HS [168011]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|435||||435|81.36|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435||||435|82.04|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|Self-pay|Self-pay|435||||435|130.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435||||435|91.35|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|435||||435|72.96|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435||||435|109.93|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|TRUSTMARK [2030]|STARMARK [203000]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435||||435|208.58|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|UMR [2035]|UMR OPTIONS [203501]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435||||435|72.01|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435||||435|391.5|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|435||||435|0|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|435||||435|16.71|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|435||||435|74.45|404.55|16.71
32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|435||||435|217.5|404.55|16.71
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|567||||567|35.67|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|567||||567|76.8|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|567||||567|125.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|567||||567|125.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|567||||567|74.59|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|567||||567|284.07|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|567||||567|199.02|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|567||||567|243.81|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|567||||567|241.54|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|567||||567|283.5|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|567||||567|368.55|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|567||||567|34.1|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|567||||567|21.21|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|567||||567|167.5|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|567||||567|243.81|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|567||||567|527.31|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|567||||567|340.2|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|567||||567|82.04|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|567||||567|148.92|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|567||||567|121.01|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|567||||567|100.5|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|567||||567|76.8|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|567||||567|111.67|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|567||||567|130.23|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|567||||567|82.04|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|Self-pay|Self-pay|567||||567|170.1|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|567||||567|119.07|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|567||||567|75.29|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|567||||567|73.79|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|567||||567|109.93|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|567||||567|271.88|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|567||||567|115.25|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|567||||567|510.3|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|567||||567|0|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|567||||567|21.21|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|567||||567|74.45|527.31|21.21
32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|567||||567|283.5|527.31|21.21
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|554||||554|37.5|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|554||||554|76.8|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|554||||554|78.28|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|554||||554|78.28|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|554||||554|74.59|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|554||||554|277.55|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|554||||554|194.45|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|554||||554|238.22|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|554||||554|236|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|554||||554|277|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|554||||554|360.1|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|554||||554|33.36|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|554||||554|21.2|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|554||||554|169.41|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|554||||554|238.22|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|554||||554|515.22|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|554||||554|332.4|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|554||||554|82.04|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|554||||554|148.92|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|554||||554|75.61|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|554||||554|101.65|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|554||||554|76.8|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|554||||554|112.94|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|554||||554|81.36|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|554||||554|82.04|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|Self-pay|Self-pay|554||||554|166.2|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|554||||554|116.34|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|554||||554|73.79|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|554||||554|109.93|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|554||||554|265.64|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|554||||554|72.01|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|554||||554|498.6|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|554||||554|0|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|554||||554|21.2|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|554||||554|75.29|515.22|21.2
32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|554||||554|277|515.22|21.2
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|436||||436|32.61|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|436||||436|76.8|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|436||||436|78.28|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|436||||436|78.28|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|436||||436|74.59|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|436||||436|218.44|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|436||||436|153.04|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|436||||436|187.48|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|436||||436|185.74|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|436||||436|218|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|436||||436|283.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|436||||436|31.33|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|436||||436|19.18|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|GEHA [1415]|GEHA [141500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|436||||436|169.41|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|436||||436|187.48|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|436||||436|405.48|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|436||||436|261.6|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|436||||436|82.04|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|436||||436|148.92|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|436||||436|75.61|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|436||||436|101.65|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|436||||436|76.8|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|436||||436|112.94|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|436||||436|81.36|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|436||||436|82.04|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|Self-pay|Self-pay|436||||436|130.8|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|436||||436|91.56|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|436||||436|73.79|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|436||||436|109.93|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|436||||436|209.06|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|436||||436|72.01|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|436||||436|392.4|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|436||||436|0|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|436||||436|19.18|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|436||||436|75.29|405.48|19.18
32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|436||||436|218|405.48|19.18
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|492||||492|36.28|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|492||||492|76.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|492||||492|78.28|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|492||||492|78.28|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|492||||492|74.59|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|492||||492|246.49|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|492||||492|172.69|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|492||||492|211.56|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|492||||492|209.59|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|492||||492|246|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|492||||492|319.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|492||||492|36.44|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|492||||492|22.31|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|492||||492|169.41|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|492||||492|211.56|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|492||||492|457.56|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|492||||492|295.2|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|492||||492|82.04|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|492||||492|148.92|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|492||||492|75.61|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|492||||492|101.65|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|492||||492|76.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|492||||492|112.94|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|492||||492|81.36|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|492||||492|82.04|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|492||||492|147.6|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|492||||492|103.32|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|492||||492|72.96|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|492||||492|109.93|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|492||||492|235.91|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|492||||492|72.01|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|492||||492|442.8|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|492||||492|0|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|492||||492|22.31|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|492||||492|75.29|457.56|22.31
32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|492||||492|246|457.56|22.31
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|400||||400|40.56|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|400||||400|76.8|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|400||||400|78.28|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|400||||400|78.28|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|400||||400|74.59|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|400||||400|200.4|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|400||||400|140.4|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|400||||400|172|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|400||||400|170.4|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|400||||400|200|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|400||||400|260|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|400||||400|35.87|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|400||||400|22.45|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|GEHA [1415]|GEHA [141500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|400||||400|169.41|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|400||||400|172|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|400||||400|372|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|400||||400|240|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|400||||400|82.04|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|400||||400|148.92|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|400||||400|75.61|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|400||||400|101.65|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|400||||400|76.8|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|400||||400|112.94|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|400||||400|81.36|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|400||||400|82.04|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|Self-pay|Self-pay|400||||400|120|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|400||||400|84|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|400||||400|73.79|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|400||||400|109.93|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|400||||400|191.8|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|400||||400|72.01|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|400||||400|360|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|400||||400|0|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|400||||400|22.45|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|400||||400|75.29|372|22.45
32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|400||||400|200|372|22.45
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|529||||529|47.89|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|529||||529|76.8|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|529||||529|78.28|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|529||||529|78.28|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|529||||529|74.59|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|529||||529|265.03|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|529||||529|185.68|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|529||||529|227.47|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|529||||529|225.35|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|529||||529|264.5|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|529||||529|343.85|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|529||||529|40.68|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|529||||529|25.7|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|529||||529|167.5|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|529||||529|227.47|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|529||||529|491.97|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|529||||529|317.4|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|529||||529|75.29|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|529||||529|82.04|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|529||||529|148.92|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|529||||529|75.61|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|529||||529|101.65|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|529||||529|76.8|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|529||||529|111.67|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|529||||529|81.36|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|529||||529|82.04|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|529||||529|158.7|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|529||||529|111.09|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|529||||529|75.29|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|529||||529|72.96|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|529||||529|109.93|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|529||||529|253.66|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|529||||529|72.01|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|529||||529|476.1|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|529||||529|0|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|529||||529|25.7|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|529||||529|74.45|491.97|25.7
32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|529||||529|264.5|491.97|25.7
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|413||||413|35.67|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|413||||413|103.45|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|413||||413|125.3|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|413||||413|125.3|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|413||||413|100.46|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|413||||413|206.91|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|413||||413|144.96|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|413||||413|177.59|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|413||||413|175.94|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|413||||413|206.5|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|413||||413|268.45|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|413||||413|32.24|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|413||||413|20.46|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|GEHA [1415]|GEHA [141500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|413||||413|228.19|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|413||||413|177.59|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|413||||413|384.09|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|413||||413|247.8|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|413||||413|110.51|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|413||||413|268.93|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|413||||413|121.01|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|413||||413|136.91|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|413||||413|103.45|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|413||||413|152.13|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|413||||413|130.23|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|413||||413|110.51|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|Self-pay|Self-pay|413||||413|123.9|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|413||||413|86.73|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|413||||413|99.39|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|413||||413|148.07|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|413||||413|198.03|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|413||||413|115.25|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|413||||413|371.7|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|413||||413|0|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|413||||413|20.46|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|413||||413|101.42|384.09|20.46
32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|413||||413|206.5|384.09|20.46
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|490||||490|42.4|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|490||||490|76.8|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|490||||490|78.28|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|490||||490|78.28|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|490||||490|74.59|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|490||||490|245.49|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|490||||490|171.99|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|490||||490|210.7|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|490||||490|208.74|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|490||||490|245|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|490||||490|318.5|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|490||||490|36.27|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|490||||490|23.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|490||||490|167.5|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|490||||490|210.7|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|490||||490|455.7|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|490||||490|294|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|490||||490|75.29|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|490||||490|82.04|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|490||||490|148.92|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|490||||490|75.61|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|490||||490|100.5|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|490||||490|76.8|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|490||||490|112.94|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|490||||490|81.36|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|490||||490|82.04|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|Self-pay|Self-pay|490||||490|147|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|490||||490|102.9|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|490||||490|73.79|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|490||||490|109.93|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|490||||490|234.96|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|490||||490|72.01|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|490||||490|441|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|490||||490|0|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|490||||490|23.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|490||||490|74.45|455.7|23.45
32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|490||||490|245|455.7|23.45
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|388||||388|46.05|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|388||||388|75.93|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|388||||388|78.28|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|388||||388|78.28|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|388||||388|74.59|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|388||||388|194.39|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|388||||388|136.19|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|388||||388|166.84|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|388||||388|165.29|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|388||||388|194|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|388||||388|252.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|388||||388|36.67|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|388||||388|23.7|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|388||||388|167.5|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|388||||388|166.84|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|388||||388|360.84|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|388||||388|232.8|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|388||||388|75.29|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|388||||388|82.04|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|388||||388|148.92|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|388||||388|75.61|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|388||||388|100.5|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|388||||388|76.8|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|388||||388|112.94|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|388||||388|81.36|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|388||||388|82.04|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|Self-pay|Self-pay|388||||388|116.4|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|388||||388|81.48|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|388||||388|73.79|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|388||||388|109.93|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|388||||388|186.05|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|388||||388|72.01|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|388||||388|349.2|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|388||||388|0|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|388||||388|23.7|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|388||||388|74.45|360.84|23.7
32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|388||||388|194|360.84|23.7
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|AETNA [1015]|AETNA ACO WILCO [101532]|497||||497|36.89|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|497||||497|75.93|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|497||||497|80.21|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|497||||497|80.21|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|497||||497|74.59|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|497||||497|249|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|497||||497|174.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|497||||497|213.71|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|497||||497|211.72|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|497||||497|248.5|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|497||||497|323.05|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|CORESOURCE [1315]|CORESOURCE [131500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|497||||497|45.93|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|497||||497|28.12|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|GEHA [1415]|GEHA [141500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|497||||497|167.5|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HEALTHNET [1495]|HEALTHNET [149500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|497||||497|213.71|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|497||||497|462.21|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|497||||497|298.2|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|497||||497|82.04|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|497||||497|148.92|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|497||||497|77.47|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|497||||497|100.5|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|497||||497|75.93|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MULTIPLAN [1680]|HMA [168003]|497||||497|111.67|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MULTIPLAN [1680]|IHC HS [168011]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|497||||497|83.37|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|497||||497|82.04|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|Self-pay|Self-pay|497||||497|149.1|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|497||||497|104.37|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|497||||497|72.96|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|497||||497|108.69|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|TRUSTMARK [2030]|STARMARK [203000]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|497||||497|238.31|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|UMR [2035]|UMR OPTIONS [203501]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|497||||497|73.78|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|497||||497|447.3|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|497||||497|0|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|497||||497|28.12|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|497||||497|74.45|462.21|28.12
32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|497||||497|248.5|462.21|28.12
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|546||||546|54.62|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|546||||546|76.8|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|546||||546|80.21|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|546||||546|80.21|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|546||||546|74.59|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|546||||546|273.55|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|546||||546|191.65|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|546||||546|234.78|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|546||||546|232.6|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|546||||546|273|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|546||||546|354.9|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|546||||546|63.43|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|546||||546|38.84|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|GEHA [1415]|GEHA [141500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|546||||546|169.41|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|546||||546|234.78|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|546||||546|507.78|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|546||||546|327.6|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|546||||546|74.45|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|546||||546|82.04|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|546||||546|148.92|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|546||||546|77.47|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|546||||546|100.5|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|546||||546|75.93|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|546||||546|112.94|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|546||||546|83.37|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|546||||546|82.04|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|Self-pay|Self-pay|546||||546|163.8|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|546||||546|114.66|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|546||||546|73.79|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|546||||546|109.93|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|546||||546|261.81|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|546||||546|73.78|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|546||||546|491.4|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|546||||546|0|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|546||||546|38.84|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|546||||546|75.29|507.78|38.84
32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|546||||546|273|507.78|38.84
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|579||||579|46.68|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|579||||579|103.45|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|579||||579|132.84|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|579||||579|132.84|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|579||||579|100.46|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|579||||579|290.08|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|579||||579|203.23|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|579||||579|248.97|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|579||||579|246.65|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|579||||579|289.5|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|579||||579|376.35|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|579||||579|61.25|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|579||||579|37.5|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|GEHA [1415]|GEHA [141500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|579||||579|228.19|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|579||||579|248.97|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|579||||579|538.47|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|579||||579|347.4|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|579||||579|110.51|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|579||||579|268.93|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|579||||579|128.3|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|579||||579|136.91|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|579||||579|102.28|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|579||||579|152.13|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|579||||579|138.07|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|579||||579|110.51|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|Self-pay|Self-pay|579||||579|173.7|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|579||||579|121.59|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|579||||579|99.39|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|579||||579|148.07|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|579||||579|277.63|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|579||||579|122.19|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|579||||579|521.1|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|579||||579|0|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|579||||579|37.5|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|579||||579|101.42|538.47|37.5
32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|579||||579|289.5|538.47|37.5
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|798||||798|60.12|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|798||||798|103.45|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|798||||798|132.84|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|798||||798|132.84|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|798||||798|100.46|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|798||||798|399.8|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|798||||798|280.1|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|798||||798|343.14|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|798||||798|339.95|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|798||||798|399|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|798||||798|518.7|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|798||||798|74.92|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|798||||798|45.87|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|GEHA [1415]|GEHA [141500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|798||||798|228.19|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|798||||798|343.14|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|798||||798|742.14|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|798||||798|478.8|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|798||||798|100.27|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|798||||798|110.51|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|798||||798|268.93|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|798||||798|128.3|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|798||||798|136.91|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|798||||798|103.45|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|798||||798|152.13|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|798||||798|138.07|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|798||||798|110.51|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|Self-pay|Self-pay|798||||798|239.4|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|798||||798|167.58|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|798||||798|99.39|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|798||||798|148.07|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|798||||798|382.64|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|798||||798|122.19|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|798||||798|718.2|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|798||||798|0|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|798||||798|45.87|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|798||||798|101.42|742.14|45.87
32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|798||||798|399|742.14|45.87
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|568||||568|41.77|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|568||||568|76.8|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|568||||568|80.21|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|568||||568|80.21|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|568||||568|74.59|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|568||||568|284.57|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|568||||568|199.37|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|568||||568|244.24|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|568||||568|241.97|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|568||||568|284|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|568||||568|369.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|568||||568|49.76|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|568||||568|30.47|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|568||||568|169.41|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|568||||568|244.24|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|568||||568|528.24|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|568||||568|340.8|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|568||||568|82.04|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|568||||568|148.92|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|568||||568|77.47|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|568||||568|101.65|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|568||||568|75.93|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|568||||568|112.94|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|568||||568|83.37|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|568||||568|82.04|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|Self-pay|Self-pay|568||||568|170.4|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|568||||568|119.28|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|568||||568|73.79|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|568||||568|109.93|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|568||||568|272.36|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|568||||568|73.78|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|568||||568|511.2|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|568||||568|0|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|568||||568|30.47|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|568||||568|75.29|528.24|30.47
32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|568||||568|284|528.24|30.47
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|491||||491|75.29|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|491||||491|41.17|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|491||||491|76.8|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|491||||491|78.28|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|491||||491|78.28|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|491||||491|74.59|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|491||||491|245.99|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|491||||491|172.34|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|491||||491|211.13|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|491||||491|209.17|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|491||||491|245.5|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|491||||491|319.15|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|491||||491|35.46|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|491||||491|22.7|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|GEHA [1415]|GEHA [141500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|491||||491|167.5|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|491||||491|211.13|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|491||||491|456.63|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|491||||491|294.6|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|491||||491|75.29|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|491||||491|82.04|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|491||||491|148.92|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|491||||491|75.61|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|491||||491|101.65|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|491||||491|76.8|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|491||||491|111.67|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|491||||491|81.36|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|491||||491|82.04|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|Self-pay|Self-pay|491||||491|147.3|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|491||||491|103.11|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|491||||491|72.96|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|491||||491|108.69|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|491||||491|235.43|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|491||||491|72.01|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|491||||491|441.9|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|491||||491|0|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|491||||491|22.7|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|491||||491|74.45|456.63|22.7
32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|491||||491|245.5|456.63|22.7
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|550||||550|47.89|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|550||||550|76.8|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|550||||550|125.3|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|550||||550|125.3|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|550||||550|74.59|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|550||||550|275.55|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|550||||550|193.05|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|550||||550|236.5|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|550||||550|234.3|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|550||||550|275|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|550||||550|357.5|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|550||||550|41.09|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|550||||550|26.19|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|GEHA [1415]|GEHA [141500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|550||||550|167.5|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|550||||550|236.5|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|550||||550|511.5|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|550||||550|330|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|550||||550|75.29|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|550||||550|82.04|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|550||||550|148.92|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|550||||550|121.01|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|550||||550|101.65|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|550||||550|75.93|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|550||||550|111.67|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|550||||550|130.23|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|550||||550|82.04|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|Self-pay|Self-pay|550||||550|165|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|550||||550|115.5|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|550||||550|72.96|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|550||||550|109.93|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|550||||550|263.73|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|550||||550|115.25|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|550||||550|495|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|550||||550|0|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|550||||550|26.19|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|550||||550|74.45|511.5|26.19
32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|550||||550|275|511.5|26.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|781||||781|52.17|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|781||||781|103.45|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|781||||781|125.3|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|781||||781|125.3|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|781||||781|100.46|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|781||||781|391.28|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|781||||781|274.13|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|781||||781|335.83|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|781||||781|332.71|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|781||||781|390.5|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|781||||781|507.65|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|781||||781|46.46|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|781||||781|29.19|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|GEHA [1415]|GEHA [141500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|781||||781|228.19|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|781||||781|335.83|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|781||||781|726.33|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|781||||781|468.6|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|781||||781|110.51|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|781||||781|268.93|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|781||||781|121.01|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|781||||781|136.91|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|781||||781|103.45|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|781||||781|152.13|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|781||||781|130.23|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|781||||781|110.51|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|Self-pay|Self-pay|781||||781|234.3|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|781||||781|164.01|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|781||||781|99.39|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|781||||781|148.07|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|781||||781|374.49|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|781||||781|115.25|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|781||||781|702.9|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|781||||781|0|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|781||||781|29.19|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|781||||781|101.42|726.33|29.19
32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|781||||781|390.5|726.33|29.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|506||||506|49.11|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|506||||506|76.8|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|506||||506|78.28|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|506||||506|78.28|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|506||||506|74.59|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|506||||506|253.51|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|506||||506|177.61|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|506||||506|217.58|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|506||||506|215.56|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|506||||506|253|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|506||||506|328.9|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|CORESOURCE [1315]|CORESOURCE [131500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|506||||506|41.09|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|506||||506|26.19|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|GEHA [1415]|GEHA [141500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|506||||506|169.41|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HEALTHNET [1495]|HEALTHNET [149500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|506||||506|217.58|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|506||||506|470.58|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|506||||506|303.6|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|506||||506|82.04|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|506||||506|148.92|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|506||||506|75.61|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|506||||506|101.65|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|506||||506|76.8|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MULTIPLAN [1680]|HMA [168003]|506||||506|112.94|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MULTIPLAN [1680]|IHC HS [168011]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|506||||506|81.36|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|506||||506|82.04|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|Self-pay|Self-pay|506||||506|151.8|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|506||||506|106.26|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|506||||506|73.79|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|506||||506|109.93|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|TRUSTMARK [2030]|STARMARK [203000]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|506||||506|242.63|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|UMR [2035]|UMR OPTIONS [203501]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|506||||506|72.01|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|506||||506|455.4|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|506||||506|0|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|506||||506|26.19|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|506||||506|75.29|470.58|26.19
32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|506||||506|253|470.58|26.19
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|496||||496|36.89|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|496||||496|76.8|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|496||||496|78.28|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|496||||496|78.28|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|496||||496|74.59|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|496||||496|248.5|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|496||||496|174.1|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|496||||496|213.28|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|496||||496|211.3|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|496||||496|248|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|496||||496|322.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|496||||496|32.96|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|496||||496|20.7|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|GEHA [1415]|GEHA [141500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|496||||496|169.41|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|496||||496|213.28|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|496||||496|461.28|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|496||||496|297.6|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|496||||496|82.04|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|496||||496|148.92|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|496||||496|75.61|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|496||||496|100.5|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|496||||496|75.93|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|496||||496|112.94|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|496||||496|81.36|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|496||||496|82.04|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|Self-pay|Self-pay|496||||496|148.8|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|496||||496|104.16|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|496||||496|73.79|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|496||||496|109.93|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|496||||496|237.83|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|496||||496|72.01|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|496||||496|446.4|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|496||||496|0|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|496||||496|20.7|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|496||||496|75.29|461.28|20.7
32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|496||||496|248|461.28|20.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|505||||505|38.73|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|505||||505|76.8|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|505||||505|125.3|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|505||||505|125.3|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|505||||505|74.59|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|505||||505|253.01|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|505||||505|177.26|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|505||||505|217.15|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|505||||505|215.13|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|505||||505|252.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|505||||505|328.25|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|505||||505|34.17|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|505||||505|21.7|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|GEHA [1415]|GEHA [141500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|505||||505|169.41|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|505||||505|217.15|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|505||||505|469.65|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|505||||505|303|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|505||||505|82.04|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|505||||505|148.92|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|505||||505|121.01|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|505||||505|101.65|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|505||||505|76.8|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|505||||505|112.94|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|505||||505|130.23|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|505||||505|82.04|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|Self-pay|Self-pay|505||||505|151.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|505||||505|106.05|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|505||||505|73.79|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|505||||505|109.93|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|505||||505|242.15|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|505||||505|115.25|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|505||||505|454.5|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|505||||505|0|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|505||||505|21.7|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|505||||505|75.29|469.65|21.7
32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|505||||505|252.5|469.65|21.7
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|541||||541|42.4|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|541||||541|75.93|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|541||||541|125.3|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|541||||541|125.3|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|541||||541|74.59|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|541||||541|271.04|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|541||||541|189.89|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|541||||541|232.63|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|541||||541|230.47|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|541||||541|270.5|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|541||||541|351.65|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|541||||541|36.21|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|541||||541|23.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|541||||541|167.5|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|541||||541|232.63|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|541||||541|503.13|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|541||||541|324.6|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|541||||541|75.29|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|541||||541|82.04|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|541||||541|148.92|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|541||||541|121.01|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|541||||541|101.65|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|541||||541|75.93|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|541||||541|111.67|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|541||||541|130.23|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|541||||541|82.04|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|541||||541|162.3|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|541||||541|113.61|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|541||||541|73.79|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|541||||541|109.93|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|541||||541|259.41|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|541||||541|115.25|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|541||||541|486.9|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|541||||541|0|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|541||||541|23.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|541||||541|74.45|503.13|23.45
32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|541||||541|270.5|503.13|23.45
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|490||||490|33.22|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|490||||490|76.8|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|490||||490|78.28|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|490||||490|78.28|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|490||||490|74.59|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|490||||490|245.49|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|490||||490|171.99|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|490||||490|210.7|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|490||||490|208.74|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|490||||490|245|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|490||||490|318.5|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|490||||490|30.08|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|490||||490|18.96|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|GEHA [1415]|GEHA [141500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|490||||490|169.41|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|490||||490|210.7|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|490||||490|455.7|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|490||||490|294|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|490||||490|82.04|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|490||||490|148.92|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|490||||490|75.61|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|490||||490|101.65|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|490||||490|76.8|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|490||||490|112.94|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|490||||490|81.36|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|490||||490|82.04|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|Self-pay|Self-pay|490||||490|147|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|490||||490|102.9|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|490||||490|73.79|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|490||||490|109.93|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|490||||490|234.96|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|490||||490|72.01|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|490||||490|441|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|490||||490|0|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|490||||490|18.96|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|490||||490|75.29|455.7|18.96
32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|490||||490|245|455.7|18.96
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|678||||678|39.34|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|678||||678|76.8|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|678||||678|78.28|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|678||||678|78.28|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|678||||678|74.59|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|678||||678|339.68|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|678||||678|237.98|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|678||||678|291.54|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|678||||678|288.83|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|678||||678|339|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|678||||678|440.7|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|678||||678|34.1|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|678||||678|21.95|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|678||||678|167.5|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|678||||678|291.54|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|678||||678|630.54|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|678||||678|406.8|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|678||||678|82.04|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|678||||678|148.92|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|678||||678|75.61|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|678||||678|100.5|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|678||||678|75.93|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|678||||678|111.67|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|678||||678|81.36|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|678||||678|82.04|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|Self-pay|Self-pay|678||||678|203.4|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|678||||678|142.38|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|678||||678|72.96|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|678||||678|108.69|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|678||||678|325.1|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|678||||678|72.01|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|678||||678|610.2|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|678||||678|0|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|678||||678|21.95|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|678||||678|74.45|630.54|21.95
32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|678||||678|339|630.54|21.95
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|430||||430|32.61|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|430||||430|76.8|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|430||||430|78.28|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|430||||430|78.28|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|430||||430|74.59|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|430||||430|215.43|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|430||||430|150.93|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|430||||430|184.9|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|430||||430|183.18|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|430||||430|215|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|430||||430|279.5|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|430||||430|31.03|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|430||||430|19|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|430||||430|169.41|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|430||||430|184.9|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|430||||430|399.9|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|430||||430|258|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|430||||430|82.04|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|430||||430|148.92|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|430||||430|75.61|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|430||||430|101.65|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|430||||430|76.8|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|430||||430|112.94|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|430||||430|81.36|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|430||||430|82.04|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|Self-pay|Self-pay|430||||430|129|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|430||||430|90.3|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|430||||430|73.79|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|430||||430|109.93|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|430||||430|206.19|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|430||||430|72.01|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|430||||430|387|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|430||||430|0|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|430||||430|19|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|430||||430|75.29|399.9|19
32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|430||||430|215|399.9|19
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|356||||356|38.11|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356||||356|76.8|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356||||356|78.28|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356||||356|78.28|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356||||356|74.59|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|356||||356|178.36|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356||||356|124.96|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356||||356|153.08|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|356||||356|151.66|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|356||||356|178|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356||||356|231.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|356||||356|32.38|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|356||||356|20.2|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|GEHA [1415]|GEHA [141500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|356||||356|169.41|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356||||356|153.08|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|356||||356|331.08|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356||||356|213.6|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356||||356|82.04|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356||||356|148.92|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356||||356|75.61|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356||||356|101.65|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356||||356|76.8|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|356||||356|112.94|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|356||||356|81.36|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356||||356|82.04|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|Self-pay|Self-pay|356||||356|106.8|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356||||356|74.76|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|356||||356|73.79|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356||||356|109.93|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356||||356|170.7|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356||||356|72.01|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356||||356|320.4|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|356||||356|0|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|356||||356|20.2|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|356||||356|75.29|331.08|20.2
32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|356||||356|178|331.08|20.2
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|436||||436|75.29|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|AETNA [1015]|AETNA ACO WILCO [101532]|436||||436|33.22|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|436||||436|76.8|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|436||||436|81.94|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|436||||436|81.94|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|436||||436|74.59|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|436||||436|218.44|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|436||||436|153.04|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|436||||436|187.48|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|436||||436|185.74|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|436||||436|218|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|436||||436|283.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|CORESOURCE [1315]|CORESOURCE [131500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|436||||436|0|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|436||||436|21.16|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|GEHA [1415]|GEHA [141500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|436||||436|167.5|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HEALTHNET [1495]|HEALTHNET [149500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|436||||436|187.48|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|436||||436|405.48|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|436||||436|261.6|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|436||||436|75.29|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|436||||436|82.04|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|436||||436|148.92|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|436||||436|79.14|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|436||||436|101.65|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|436||||436|76.8|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MULTIPLAN [1680]|HMA [168003]|436||||436|111.67|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MULTIPLAN [1680]|IHC HS [168011]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|436||||436|85.17|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|436||||436|82.04|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|Self-pay|Self-pay|436||||436|130.8|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|436||||436|91.56|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|436||||436|72.96|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|436||||436|109.93|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|TRUSTMARK [2030]|STARMARK [203000]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|436||||436|209.06|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|UMR [2035]|UMR OPTIONS [203501]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|436||||436|0|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|436||||436|392.4|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|436||||436|0|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|436||||436|21.16|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|436||||436|74.45|405.48|21.16
32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|436||||436|218|405.48|21.16
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|479||||479|39.95|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|479||||479|103.45|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|479||||479|156.65|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|479||||479|156.65|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|479||||479|100.46|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|479||||479|239.98|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|479||||479|168.13|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|479||||479|205.97|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|479||||479|204.05|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|479||||479|239.5|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|479||||479|311.35|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|479||||479|0|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|479||||479|25.9|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|GEHA [1415]|GEHA [141500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|479||||479|228.19|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|479||||479|205.97|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|479||||479|445.47|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|479||||479|287.4|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|479||||479|110.51|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|479||||479|268.93|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|479||||479|151.3|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|479||||479|136.91|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|479||||479|102.28|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|479||||479|152.13|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|479||||479|162.82|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|479||||479|110.51|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|Self-pay|Self-pay|479||||479|143.7|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|479||||479|100.59|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|479||||479|99.39|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|479||||479|148.07|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|479||||479|229.68|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|479||||479|0|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|479||||479|431.1|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|479||||479|0|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|479||||479|25.9|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|479||||479|101.42|445.47|25.9
32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|479||||479|239.5|445.47|25.9
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|AETNA [1015]|AETNA ACO WILCO [101532]|908||||908|52.17|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|908||||908|102.28|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|908||||908|125.3|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|908||||908|125.3|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|908||||908|100.46|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|908||||908|454.91|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|908||||908|318.71|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|908||||908|390.44|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|908||||908|386.81|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|908||||908|454|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|908||||908|590.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|CORESOURCE [1315]|CORESOURCE [131500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|CORVEL CORP [2235]|CORVEL CORP [223500]|908||||908|52.99|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|908||||908|32.69|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|GEHA [1415]|GEHA [141500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|908||||908|225.62|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HEALTHNET [1495]|HEALTHNET [149500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|908||||908|390.44|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HEALTHSMART [1505]|HEALTHSMART [150501]|908||||908|844.44|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|908||||908|544.8|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|908||||908|110.51|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|908||||908|268.93|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|908||||908|121.01|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|908||||908|135.37|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|908||||908|102.28|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MULTIPLAN [1680]|HMA [168003]|908||||908|150.41|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MULTIPLAN [1680]|IHC HS [168011]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|908||||908|130.23|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|908||||908|110.51|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|Self-pay|Self-pay|908||||908|272.4|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|908||||908|190.68|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|908||||908|98.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|908||||908|146.4|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|TRUSTMARK [2030]|STARMARK [203000]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|908||||908|435.39|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|UMR [2035]|UMR OPTIONS [203501]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|908||||908|115.25|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|908||||908|817.2|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|908||||908|0|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|908||||908|32.69|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|908||||908|100.27|844.44|32.69
32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2+V & CHEST 1V|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|908||||908|454|844.44|32.69
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1285||||1285|108.4|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1285||||1285|169.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1285||||1285|115.48|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1285||||1285|115.48|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1285||||1285|164.61|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1285||||1285|643.79|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1285||||1285|451.04|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1285||||1285|552.55|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1285||||1285|547.41|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1285||||1285|642.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1285||||1285|835.25|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|CORESOURCE [1315]|CORESOURCE [131500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1285||||1285|101.31|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1285||||1285|68.13|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|GEHA [1415]|GEHA [141500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1285||||1285|373.9|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HEALTHNET [1495]|HEALTHNET [149500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1285||||1285|552.55|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1285||||1285|1195.05|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1285||||1285|771|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1285||||1285|181.08|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1285||||1285|482.2|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1285||||1285|111.53|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1285||||1285|224.34|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1285||||1285|167.59|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MULTIPLAN [1680]|HMA [168003]|1285||||1285|249.27|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MULTIPLAN [1680]|IHC HS [168011]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1285||||1285|120.03|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1285||||1285|181.08|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|Self-pay|Self-pay|1285||||1285|385.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1285||||1285|269.85|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1285||||1285|161.02|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1285||||1285|242.62|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|TRUSTMARK [2030]|STARMARK [203000]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1285||||1285|616.16|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|UMR [2035]|UMR OPTIONS [203501]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1285||||1285|106.22|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1285||||1285|1156.5|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1285||||1285|0|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1285||||1285|68.13|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1285||||1285|166.18|1195.05|68.13
32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1285||||1285|642.5|1195.05|68.13
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|AETNA [1015]|AETNA ACO WILCO [101532]|1415||||1415|173.19|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1415||||1415|169.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1415||||1415|115.48|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1415||||1415|115.48|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1415||||1415|164.61|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1415||||1415|708.92|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1415||||1415|496.67|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1415||||1415|608.45|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1415||||1415|602.79|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1415||||1415|707.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1415||||1415|919.75|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|CORESOURCE [1315]|CORESOURCE [131500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1415||||1415|147.09|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1415||||1415|90.06|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|GEHA [1415]|GEHA [141500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1415||||1415|373.9|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HEALTHNET [1495]|HEALTHNET [149500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1415||||1415|608.45|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1415||||1415|1315.95|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1415||||1415|849|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1415||||1415|181.08|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1415||||1415|268.93|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1415||||1415|111.53|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1415||||1415|224.34|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1415||||1415|169.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MULTIPLAN [1680]|HMA [168003]|1415||||1415|249.27|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MULTIPLAN [1680]|IHC HS [168011]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1415||||1415|120.03|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1415||||1415|181.08|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|Self-pay|Self-pay|1415||||1415|424.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1415||||1415|297.15|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1415||||1415|162.85|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1415||||1415|242.62|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|TRUSTMARK [2030]|STARMARK [203000]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1415||||1415|678.49|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|UMR [2035]|UMR OPTIONS [203501]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1415||||1415|106.22|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1415||||1415|1273.5|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1415||||1415|0|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1415||||1415|90.06|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1415||||1415|166.18|1315.95|90.06
32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF C+|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1415||||1415|707.5|1315.95|90.06
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|AETNA [1015]|AETNA ACO WILCO [101532]|1333||||1333|150.58|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1333||||1333|169.5|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1333||||1333|115.48|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1333||||1333|115.48|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1333||||1333|164.61|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1333||||1333|667.83|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1333||||1333|467.88|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1333||||1333|573.19|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1333||||1333|567.86|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1333||||1333|666.5|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1333||||1333|866.45|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|CORESOURCE [1315]|CORESOURCE [131500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1333||||1333|129.38|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1333||||1333|86.09|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|GEHA [1415]|GEHA [141500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1333||||1333|373.9|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HEALTHNET [1495]|HEALTHNET [149500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1333||||1333|573.19|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1333||||1333|1239.69|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1333||||1333|799.8|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1333||||1333|181.08|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1333||||1333|482.2|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1333||||1333|111.53|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1333||||1333|221.81|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1333||||1333|169.5|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MULTIPLAN [1680]|HMA [168003]|1333||||1333|249.27|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MULTIPLAN [1680]|IHC HS [168011]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1333||||1333|120.03|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1333||||1333|181.08|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|Self-pay|Self-pay|1333||||1333|399.9|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1333||||1333|279.93|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1333||||1333|162.85|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1333||||1333|242.62|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|TRUSTMARK [2030]|STARMARK [203000]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1333||||1333|639.17|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|UMR [2035]|UMR OPTIONS [203501]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1333||||1333|106.22|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1333||||1333|1199.7|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1333||||1333|0|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1333||||1333|86.09|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1333||||1333|166.18|1239.69|86.09
32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1333||||1333|666.5|1239.69|86.09
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1385||||1385|175.03|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1385||||1385|169.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1385||||1385|115.48|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1385||||1385|115.48|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1385||||1385|164.61|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1385||||1385|693.89|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1385||||1385|486.14|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1385||||1385|595.55|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1385||||1385|590.01|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1385||||1385|692.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1385||||1385|900.25|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|CORESOURCE [1315]|CORESOURCE [131500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1385||||1385|145.65|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1385||||1385|95.82|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|GEHA [1415]|GEHA [141500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1385||||1385|373.9|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HEALTHNET [1495]|HEALTHNET [149500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1385||||1385|595.55|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1385||||1385|1288.05|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1385||||1385|831|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1385||||1385|181.08|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1385||||1385|482.2|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1385||||1385|111.53|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1385||||1385|224.34|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1385||||1385|169.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MULTIPLAN [1680]|HMA [168003]|1385||||1385|249.27|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MULTIPLAN [1680]|IHC HS [168011]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1385||||1385|120.03|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1385||||1385|181.08|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|Self-pay|Self-pay|1385||||1385|415.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1385||||1385|290.85|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1385||||1385|162.85|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1385||||1385|242.62|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|TRUSTMARK [2030]|STARMARK [203000]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1385||||1385|664.11|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|UMR [2035]|UMR OPTIONS [203501]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1385||||1385|106.22|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1385||||1385|1246.5|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1385||||1385|0|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1385||||1385|95.82|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1385||||1385|166.18|1288.05|95.82
32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI DOUBLE CONTRAST STUDY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1385||||1385|692.5|1288.05|95.82
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|AETNA [1015]|AETNA ACO WILCO [101532]|1859||||1859|153.64|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1859||||1859|167.59|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1859||||1859|115.48|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1859||||1859|115.48|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1859||||1859|164.61|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1859||||1859|931.36|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1859||||1859|652.51|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1859||||1859|799.37|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1859||||1859|791.93|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1859||||1859|929.5|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1859||||1859|1208.35|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|CORESOURCE [1315]|CORESOURCE [131500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1859||||1859|119.21|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1859||||1859|79.34|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|GEHA [1415]|GEHA [141500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1859||||1859|369.68|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HEALTHNET [1495]|HEALTHNET [149500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1859||||1859|799.37|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1859||||1859|1728.87|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1859||||1859|1115.4|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1859||||1859|181.08|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1859||||1859|268.93|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1859||||1859|111.53|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1859||||1859|221.81|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1859||||1859|167.59|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MULTIPLAN [1680]|HMA [168003]|1859||||1859|246.45|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MULTIPLAN [1680]|IHC HS [168011]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1859||||1859|120.03|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1859||||1859|181.08|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|Self-pay|Self-pay|1859||||1859|557.7|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1859||||1859|390.39|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1859||||1859|161.02|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1859||||1859|239.88|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|TRUSTMARK [2030]|STARMARK [203000]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1859||||1859|891.39|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|UMR [2035]|UMR OPTIONS [203501]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1859||||1859|106.22|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1859||||1859|1673.1|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1859||||1859|0|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1859||||1859|79.34|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1859||||1859|164.3|1728.87|79.34
32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL SINGLE CNTRST STD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1859||||1859|929.5|1728.87|79.34
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|AETNA [1015]|AETNA ACO WILCO [101532]|1285||||1285|217.82|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1285||||1285|169.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1285||||1285|115.48|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1285||||1285|115.48|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1285||||1285|164.61|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1285||||1285|643.79|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1285||||1285|451.04|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1285||||1285|552.55|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1285||||1285|547.41|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1285||||1285|642.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1285||||1285|835.25|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|CORESOURCE [1315]|CORESOURCE [131500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1285||||1285|172.1|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1285||||1285|113.28|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|GEHA [1415]|GEHA [141500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1285||||1285|373.9|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HEALTHNET [1495]|HEALTHNET [149500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1285||||1285|552.55|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1285||||1285|1195.05|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1285||||1285|771|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1285||||1285|181.08|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1285||||1285|482.2|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1285||||1285|111.53|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1285||||1285|224.34|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1285||||1285|169.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MULTIPLAN [1680]|HMA [168003]|1285||||1285|249.27|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MULTIPLAN [1680]|IHC HS [168011]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1285||||1285|120.03|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1285||||1285|181.08|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|Self-pay|Self-pay|1285||||1285|385.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1285||||1285|269.85|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1285||||1285|162.85|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1285||||1285|242.62|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|TRUSTMARK [2030]|STARMARK [203000]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1285||||1285|616.16|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|UMR [2035]|UMR OPTIONS [203501]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1285||||1285|106.22|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1285||||1285|1156.5|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1285||||1285|0|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1285||||1285|113.28|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1285||||1285|166.18|1195.05|106.22
32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1285||||1285|642.5|1195.05|106.22
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1690||||1690|305.83|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1690||||1690|167.59|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1690||||1690|186.76|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1690||||1690|186.76|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1690||||1690|164.61|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1690||||1690|846.69|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1690||||1690|593.19|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1690||||1690|726.7|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1690||||1690|719.94|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1690||||1690|845|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1690||||1690|1098.5|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|CORESOURCE [1315]|CORESOURCE [131500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1690||||1690|244.93|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1690||||1690|159.94|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|GEHA [1415]|GEHA [141500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1690||||1690|369.68|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HEALTHNET [1495]|HEALTHNET [149500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1690||||1690|726.7|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1690||||1690|1571.7|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1690||||1690|1014|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1690||||1690|181.08|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1690||||1690|482.2|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1690||||1690|180.38|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1690||||1690|224.34|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1690||||1690|167.59|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MULTIPLAN [1680]|HMA [168003]|1690||||1690|246.45|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MULTIPLAN [1680]|IHC HS [168011]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1690||||1690|194.11|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1690||||1690|181.08|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|Self-pay|Self-pay|1690||||1690|507|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1690||||1690|354.9|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1690||||1690|161.02|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1690||||1690|239.88|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|TRUSTMARK [2030]|STARMARK [203000]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1690||||1690|810.36|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|UMR [2035]|UMR OPTIONS [203501]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1690||||1690|171.78|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1690||||1690|1521|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1690||||1690|0|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1690||||1690|159.94|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1690||||1690|164.3|1571.7|159.94
32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1690||||1690|845|1571.7|159.94
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1654||||1654|60.38|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1654||||1654|0|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1654||||1654|0|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1654||||1654|828.65|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1654||||1654|580.55|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1654||||1654|711.22|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1654||||1654|704.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1654||||1654|827|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1654||||1654|1075.1|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|CORESOURCE [1315]|CORESOURCE [131500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1654||||1654|61.26|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1654||||1654|37.5|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|GEHA [1415]|GEHA [141500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HEALTHNET [1495]|HEALTHNET [149500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1654||||1654|711.22|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1654||||1654|1538.22|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1654||||1654|992.4|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1654||||1654|827|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1654||||1654|0|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MULTIPLAN [1680]|HMA [168003]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MULTIPLAN [1680]|IHC HS [168011]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1654||||1654|0|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|Self-pay|Self-pay|1654||||1654|496.2|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1654||||1654|347.34|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|TRUSTMARK [2030]|STARMARK [203000]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1654||||1654|793.09|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|UMR [2035]|UMR OPTIONS [203501]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1654||||1654|0|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1654||||1654|1488.6|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1654||||1654|0|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1654||||1654|37.5|1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1654||||1654||1538.22|37.5
32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1654||||1654|827|1538.22|37.5
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|734||||734|34.87|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|734||||734|0|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|734||||734|0|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|734||||734|367.73|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|734||||734|257.63|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|734||||734|315.62|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|734||||734|312.68|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|734||||734|367|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|734||||734|477.1|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|CORESOURCE [1315]|CORESOURCE [131500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|734||||734|34.99|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|734||||734|21.45|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|GEHA [1415]|GEHA [141500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HEALTHNET [1495]|HEALTHNET [149500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|734||||734|315.62|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|734||||734|682.62|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|734||||734|440.4|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|734||||734|367|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|734||||734|0|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MULTIPLAN [1680]|HMA [168003]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MULTIPLAN [1680]|IHC HS [168011]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|734||||734|0|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|Self-pay|Self-pay|734||||734|220.2|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|734||||734|154.14|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|TRUSTMARK [2030]|STARMARK [203000]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|734||||734|351.95|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|UMR [2035]|UMR OPTIONS [203501]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|734||||734|0|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|734||||734|660.6|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|734||||734|0|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|734||||734|21.45|682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|734||||734||682.62|21.45
32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|734||||734|367|682.62|21.45
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|AETNA [1015]|AETNA ACO WILCO [101532]|2367||||2367|216.99|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2367||||2367|0|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2367||||2367|0|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2367||||2367|1185.87|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2367||||2367|830.82|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2367||||2367|1017.81|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2367||||2367|1008.34|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2367||||2367|1183.5|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2367||||2367|1538.55|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2367||||2367|195.69|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2367||||2367|119.81|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|GEHA [1415]|GEHA [141500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2367||||2367|1017.81|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2367||||2367|2201.31|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2367||||2367|1420.2|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2367||||2367|1183.5|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2367||||2367|0|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MULTIPLAN [1680]|HMA [168003]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MULTIPLAN [1680]|IHC HS [168011]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2367||||2367|0|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|Self-pay|Self-pay|2367||||2367|710.1|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2367||||2367|497.07|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2367||||2367|1134.98|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2367||||2367|0|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2367||||2367|2130.3|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2367||||2367|0|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2367||||2367|119.81|2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2367||||2367||2201.31|119.81
32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2367||||2367|1183.5|2201.31|119.81
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|816||||816|143.8|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|816||||816|0|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|816||||816|0|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|816||||816|408.82|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|816||||816|286.42|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|816||||816|350.88|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|816||||816|347.62|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|816||||816|408|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|816||||816|530.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|816||||816|130.78|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|816||||816|80.07|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|GEHA [1415]|GEHA [141500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|816||||816|350.88|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|816||||816|758.88|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|816||||816|489.6|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|816||||816|408|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|816||||816|0|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MULTIPLAN [1680]|HMA [168003]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|816||||816|0|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|Self-pay|Self-pay|816||||816|244.8|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|816||||816|171.36|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|816||||816|391.27|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|UMR [2035]|UMR OPTIONS [203501]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|816||||816|0|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|816||||816|734.4|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|816||||816|0|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|816||||816|80.07|758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|816||||816||758.88|80.07
32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|816||||816|408|758.88|80.07
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|AETNA [1015]|AETNA ACO WILCO [101532]|892||||892|157.46|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|892||||892|0|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|892||||892|0|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|892||||892|446.89|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|892||||892|313.09|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|892||||892|383.56|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|892||||892|379.99|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|892||||892|446|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|892||||892|579.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|CORESOURCE [1315]|CORESOURCE [131500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|892||||892|168.81|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|892||||892|103.35|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|GEHA [1415]|GEHA [141500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HEALTHNET [1495]|HEALTHNET [149500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|892||||892|383.56|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|892||||892|829.56|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|892||||892|535.2|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|892||||892|446|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|892||||892|0|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MULTIPLAN [1680]|HMA [168003]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MULTIPLAN [1680]|IHC HS [168011]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|892||||892|0|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|Self-pay|Self-pay|892||||892|267.6|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|892||||892|187.32|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|TRUSTMARK [2030]|STARMARK [203000]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|892||||892|427.71|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|UMR [2035]|UMR OPTIONS [203501]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|892||||892|0|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|892||||892|802.8|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|892||||892|0|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|892||||892|103.35|829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|892||||892||829.56|103.35
32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|892||||892|446|829.56|103.35
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1136||||1136|79.07|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1136||||1136|226.42|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1136||||1136|226.42|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1136||||1136|569.14|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1136||||1136|398.74|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1136||||1136|488.48|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1136||||1136|483.94|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1136||||1136|568|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1136||||1136|738.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|CORESOURCE [1315]|CORESOURCE [131500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1136||||1136|135.48|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1136||||1136|82.95|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|GEHA [1415]|GEHA [141500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HEALTHNET [1495]|HEALTHNET [149500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1136||||1136|488.48|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1136||||1136|1056.48|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1136||||1136|681.6|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1136||||1136|922.36|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1136||||1136|218.68|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MULTIPLAN [1680]|HMA [168003]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MULTIPLAN [1680]|IHC HS [168011]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1136||||1136|235.34|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|Self-pay|Self-pay|1136||||1136|340.8|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1136||||1136|238.56|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|TRUSTMARK [2030]|STARMARK [203000]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1136||||1136|544.71|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|UMR [2035]|UMR OPTIONS [203501]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1136||||1136|208.26|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1136||||1136|1022.4|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1136||||1136|0|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1136||||1136|82.95|1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1136||||1136||1056.48|79.07
32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1136||||1136|568|1056.48|79.07
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|AETNA [1015]|AETNA ACO WILCO [101532]|1227||||1227|654.85|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1227||||1227|226.42|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1227||||1227|226.42|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1227||||1227|614.73|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1227||||1227|430.68|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1227||||1227|527.61|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1227||||1227|522.7|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1227||||1227|613.5|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1227||||1227|797.55|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|CORESOURCE [1315]|CORESOURCE [131500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1227||||1227|75.27|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1227||||1227|46.12|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|GEHA [1415]|GEHA [141500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HEALTHNET [1495]|HEALTHNET [149500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1227||||1227|527.61|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1227||||1227|1141.11|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1227||||1227|736.2|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1227||||1227|922.36|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1227||||1227|218.68|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MULTIPLAN [1680]|HMA [168003]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MULTIPLAN [1680]|IHC HS [168011]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1227||||1227|235.34|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|Self-pay|Self-pay|1227||||1227|368.1|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1227||||1227|257.67|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|TRUSTMARK [2030]|STARMARK [203000]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1227||||1227|588.35|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|UMR [2035]|UMR OPTIONS [203501]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1227||||1227|208.26|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1227||||1227|1104.3|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1227||||1227|0|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1227||||1227|46.12|1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1227||||1227||1141.11|46.12
32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAPHY ANTEGRADE RS&I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1227||||1227|613.5|1141.11|46.12
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|992||||992|39.95|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|992||||992|349.46|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|992||||992|226.42|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|992||||992|226.42|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|992||||992|339.38|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|992||||992|496.99|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|992||||992|348.19|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|992||||992|426.56|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|992||||992|422.59|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|992||||992|496|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|992||||992|644.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|992||||992|64.34|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|992||||992|39.39|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|GEHA [1415]|GEHA [141500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|992||||992|770.86|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|992||||992|426.56|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|992||||992|922.56|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|992||||992|595.2|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|992||||992|373.32|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|992||||992|922.36|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|992||||992|218.68|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|992||||992|462.52|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|992||||992|349.46|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MULTIPLAN [1680]|HMA [168003]|992||||992|513.91|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|992||||992|235.34|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|992||||992|373.32|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|Self-pay|Self-pay|992||||992|297.6|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|992||||992|208.32|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|992||||992|335.75|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|992||||992|500.2|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|992||||992|475.66|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|992||||992|208.26|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|992||||992|892.8|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|992||||992|0|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|992||||992|39.39|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|992||||992|342.61|922.56|39.39
32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|992||||992|496|922.56|39.39
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|AETNA [1015]|AETNA ACO WILCO [101532]|945||||945|391.4|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|945||||945|216|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|945||||945|226.42|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|945||||945|226.42|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|945||||945|212.16|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|945||||945|473.45|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|945||||945|331.7|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|945||||945|406.35|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|945||||945|402.57|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|945||||945|472.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|945||||945|614.25|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|CORESOURCE [1315]|CORESOURCE [131500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|945||||945|83|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|945||||945|50.85|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|GEHA [1415]|GEHA [141500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|945||||945|476.46|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HEALTHNET [1495]|HEALTHNET [149500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|945||||945|406.35|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|945||||945|878.85|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|945||||945|567|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|945||||945|233.38|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|945||||945|551.1|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|945||||945|218.68|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|945||||945|285.88|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|945||||945|216|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MULTIPLAN [1680]|HMA [168003]|945||||945|317.64|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MULTIPLAN [1680]|IHC HS [168011]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|945||||945|235.34|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|945||||945|233.38|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|Self-pay|Self-pay|945||||945|283.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|945||||945|198.45|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|945||||945|207.53|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|945||||945|309.17|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|TRUSTMARK [2030]|STARMARK [203000]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|945||||945|453.13|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|UMR [2035]|UMR OPTIONS [203501]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|945||||945|208.26|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|945||||945|850.5|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|945||||945|0|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|945||||945|50.85|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|945||||945|211.76|878.85|50.85
32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|945||||945|472.5|878.85|50.85
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|AETNA [1015]|AETNA ACO WILCO [101532]|1244||||1244|127.35|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1244||||1244|218.46|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1244||||1244|226.42|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1244||||1244|226.42|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1244||||1244|212.16|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1244||||1244|623.24|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1244||||1244|436.64|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1244||||1244|534.92|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1244||||1244|529.94|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1244||||1244|622|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1244||||1244|808.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|CORESOURCE [1315]|CORESOURCE [131500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1244||||1244|93.98|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1244||||1244|63.62|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|GEHA [1415]|GEHA [141500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1244||||1244|481.9|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HEALTHNET [1495]|HEALTHNET [149500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1244||||1244|534.92|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1244||||1244|1156.92|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1244||||1244|746.4|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1244||||1244|233.38|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1244||||1244|551.1|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1244||||1244|218.68|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1244||||1244|289.14|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1244||||1244|218.46|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MULTIPLAN [1680]|HMA [168003]|1244||||1244|321.27|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MULTIPLAN [1680]|IHC HS [168011]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1244||||1244|235.34|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1244||||1244|233.38|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|Self-pay|Self-pay|1244||||1244|373.2|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1244||||1244|261.24|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1244||||1244|209.89|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1244||||1244|312.7|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|TRUSTMARK [2030]|STARMARK [203000]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1244||||1244|596.5|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|UMR [2035]|UMR OPTIONS [203501]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1244||||1244|208.26|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1244||||1244|1119.6|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1244||||1244|0|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1244||||1244|63.62|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1244||||1244|214.18|1156.92|63.62
32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1244||||1244|622|1156.92|63.62
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|AETNA [1015]|AETNA ACO WILCO [101532]|1146||||1146|109.01|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1146||||1146|218.46|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1146||||1146|277.37|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1146||||1146|277.37|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1146||||1146|212.16|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1146||||1146|574.15|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1146||||1146|402.25|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1146||||1146|492.78|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1146||||1146|488.2|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1146||||1146|573|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1146||||1146|744.9|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|CORESOURCE [1315]|CORESOURCE [131500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1146||||1146|85.85|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1146||||1146|57.89|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|GEHA [1415]|GEHA [141500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1146||||1146|481.9|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HEALTHNET [1495]|HEALTHNET [149500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1146||||1146|492.78|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1146||||1146|1065.78|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1146||||1146|687.6|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1146||||1146|233.38|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1146||||1146|551.1|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1146||||1146|267.9|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1146||||1146|289.14|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1146||||1146|218.46|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MULTIPLAN [1680]|HMA [168003]|1146||||1146|321.27|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MULTIPLAN [1680]|IHC HS [168011]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1146||||1146|288.29|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1146||||1146|233.38|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|Self-pay|Self-pay|1146||||1146|343.8|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1146||||1146|240.66|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1146||||1146|209.89|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1146||||1146|312.7|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|TRUSTMARK [2030]|STARMARK [203000]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1146||||1146|549.51|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|UMR [2035]|UMR OPTIONS [203501]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1146||||1146|255.13|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1146||||1146|1031.4|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1146||||1146|0|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1146||||1146|57.89|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1146||||1146|214.18|1065.78|57.89
32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1146||||1146|573|1065.78|57.89
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|362||||362|123.08|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|362||||362|99.25|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|362||||362|99.25|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|362||||362|181.36|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|362||||362|127.06|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|362||||362|155.66|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|362||||362|154.21|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|362||||362|181|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|362||||362|235.3|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|CORESOURCE [1315]|CORESOURCE [131500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|362||||362|113.51|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|362||||362|69.5|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|GEHA [1415]|GEHA [141500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HEALTHNET [1495]|HEALTHNET [149500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|362||||362|155.66|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|362||||362|336.66|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|362||||362|217.2|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|362||||362|268.93|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|362||||362|95.86|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MULTIPLAN [1680]|HMA [168003]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MULTIPLAN [1680]|IHC HS [168011]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|362||||362|103.16|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|Self-pay|Self-pay|362||||362|108.6|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|362||||362|76.02|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|TRUSTMARK [2030]|STARMARK [203000]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|362||||362|173.58|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|UMR [2035]|UMR OPTIONS [203501]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|362||||362|91.29|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|362||||362|325.8|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|362||||362|0|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|362||||362|69.5|336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|362||||362||336.66|69.5
32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|362||||362|181|336.66|69.5
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|AETNA [1015]|AETNA ACO WILCO [101532]|7991||||7991|145.7|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7991||||7991|2588.88|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7991||||7991|2588.88|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7991||||7991|4003.49|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7991||||7991|2804.84|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7991||||7991|3436.13|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7991||||7991|3404.17|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7991||||7991|3995.5|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7991||||7991|5194.15|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|CORESOURCE [1315]|CORESOURCE [131500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7991||||7991|261.72|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7991||||7991|160.24|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|GEHA [1415]|GEHA [141500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HEALTHNET [1495]|HEALTHNET [149500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7991||||7991|3436.13|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7991||||7991|7431.63|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7991||||7991|4794.6|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7991||||7991|6313.87|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7991||||7991|2500.44|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MULTIPLAN [1680]|HMA [168003]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MULTIPLAN [1680]|IHC HS [168011]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7991||||7991|2690.82|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|Self-pay|Self-pay|7991||||7991|2397.3|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7991||||7991|1678.11|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|TRUSTMARK [2030]|STARMARK [203000]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7991||||7991|3831.68|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|UMR [2035]|UMR OPTIONS [203501]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7991||||7991|2381.31|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7991||||7991|7191.9|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7991||||7991|0|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7991||||7991|160.24|7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7991||||7991||7431.63|145.7
32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7991||||7991|3995.5|7431.63|145.7
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|AETNA [1015]|AETNA ACO WILCO [101532]|3125||||3125|710.96|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3125||||3125|0|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3125||||3125|0|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3125||||3125|1565.63|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3125||||3125|1096.88|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3125||||3125|1343.75|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3125||||3125|1331.25|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3125||||3125|1562.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3125||||3125|2031.25|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|CORESOURCE [1315]|CORESOURCE [131500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3125||||3125|515.48|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3125||||3125|315.6|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|GEHA [1415]|GEHA [141500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HEALTHNET [1495]|HEALTHNET [149500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3125||||3125|1343.75|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3125||||3125|2906.25|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3125||||3125|1875|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3125||||3125|1562.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3125||||3125|0|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MULTIPLAN [1680]|HMA [168003]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MULTIPLAN [1680]|IHC HS [168011]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3125||||3125|0|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|Self-pay|Self-pay|3125||||3125|937.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3125||||3125|656.25|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|TRUSTMARK [2030]|STARMARK [203000]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3125||||3125|1498.44|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|UMR [2035]|UMR OPTIONS [203501]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3125||||3125|0|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3125||||3125|2812.5|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3125||||3125|0|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3125||||3125|315.6|2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3125||||3125||2906.25|315.6
32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3125||||3125|1562.5|2906.25|315.6
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|AETNA [1015]|AETNA ACO WILCO [101532]|1618||||1618|116.35|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1618||||1618|0|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1618||||1618|0|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1618||||1618|810.62|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1618||||1618|567.92|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1618||||1618|695.74|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1618||||1618|689.27|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1618||||1618|809|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1618||||1618|1051.7|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|CORESOURCE [1315]|CORESOURCE [131500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1618||||1618|121.65|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1618||||1618|74.48|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|GEHA [1415]|GEHA [141500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HEALTHNET [1495]|HEALTHNET [149500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1618||||1618|695.74|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1618||||1618|1504.74|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1618||||1618|970.8|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1618||||1618|809|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1618||||1618|0|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MULTIPLAN [1680]|HMA [168003]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MULTIPLAN [1680]|IHC HS [168011]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1618||||1618|0|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|Self-pay|Self-pay|1618||||1618|485.4|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1618||||1618|339.78|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|TRUSTMARK [2030]|STARMARK [203000]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1618||||1618|775.83|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|UMR [2035]|UMR OPTIONS [203501]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1618||||1618|0|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1618||||1618|1456.2|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1618||||1618|0|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1618||||1618|74.48|1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1618||||1618||1504.74|74.48
32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1618||||1618|809|1504.74|74.48
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2597||||2597|131.46|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2597||||2597|0|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2597||||2597|0|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2597||||2597|1301.1|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2597||||2597|911.55|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2597||||2597|1116.71|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2597||||2597|1106.32|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2597||||2597|1298.5|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2597||||2597|1688.05|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2597||||2597|201.62|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2597||||2597|123.44|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|GEHA [1415]|GEHA [141500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2597||||2597|1116.71|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2597||||2597|2415.21|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2597||||2597|1558.2|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2597||||2597|1298.5|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2597||||2597|0|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MULTIPLAN [1680]|HMA [168003]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MULTIPLAN [1680]|IHC HS [168011]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2597||||2597|0|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|Self-pay|Self-pay|2597||||2597|779.1|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2597||||2597|545.37|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|TRUSTMARK [2030]|STARMARK [203000]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2597||||2597|1245.26|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|UMR [2035]|UMR OPTIONS [203501]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2597||||2597|0|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2597||||2597|2337.3|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2597||||2597|0|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2597||||2597|123.44|2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2597||||2597||2415.21|123.44
32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2597||||2597|1298.5|2415.21|123.44
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|AETNA [1015]|AETNA ACO WILCO [101532]|708||||708|54.62|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|708||||708|218.46|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|708||||708|210.38|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|708||||708|210.38|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|708||||708|212.16|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|708||||708|354.71|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|708||||708|248.51|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|708||||708|304.44|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|708||||708|301.61|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|708||||708|354|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|708||||708|460.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|CORESOURCE [1315]|CORESOURCE [131500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|708||||708|87.86|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|708||||708|53.79|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|GEHA [1415]|GEHA [141500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|708||||708|481.9|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HEALTHNET [1495]|HEALTHNET [149500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|708||||708|304.44|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|708||||708|658.44|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|708||||708|424.8|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|708||||708|233.38|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|708||||708|551.1|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|708||||708|203.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|708||||708|289.14|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|708||||708|218.46|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MULTIPLAN [1680]|HMA [168003]|708||||708|321.27|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MULTIPLAN [1680]|IHC HS [168011]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|708||||708|218.66|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|708||||708|233.38|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|Self-pay|Self-pay|708||||708|212.4|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|708||||708|148.68|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|708||||708|209.89|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|708||||708|312.7|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|TRUSTMARK [2030]|STARMARK [203000]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|708||||708|339.49|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|UMR [2035]|UMR OPTIONS [203501]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|708||||708|193.52|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|708||||708|637.2|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|708||||708|0|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|708||||708|53.79|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|708||||708|214.18|658.44|53.79
32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|708||||708|354|658.44|53.79
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|AETNA [1015]|AETNA ACO WILCO [101532]|383||||383|31.39|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|383||||383|78.28|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|383||||383|78.28|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|383||||383|191.88|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|383||||383|134.43|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|383||||383|164.69|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|383||||383|163.16|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|383||||383|191.5|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|383||||383|248.95|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|CORESOURCE [1315]|CORESOURCE [131500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|383||||383|30.11|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|383||||383|19.21|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|GEHA [1415]|GEHA [141500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HEALTHNET [1495]|HEALTHNET [149500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|383||||383|164.69|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|383||||383|356.19|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|383||||383|229.8|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|383||||383|148.92|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|383||||383|75.61|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MULTIPLAN [1680]|HMA [168003]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MULTIPLAN [1680]|IHC HS [168011]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|383||||383|81.36|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|Self-pay|Self-pay|383||||383|114.9|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|383||||383|80.43|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|TRUSTMARK [2030]|STARMARK [203000]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|383||||383|183.65|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|UMR [2035]|UMR OPTIONS [203501]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|383||||383|72.01|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|383||||383|344.7|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|383||||383|0|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|383||||383|19.21|356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|383||||383||356.19|19.21
32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|383||||383|191.5|356.19|19.21
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1202||||1202|53.39|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1202||||1202|458.41|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1202||||1202|277.37|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1202||||1202|277.37|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1202||||1202|445.19|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1202||||1202|602.2|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1202||||1202|421.9|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1202||||1202|516.86|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1202||||1202|512.05|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1202||||1202|601|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1202||||1202|781.3|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|CORESOURCE [1315]|CORESOURCE [131500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1202||||1202|70.44|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1202||||1202|43.12|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|GEHA [1415]|GEHA [141500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1202||||1202|1011.21|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HEALTHNET [1495]|HEALTHNET [149500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1202||||1202|516.86|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1202||||1202|1117.86|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1202||||1202|721.2|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1202||||1202|489.71|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1202||||1202|1189.12|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1202||||1202|267.9|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1202||||1202|606.72|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1202||||1202|458.41|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MULTIPLAN [1680]|HMA [168003]|1202||||1202|674.14|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MULTIPLAN [1680]|IHC HS [168011]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1202||||1202|288.29|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1202||||1202|489.71|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|Self-pay|Self-pay|1202||||1202|360.6|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1202||||1202|252.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1202||||1202|440.44|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1202||||1202|656.16|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|TRUSTMARK [2030]|STARMARK [203000]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1202||||1202|576.36|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|UMR [2035]|UMR OPTIONS [203501]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1202||||1202|255.13|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1202||||1202|1081.8|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1202||||1202|0|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1202||||1202|43.12|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1202||||1202|449.42|1189.12|43.12
32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1202||||1202|601|1189.12|43.12
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|AETNA [1015]|AETNA ACO WILCO [101532]|507||||507|123.69|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|507||||507|0|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|507||||507|0|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|507||||507|254.01|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|507||||507|177.96|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|507||||507|218.01|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|507||||507|215.98|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|507||||507|253.5|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|507||||507|329.55|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|CORESOURCE [1315]|CORESOURCE [131500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|507||||507|96.83|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|507||||507|63.62|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|GEHA [1415]|GEHA [141500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HEALTHNET [1495]|HEALTHNET [149500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|507||||507|218.01|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|507||||507|471.51|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|507||||507|304.2|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|507||||507|253.5|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|507||||507|0|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MULTIPLAN [1680]|HMA [168003]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MULTIPLAN [1680]|IHC HS [168011]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|507||||507|0|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|Self-pay|Self-pay|507||||507|152.1|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|507||||507|106.47|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|TRUSTMARK [2030]|STARMARK [203000]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|507||||507|243.11|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|UMR [2035]|UMR OPTIONS [203501]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|507||||507|0|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|507||||507|456.3|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|507||||507|0|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|507||||507|63.62|471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|507||||507||471.51|63.62
32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|507||||507|253.5|471.51|63.62
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|995||||995|126.74|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|995||||995|0|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|995||||995|0|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|995||||995|498.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|995||||995|349.25|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|995||||995|427.85|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|995||||995|423.87|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|995||||995|497.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|995||||995|646.75|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|CORESOURCE [1315]|CORESOURCE [131500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|995||||995|107.6|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|995||||995|71.37|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|GEHA [1415]|GEHA [141500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HEALTHNET [1495]|HEALTHNET [149500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|995||||995|427.85|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|995||||995|925.35|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|995||||995|597|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|995||||995|497.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|995||||995|0|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MULTIPLAN [1680]|HMA [168003]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MULTIPLAN [1680]|IHC HS [168011]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|995||||995|0|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|Self-pay|Self-pay|995||||995|298.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|995||||995|208.95|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|TRUSTMARK [2030]|STARMARK [203000]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|995||||995|477.1|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|UMR [2035]|UMR OPTIONS [203501]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|995||||995|0|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|995||||995|895.5|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|995||||995|0|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|995||||995|71.37|925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|995||||995||925.35|71.37
32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|995||||995|497.5|925.35|71.37
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1531||||1531|116.96|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1531||||1531|0|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1531||||1531|0|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1531||||1531|767.03|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1531||||1531|537.38|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1531||||1531|658.33|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1531||||1531|652.21|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1531||||1531|765.5|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1531||||1531|995.15|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|CORESOURCE [1315]|CORESOURCE [131500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1531||||1531|108.22|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1531||||1531|69.12|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|GEHA [1415]|GEHA [141500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HEALTHNET [1495]|HEALTHNET [149500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1531||||1531|658.33|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1531||||1531|1423.83|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1531||||1531|918.6|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1531||||1531|765.5|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1531||||1531|0|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MULTIPLAN [1680]|HMA [168003]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MULTIPLAN [1680]|IHC HS [168011]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1531||||1531|0|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|Self-pay|Self-pay|1531||||1531|459.3|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1531||||1531|321.51|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|TRUSTMARK [2030]|STARMARK [203000]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1531||||1531|734.11|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|UMR [2035]|UMR OPTIONS [203501]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1531||||1531|0|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1531||||1531|1377.9|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1531||||1531|0|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1531||||1531|69.12|1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1531||||1531||1423.83|69.12
32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1531||||1531|765.5|1423.83|69.12
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|AETNA [1015]|AETNA ACO WILCO [101532]|451||||451|25.27|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|451||||451|103.45|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|451||||451|125.3|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|451||||451|125.3|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|451||||451|100.46|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|451||||451|225.95|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|451||||451|158.3|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|451||||451|193.93|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|451||||451|192.13|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|451||||451|225.5|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|451||||451|293.15|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|CORESOURCE [1315]|CORESOURCE [131500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|CORVEL CORP [2235]|CORVEL CORP [223500]|451||||451|30.78|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|451||||451|18.84|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|GEHA [1415]|GEHA [141500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|451||||451|228.19|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HEALTHNET [1495]|HEALTHNET [149500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|451||||451|193.93|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HEALTHSMART [1505]|HEALTHSMART [150501]|451||||451|419.43|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|451||||451|270.6|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|451||||451|110.51|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|451||||451|268.93|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|451||||451|121.01|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|451||||451|136.91|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|451||||451|103.45|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MULTIPLAN [1680]|HMA [168003]|451||||451|152.13|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MULTIPLAN [1680]|IHC HS [168011]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|451||||451|130.23|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|451||||451|110.51|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|Self-pay|Self-pay|451||||451|135.3|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|451||||451|94.71|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|451||||451|99.39|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|451||||451|148.07|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|TRUSTMARK [2030]|STARMARK [203000]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|451||||451|216.25|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|UMR [2035]|UMR OPTIONS [203501]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|451||||451|115.25|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|451||||451|405.9|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|451||||451|0|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|451||||451|18.84|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|451||||451|101.42|419.43|18.84
32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|451||||451|225.5|419.43|18.84
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|582||||582|39.95|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|582||||582|103.45|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|582||||582|125.3|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|582||||582|125.3|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|582||||582|100.46|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|582||||582|291.58|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|582||||582|204.28|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|582||||582|250.26|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|582||||582|247.93|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|582||||582|291|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|582||||582|378.3|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|582||||582|42.49|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|582||||582|26.45|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|GEHA [1415]|GEHA [141500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|582||||582|228.19|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|582||||582|250.26|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|582||||582|541.26|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|582||||582|349.2|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|582||||582|110.51|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|582||||582|268.93|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|582||||582|121.01|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|582||||582|136.91|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|582||||582|103.45|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MULTIPLAN [1680]|HMA [168003]|582||||582|152.13|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|582||||582|130.23|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|582||||582|110.51|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|Self-pay|Self-pay|582||||582|174.6|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|582||||582|122.22|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|582||||582|99.39|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|582||||582|148.07|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|582||||582|279.07|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|582||||582|115.25|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|582||||582|523.8|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|582||||582|0|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|582||||582|26.45|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|582||||582|101.42|541.26|26.45
32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|582||||582|291|541.26|26.45
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|531||||531|77.23|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|531||||531|102.28|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|531||||531|125.3|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|531||||531|125.3|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|531||||531|100.46|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|531||||531|266.03|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|531||||531|186.38|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|531||||531|228.33|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|531||||531|226.21|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|531||||531|265.5|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|531||||531|345.15|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|531||||531|74.21|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|531||||531|47.66|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|GEHA [1415]|GEHA [141500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|531||||531|225.62|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|531||||531|228.33|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|531||||531|493.83|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|531||||531|318.6|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|531||||531|110.51|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|531||||531|268.93|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|531||||531|121.01|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|531||||531|135.37|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|531||||531|102.28|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MULTIPLAN [1680]|HMA [168003]|531||||531|150.41|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|531||||531|130.23|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|531||||531|110.51|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|Self-pay|Self-pay|531||||531|159.3|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|531||||531|111.51|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|531||||531|98.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|531||||531|146.4|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|531||||531|254.61|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|531||||531|115.25|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|531||||531|477.9|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|531||||531|0|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|531||||531|47.66|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|531||||531|100.27|493.83|47.66
32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|531||||531|265.5|493.83|47.66
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1243||||1243|112.07|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1243||||1243|103.45|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1243||||1243|210.38|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1243||||1243|210.38|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1243||||1243|100.46|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1243||||1243|622.74|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1243||||1243|436.29|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1243||||1243|534.49|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1243||||1243|529.52|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1243||||1243|621.5|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1243||||1243|807.95|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|CORESOURCE [1315]|CORESOURCE [131500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1243||||1243|111.52|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1243||||1243|68.28|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|GEHA [1415]|GEHA [141500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1243||||1243|228.19|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HEALTHNET [1495]|HEALTHNET [149500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1243||||1243|534.49|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1243||||1243|1155.99|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1243||||1243|745.8|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1243||||1243|110.51|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1243||||1243|268.93|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1243||||1243|203.2|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1243||||1243|136.91|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1243||||1243|103.45|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MULTIPLAN [1680]|HMA [168003]|1243||||1243|152.13|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MULTIPLAN [1680]|IHC HS [168011]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1243||||1243|218.66|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1243||||1243|110.51|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|Self-pay|Self-pay|1243||||1243|372.9|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1243||||1243|261.03|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1243||||1243|99.39|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1243||||1243|148.07|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|TRUSTMARK [2030]|STARMARK [203000]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1243||||1243|596.02|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|UMR [2035]|UMR OPTIONS [203501]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1243||||1243|193.52|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1243||||1243|1118.7|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1243||||1243|0|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1243||||1243|68.28|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1243||||1243|101.42|1155.99|68.28
32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1243||||1243|621.5|1155.99|68.28
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|237.42||||237.42|118.95|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237.42||||237.42|83.33|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237.42||||237.42|102.09|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|237.42||||237.42|101.14|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|237.42||||237.42|118.71|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237.42||||237.42|154.32|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|237.42||||237.42|87.85|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237.42||||237.42|102.09|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|237.42||||237.42|220.8|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237.42||||237.42|142.45|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|Self-pay|Self-pay|237.42||||237.42|71.23|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237.42||||237.42|49.86|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237.42||||237.42|113.84|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237.42||||237.42|213.68|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|237.42||||237.42|0|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|237.42||||237.42|87.85|220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|237.42||||237.42||220.8|49.86
3208|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|237.42||||237.42|118.71|220.8|49.86
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95.79||||95.79|47.99|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.79||||95.79|33.62|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.79||||95.79|41.19|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95.79||||95.79|40.81|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95.79||||95.79|47.9|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.79||||95.79|62.26|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|95.79||||95.79|10.12|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95.79||||95.79|35.44|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|GEHA [1415]|GEHA [141500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.79||||95.79|41.19|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|95.79||||95.79|89.08|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.79||||95.79|57.47|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MULTIPLAN [1680]|HMA [168003]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MULTIPLAN [1680]|IHC HS [168011]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|Self-pay|Self-pay|95.79||||95.79|28.74|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.79||||95.79|20.12|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|TRUSTMARK [2030]|STARMARK [203000]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.79||||95.79|45.93|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|UMR [2035]|UMR OPTIONS [203501]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.79||||95.79|86.21|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95.79||||95.79|0|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95.79||||95.79|35.44|89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95.79||||95.79||89.08|10.12
32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|0.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95.79||||95.79|47.9|89.08|10.12
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|931||||931|143.25|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|931||||931|345.51|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|931||||931|350.03|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|931||||931|350.03|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|931||||931|339.38|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|931||||931|466.43|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|931||||931|326.78|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|931||||931|400.33|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|931||||931|396.61|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|931||||931|465.5|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|931||||931|605.15|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|CORESOURCE [1315]|CORESOURCE [131500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|931||||931|115.25|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|931||||931|77.85|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|GEHA [1415]|GEHA [141500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|931||||931|762.16|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HEALTHNET [1495]|HEALTHNET [149500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|931||||931|400.33|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|931||||931|865.83|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|931||||931|558.6|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|931||||931|373.32|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|931||||931|922.36|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|931||||931|338.07|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|931||||931|457.3|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|931||||931|345.51|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MULTIPLAN [1680]|HMA [168003]|931||||931|508.11|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MULTIPLAN [1680]|IHC HS [168011]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|931||||931|363.81|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|931||||931|373.32|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|Self-pay|Self-pay|931||||931|279.3|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|931||||931|195.51|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|931||||931|331.97|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|931||||931|494.56|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|TRUSTMARK [2030]|STARMARK [203000]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|931||||931|446.41|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|UMR [2035]|UMR OPTIONS [203501]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|931||||931|321.96|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|931||||931|837.9|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|931||||931|0|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|931||||931|77.85|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|931||||931|338.74|922.36|77.85
32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|931||||931|465.5|922.36|77.85
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|510||||510|46.05|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|510||||510|76.8|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|510||||510|125.3|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|510||||510|125.3|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|510||||510|74.59|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|510||||510|255.51|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|510||||510|179.01|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|510||||510|219.3|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|510||||510|217.26|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|510||||510|255|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|510||||510|331.5|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|510||||510|42.71|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|510||||510|26.2|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|GEHA [1415]|GEHA [141500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|510||||510|169.41|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|510||||510|219.3|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|510||||510|474.3|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|510||||510|306|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|510||||510|82.04|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|510||||510|148.92|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|510||||510|121.01|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|510||||510|101.65|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|510||||510|76.8|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MULTIPLAN [1680]|HMA [168003]|510||||510|112.94|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|510||||510|130.23|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|510||||510|82.04|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|Self-pay|Self-pay|510||||510|153|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|510||||510|107.1|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|510||||510|73.79|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|510||||510|109.93|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|510||||510|244.55|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|UMR [2035]|UMR OPTIONS [203501]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|510||||510|115.25|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|510||||510|459|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|510||||510|0|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|510||||510|26.2|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|510||||510|75.29|474.3|26.2
32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|510||||510|255|474.3|26.2
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|AETNA [1015]|AETNA ACO WILCO [101532]|449||||449|33.83|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|449||||449|76.8|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|449||||449|78.28|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|449||||449|78.28|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|449||||449|74.59|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|449||||449|224.95|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|449||||449|157.6|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|449||||449|193.07|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|449||||449|191.27|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|449||||449|224.5|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|449||||449|291.85|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|CORESOURCE [1315]|CORESOURCE [131500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|449||||449|30.35|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|449||||449|19.71|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|GEHA [1415]|GEHA [141500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|449||||449|169.41|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HEALTHNET [1495]|HEALTHNET [149500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|449||||449|193.07|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|449||||449|417.57|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|449||||449|269.4|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|449||||449|82.04|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|449||||449|148.92|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|449||||449|75.61|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|449||||449|101.65|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|449||||449|76.8|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MULTIPLAN [1680]|HMA [168003]|449||||449|112.94|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MULTIPLAN [1680]|IHC HS [168011]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|449||||449|81.36|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|449||||449|82.04|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|Self-pay|Self-pay|449||||449|134.7|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|449||||449|94.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|449||||449|73.79|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|449||||449|109.93|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|TRUSTMARK [2030]|STARMARK [203000]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|449||||449|215.3|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|UMR [2035]|UMR OPTIONS [203501]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|449||||449|72.01|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|449||||449|404.1|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|449||||449|0|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|449||||449|19.71|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|449||||449|75.29|417.57|19.71
32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|449||||449|224.5|417.57|19.71
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|AETNA [1015]|AETNA ACO WILCO [101532]|806||||806|143.85|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|806||||806|345.51|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|806||||806|350.03|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|806||||806|350.03|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|806||||806|339.38|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|806||||806|403.81|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|806||||806|282.91|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|806||||806|346.58|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|806||||806|343.36|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|806||||806|403|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|806||||806|523.9|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|CORESOURCE [1315]|CORESOURCE [131500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|806||||806|117.68|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|806||||806|79.33|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|GEHA [1415]|GEHA [141500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|806||||806|762.16|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|806||||806|346.58|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|806||||806|749.58|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|806||||806|483.6|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|806||||806|373.32|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|806||||806|806|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|806||||806|338.07|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|806||||806|457.3|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|806||||806|345.51|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MULTIPLAN [1680]|HMA [168003]|806||||806|508.11|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|806||||806|363.81|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|806||||806|373.32|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|Self-pay|Self-pay|806||||806|241.8|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|806||||806|169.26|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|806||||806|331.97|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|806||||806|494.56|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|806||||806|386.48|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|UMR [2035]|UMR OPTIONS [203501]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|806||||806|321.96|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|806||||806|725.4|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|806||||806|0|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|806||||806|79.33|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|806||||806|338.74|806|79.33
32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|806||||806|403|806|79.33
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|AETNA [1015]|AETNA ACO WILCO [101532]|11274||||11274|134.69|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11274||||11274|4528.58|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11274||||11274|2588.88|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11274||||11274|2588.88|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11274||||11274|4398|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11274||||11274|5648.27|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11274||||11274|3957.17|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11274||||11274|4847.82|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11274||||11274|4802.72|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11274||||11274|5637|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11274||||11274|7328.1|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|CORESOURCE [1315]|CORESOURCE [131500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11274||||11274|263.88|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11274||||11274|161.56|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|GEHA [1415]|GEHA [141500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11274||||11274|9989.52|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HEALTHNET [1495]|HEALTHNET [149500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11274||||11274|4847.82|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11274||||11274|10484.82|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11274||||11274|6764.4|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11274||||11274|4837.8|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11274||||11274|10460.93|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11274||||11274|2500.44|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11274||||11274|5993.71|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11274||||11274|4528.58|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MULTIPLAN [1680]|HMA [168003]|11274||||11274|6659.68|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MULTIPLAN [1680]|IHC HS [168011]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11274||||11274|2690.82|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11274||||11274|4837.8|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|Self-pay|Self-pay|11274||||11274|3382.2|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11274||||11274|2367.54|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11274||||11274|4350.99|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11274||||11274|6482.09|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|TRUSTMARK [2030]|STARMARK [203000]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11274||||11274|5405.88|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|UMR [2035]|UMR OPTIONS [203501]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11274||||11274|2381.31|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11274||||11274|10146.6|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11274||||11274|0|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11274||||11274|161.56|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11274||||11274|4439.79|10484.82|134.69
32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11274||||11274|5637|10484.82|134.69
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3645||||3645|139.58|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3645||||3645|2716.62|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3645||||3645|2588.88|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3645||||3645|2588.88|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3645||||3645|2638.28|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3645||||3645|1826.15|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3645||||3645|1279.4|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3645||||3645|1567.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3645||||3645|1552.77|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3645||||3645|1822.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3645||||3645|2369.25|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3645||||3645|263.96|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3645||||3645|161.61|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|GEHA [1415]|GEHA [141500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3645||||3645|3645|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3645||||3645|1567.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3645||||3645|3389.85|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3645||||3645|2187|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3645||||3645|2902.11|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3645||||3645|3645|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3645||||3645|2500.44|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3645||||3645|3595.52|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3645||||3645|2716.62|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MULTIPLAN [1680]|HMA [168003]|3645||||3645|3645|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MULTIPLAN [1680]|IHC HS [168011]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3645||||3645|2690.82|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3645||||3645|2902.11|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|Self-pay|Self-pay|3645||||3645|1093.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3645||||3645|765.45|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3645||||3645|2610.08|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3645||||3645|3645|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|TRUSTMARK [2030]|STARMARK [203000]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3645||||3645|1747.78|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|UMR [2035]|UMR OPTIONS [203501]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3645||||3645|2381.31|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3645||||3645|3280.5|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3645||||3645|0|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3645||||3645|161.61|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3645||||3645|2663.35|3645|139.58
32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3645||||3645|1822.5|3645|139.58
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|14922||||14922|154.25|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14922||||14922|4528.58|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14922||||14922|2588.88|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14922||||14922|2588.88|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14922||||14922|4398|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14922||||14922|7475.92|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14922||||14922|5237.62|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14922||||14922|6416.46|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14922||||14922|6356.77|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14922||||14922|7461|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14922||||14922|9699.3|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14922||||14922|314.39|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14922||||14922|192.48|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|GEHA [1415]|GEHA [141500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14922||||14922|9989.52|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14922||||14922|6416.46|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14922||||14922|13877.46|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14922||||14922|8953.2|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14922||||14922|4837.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14922||||14922|10460.93|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14922||||14922|2500.44|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14922||||14922|5993.71|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14922||||14922|4528.58|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MULTIPLAN [1680]|HMA [168003]|14922||||14922|6659.68|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MULTIPLAN [1680]|IHC HS [168011]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14922||||14922|2690.82|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14922||||14922|4837.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|Self-pay|Self-pay|14922||||14922|4476.6|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14922||||14922|3133.62|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14922||||14922|4350.99|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14922||||14922|6482.09|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|TRUSTMARK [2030]|STARMARK [203000]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14922||||14922|7155.1|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|UMR [2035]|UMR OPTIONS [203501]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14922||||14922|2381.31|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14922||||14922|13429.8|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14922||||14922|0|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14922||||14922|192.48|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14922||||14922|4439.79|13877.46|154.25
32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14922||||14922|7461|13877.46|154.25
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|11274||||11274|172.8|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11274||||11274|4528.58|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11274||||11274|2588.88|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11274||||11274|2588.88|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11274||||11274|4398|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11274||||11274|5648.27|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11274||||11274|3957.17|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11274||||11274|4847.82|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11274||||11274|4802.72|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11274||||11274|5637|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11274||||11274|7328.1|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|CORESOURCE [1315]|CORESOURCE [131500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11274||||11274|300.44|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11274||||11274|183.95|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|GEHA [1415]|GEHA [141500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11274||||11274|9989.52|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HEALTHNET [1495]|HEALTHNET [149500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11274||||11274|4847.82|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11274||||11274|10484.82|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11274||||11274|6764.4|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11274||||11274|4837.8|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11274||||11274|10460.93|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11274||||11274|2500.44|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11274||||11274|5993.71|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11274||||11274|4528.58|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MULTIPLAN [1680]|HMA [168003]|11274||||11274|6659.68|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MULTIPLAN [1680]|IHC HS [168011]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11274||||11274|2690.82|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11274||||11274|4837.8|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|Self-pay|Self-pay|11274||||11274|3382.2|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11274||||11274|2367.54|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11274||||11274|4350.99|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11274||||11274|6482.09|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|TRUSTMARK [2030]|STARMARK [203000]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11274||||11274|5405.88|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|UMR [2035]|UMR OPTIONS [203501]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11274||||11274|2381.31|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11274||||11274|10146.6|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11274||||11274|0|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11274||||11274|183.95|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11274||||11274|4439.79|10484.82|172.8
32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11274||||11274|5637|10484.82|172.8
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|7175||||7175|142.64|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7175||||7175|2588.88|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7175||||7175|2588.88|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7175||||7175|3594.68|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7175||||7175|2518.43|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7175||||7175|3085.25|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7175||||7175|3056.55|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7175||||7175|3587.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7175||||7175|4663.75|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7175||||7175|285.85|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7175||||7175|175.01|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|GEHA [1415]|GEHA [141500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7175||||7175|3085.25|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7175||||7175|6672.75|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7175||||7175|4305|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7175||||7175|6313.87|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7175||||7175|2500.44|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MULTIPLAN [1680]|HMA [168003]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MULTIPLAN [1680]|IHC HS [168011]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7175||||7175|2690.82|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|Self-pay|Self-pay|7175||||7175|2152.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7175||||7175|1506.75|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|TRUSTMARK [2030]|STARMARK [203000]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7175||||7175|3440.41|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|UMR [2035]|UMR OPTIONS [203501]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7175||||7175|2381.31|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7175||||7175|6457.5|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7175||||7175|0|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7175||||7175|175.01|6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7175||||7175||6672.75|142.64
32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7175||||7175|3587.5|6672.75|142.64
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|AETNA [1015]|AETNA ACO WILCO [101532]|7991||||7991|157.92|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7991||||7991|915.74|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7991||||7991|915.74|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7991||||7991|4003.49|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7991||||7991|2804.84|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7991||||7991|3436.13|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7991||||7991|3404.17|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7991||||7991|3995.5|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7991||||7991|5194.15|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|CORESOURCE [1315]|CORESOURCE [131500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7991||||7991|240.01|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7991||||7991|146.94|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|GEHA [1415]|GEHA [141500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HEALTHNET [1495]|HEALTHNET [149500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7991||||7991|3436.13|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7991||||7991|7431.63|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7991||||7991|4794.6|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7991||||7991|2614.04|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7991||||7991|884.46|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MULTIPLAN [1680]|HMA [168003]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MULTIPLAN [1680]|IHC HS [168011]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7991||||7991|951.8|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|Self-pay|Self-pay|7991||||7991|2397.3|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7991||||7991|1678.11|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|TRUSTMARK [2030]|STARMARK [203000]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7991||||7991|3831.68|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|UMR [2035]|UMR OPTIONS [203501]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7991||||7991|842.32|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7991||||7991|7191.9|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7991||||7991|0|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7991||||7991|146.94|7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7991||||7991||7431.63|146.94
32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7991||||7991|3995.5|7431.63|146.94
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|2324||||2324|112.68|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2324||||2324|0|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2324||||2324|0|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2324||||2324|1164.32|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2324||||2324|815.72|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2324||||2324|999.32|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2324||||2324|990.02|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2324||||2324|1162|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2324||||2324|1510.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|CORESOURCE [1315]|CORESOURCE [131500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2324||||2324|208.65|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2324||||2324|127.74|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|GEHA [1415]|GEHA [141500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HEALTHNET [1495]|HEALTHNET [149500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2324||||2324|999.32|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2324||||2324|2161.32|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2324||||2324|1394.4|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2324||||2324|1162|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2324||||2324|0|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MULTIPLAN [1680]|HMA [168003]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MULTIPLAN [1680]|IHC HS [168011]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2324||||2324|0|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|Self-pay|Self-pay|2324||||2324|697.2|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2324||||2324|488.04|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|TRUSTMARK [2030]|STARMARK [203000]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2324||||2324|1114.36|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|UMR [2035]|UMR OPTIONS [203501]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2324||||2324|0|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2324||||2324|2091.6|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2324||||2324|0|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2324||||2324|127.74|2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2324||||2324||2161.32|112.68
32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2324||||2324|1162|2161.32|112.68
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1685||||1685|132.24|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1685||||1685|1334.87|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1685||||1685|915.74|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1685||||1685|915.74|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1685||||1685|1296.38|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1685||||1685|844.19|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1685||||1685|591.44|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1685||||1685|724.55|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1685||||1685|717.81|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1685||||1685|842.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1685||||1685|1095.25|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1685||||1685|132.64|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1685||||1685|81.21|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|GEHA [1415]|GEHA [141500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1685||||1685|1685|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1685||||1685|724.55|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1685||||1685|1567.05|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1685||||1685|1011|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1685||||1685|1426.02|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1685||||1685|1481.98|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1685||||1685|884.46|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1685||||1685|1685|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1685||||1685|1334.87|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MULTIPLAN [1680]|HMA [168003]|1685||||1685|1685|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MULTIPLAN [1680]|IHC HS [168011]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1685||||1685|951.8|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1685||||1685|1426.02|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|Self-pay|Self-pay|1685||||1685|505.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1685||||1685|353.85|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1685||||1685|1282.52|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1685||||1685|1685|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|TRUSTMARK [2030]|STARMARK [203000]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1685||||1685|807.96|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|UMR [2035]|UMR OPTIONS [203501]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1685||||1685|842.32|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1685||||1685|1516.5|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1685||||1685|0|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1685||||1685|81.21|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1685||||1685|1308.7|1685|81.21
32375820|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC S&I VENOGRAM EXTREMITY UNILATERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1685||||1685|842.5|1685|81.21
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1805||||1805|135.3|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1805||||1805|1334.87|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1805||||1805|915.74|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1805||||1805|915.74|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1805||||1805|1296.38|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1805||||1805|904.31|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1805||||1805|633.56|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1805||||1805|776.15|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1805||||1805|768.93|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1805||||1805|902.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1805||||1805|1173.25|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1805||||1805|163.72|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1805||||1805|100.24|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|GEHA [1415]|GEHA [141500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1805||||1805|1805|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1805||||1805|776.15|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1805||||1805|1678.65|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1805||||1805|1083|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1805||||1805|1426.02|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1805||||1805|1805|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1805||||1805|884.46|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1805||||1805|1766.74|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1805||||1805|1334.87|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MULTIPLAN [1680]|HMA [168003]|1805||||1805|1805|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MULTIPLAN [1680]|IHC HS [168011]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1805||||1805|951.8|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1805||||1805|1426.02|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|Self-pay|Self-pay|1805||||1805|541.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1805||||1805|379.05|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1805||||1805|1282.52|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1805||||1805|1805|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|TRUSTMARK [2030]|STARMARK [203000]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1805||||1805|865.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|UMR [2035]|UMR OPTIONS [203501]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1805||||1805|842.32|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1805||||1805|1624.5|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1805||||1805|0|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1805||||1805|100.24|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1805||||1805|1308.7|1805|100.24
32375822|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM EXTREMITY BILATERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1805||||1805|902.5|1805|100.24
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|7991||||7991|128.57|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7991||||7991|2716.62|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7991||||7991|2588.88|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7991||||7991|2588.88|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7991||||7991|2638.28|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7991||||7991|4003.49|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7991||||7991|2804.84|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7991||||7991|3436.13|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7991||||7991|3404.17|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7991||||7991|3995.5|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7991||||7991|5194.15|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|CORESOURCE [1315]|CORESOURCE [131500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7991||||7991|258.87|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7991||||7991|158.49|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|GEHA [1415]|GEHA [141500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7991||||7991|5992.54|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HEALTHNET [1495]|HEALTHNET [149500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7991||||7991|3436.13|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7991||||7991|7431.63|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7991||||7991|4794.6|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7991||||7991|2902.11|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7991||||7991|6313.87|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7991||||7991|2500.44|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7991||||7991|3595.52|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7991||||7991|2716.62|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MULTIPLAN [1680]|HMA [168003]|7991||||7991|3995.02|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MULTIPLAN [1680]|IHC HS [168011]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7991||||7991|2690.82|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7991||||7991|2902.11|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|Self-pay|Self-pay|7991||||7991|2397.3|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7991||||7991|1678.11|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7991||||7991|2610.08|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7991||||7991|3888.49|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|TRUSTMARK [2030]|STARMARK [203000]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7991||||7991|3831.68|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|UMR [2035]|UMR OPTIONS [203501]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7991||||7991|2381.31|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7991||||7991|7191.9|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7991||||7991|0|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7991||||7991|158.49|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7991||||7991|2663.35|7431.63|128.57
32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7991||||7991|3995.5|7431.63|128.57
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|AETNA [1015]|AETNA ACO WILCO [101532]|2551||||2551|135.91|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2551||||2551|1334.87|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2551||||2551|915.74|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2551||||2551|915.74|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2551||||2551|1296.38|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2551||||2551|1278.05|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2551||||2551|895.4|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2551||||2551|1096.93|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2551||||2551|1086.73|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2551||||2551|1275.5|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2551||||2551|1658.15|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|CORESOURCE [1315]|CORESOURCE [131500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2551||||2551|260.2|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2551||||2551|159.3|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|GEHA [1415]|GEHA [141500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2551||||2551|2551|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HEALTHNET [1495]|HEALTHNET [149500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2551||||2551|1096.93|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2551||||2551|2372.43|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2551||||2551|1530.6|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2551||||2551|1426.02|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2551||||2551|1481.98|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2551||||2551|884.46|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2551||||2551|1766.74|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2551||||2551|1334.87|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MULTIPLAN [1680]|HMA [168003]|2551||||2551|1963.04|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MULTIPLAN [1680]|IHC HS [168011]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2551||||2551|951.8|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2551||||2551|1426.02|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|Self-pay|Self-pay|2551||||2551|765.3|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2551||||2551|535.71|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2551||||2551|1282.52|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2551||||2551|1910.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|TRUSTMARK [2030]|STARMARK [203000]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2551||||2551|1223.2|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|UMR [2035]|UMR OPTIONS [203501]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2551||||2551|842.32|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2551||||2551|2295.9|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2551||||2551|0|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2551||||2551|159.3|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2551||||2551|1308.7|2551|135.91
32375827|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SUPERIOR VENOCAVOGRAM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2551||||2551|1275.5|2551|135.91
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|7175||||7175|139.58|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7175||||7175|2716.62|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7175||||7175|2588.88|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7175||||7175|2588.88|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7175||||7175|2638.28|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7175||||7175|3594.68|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7175||||7175|2518.43|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7175||||7175|3085.25|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7175||||7175|3056.55|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7175||||7175|3587.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7175||||7175|4663.75|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7175||||7175|262.26|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7175||||7175|160.57|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|GEHA [1415]|GEHA [141500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7175||||7175|5992.54|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7175||||7175|3085.25|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7175||||7175|6672.75|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7175||||7175|4305|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7175||||7175|2902.11|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7175||||7175|6313.87|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7175||||7175|2500.44|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7175||||7175|3595.52|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7175||||7175|2716.62|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MULTIPLAN [1680]|HMA [168003]|7175||||7175|3995.02|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MULTIPLAN [1680]|IHC HS [168011]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7175||||7175|2690.82|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7175||||7175|2902.11|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|Self-pay|Self-pay|7175||||7175|2152.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7175||||7175|1506.75|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7175||||7175|2610.08|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7175||||7175|3888.49|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|TRUSTMARK [2030]|STARMARK [203000]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7175||||7175|3440.41|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|UMR [2035]|UMR OPTIONS [203501]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7175||||7175|2381.31|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7175||||7175|6457.5|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7175||||7175|0|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7175||||7175|160.57|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7175||||7175|2663.35|6672.75|139.58
32375831|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM RENAL UNILATERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7175||||7175|3587.5|6672.75|139.58
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|AETNA [1015]|AETNA ACO WILCO [101532]|7991||||7991|1855.3|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7991||||7991|99.25|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7991||||7991|99.25|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7991||||7991|4003.49|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7991||||7991|2804.84|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7991||||7991|3436.13|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7991||||7991|3404.17|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7991||||7991|3995.5|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7991||||7991|5194.15|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|CORESOURCE [1315]|CORESOURCE [131500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7991||||7991|153.94|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7991||||7991|95.68|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|GEHA [1415]|GEHA [141500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HEALTHNET [1495]|HEALTHNET [149500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7991||||7991|3436.13|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7991||||7991|7431.63|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7991||||7991|4794.6|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7991||||7991|2614.04|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7991||||7991|95.86|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MULTIPLAN [1680]|HMA [168003]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MULTIPLAN [1680]|IHC HS [168011]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7991||||7991|103.16|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|Self-pay|Self-pay|7991||||7991|2397.3|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7991||||7991|1678.11|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|TRUSTMARK [2030]|STARMARK [203000]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7991||||7991|3831.68|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|UMR [2035]|UMR OPTIONS [203501]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7991||||7991|91.29|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7991||||7991|7191.9|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7991||||7991|0|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7991||||7991|95.68|7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7991||||7991||7431.63|91.29
32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7991||||7991|3995.5|7431.63|91.29
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|AETNA [1015]|AETNA ACO WILCO [101532]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|356.21||||356.21|178.46|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356.21||||356.21|125.03|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356.21||||356.21|153.17|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|356.21||||356.21|151.75|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|356.21||||356.21|178.11|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356.21||||356.21|231.54|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|CORESOURCE [1315]|CORESOURCE [131500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|CORVEL CORP [2235]|CORVEL CORP [223500]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|356.21||||356.21|131.8|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|GEHA [1415]|GEHA [141500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HEALTHNET [1495]|HEALTHNET [149500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356.21||||356.21|153.17|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HEALTHSMART [1505]|HEALTHSMART [150501]|356.21||||356.21|331.28|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356.21||||356.21|213.73|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MULTIPLAN [1680]|HMA [168003]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MULTIPLAN [1680]|IHC HS [168011]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|Self-pay|Self-pay|356.21||||356.21|106.86|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356.21||||356.21|74.8|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|TRUSTMARK [2030]|STARMARK [203000]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356.21||||356.21|170.8|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|UMR [2035]|UMR OPTIONS [203501]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356.21||||356.21|320.59|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|356.21||||356.21|0|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|356.21||||356.21|131.8|331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|356.21||||356.21||331.28|74.8
32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|30 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|356.21||||356.21|178.11|331.28|74.8
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|1582.06||||1582.06|0|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1582.06||||1582.06|620.67|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1582.06||||1582.06|735|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1582.06||||1582.06|735|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1582.06||||1582.06|792.61|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1582.06||||1582.06|555.3|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1582.06||||1582.06|680.29|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1582.06||||1582.06|673.96|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1582.06||||1582.06|791.03|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1582.06||||1582.06|1028.34|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|CORESOURCE [1315]|CORESOURCE [131500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|1582.06||||1582.06|601.43|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1582.06||||1582.06|585.36|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|GEHA [1415]|GEHA [141500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1582.06||||1582.06|553.72|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HEALTHNET [1495]|HEALTHNET [149500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1582.06||||1582.06|680.29|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|1582.06||||1582.06|1471.32|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1582.06||||1582.06|949.24|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1582.06||||1582.06|669.35|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1582.06||||1582.06|887|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1582.06||||1582.06|710.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1582.06||||1582.06|821.48|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1582.06||||1582.06|620.67|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MULTIPLAN [1680]|HMA [168003]|1582.06||||1582.06|553.72|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MULTIPLAN [1680]|IHC HS [168011]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|1582.06||||1582.06|763.94|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1582.06||||1582.06|669.35|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|Self-pay|Self-pay|1582.06||||1582.06|474.62|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1582.06||||1582.06|332.23|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1582.06||||1582.06|596.33|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1582.06||||1582.06|644.48|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|TRUSTMARK [2030]|STARMARK [203000]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1582.06||||1582.06|758.6|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|UMR [2035]|UMR OPTIONS [203501]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1582.06||||1582.06|676.65|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1582.06||||1582.06|1423.85|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1582.06||||1582.06|0|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1582.06||||1582.06|585.36|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1582.06||||1582.06|608.5|1471.32|332.23
32700|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1582.06||||1582.06|791.03|1471.32|332.23
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.81|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0.81|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.84|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.84|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.81
3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.81
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|397||||397|91.96|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|397||||397|63.38|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|397||||397|67.32|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|397||||397|67.32|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|397||||397|198.9|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|397||||397|139.35|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|397||||397|71.83|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|397||||397|169.12|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|397||||397|198.5|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|397||||397|258.05|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|CORESOURCE [1315]|CORESOURCE [131500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|397||||397|0|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|397||||397|46.4|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|GEHA [1415]|GEHA [141500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|397||||397|139.82|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HEALTHNET [1495]|HEALTHNET [149500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|397||||397|71.83|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|397||||397|369.21|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|397||||397|238.2|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|397||||397|68.35|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|397||||397|198.5|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|397||||397|65.03|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|397||||397|83.89|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|397||||397|63.38|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MULTIPLAN [1680]|HMA [168003]|397||||397|93.21|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MULTIPLAN [1680]|IHC HS [168011]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|397||||397|69.97|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|397||||397|68.35|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|Self-pay|Self-pay|397||||397|119.1|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|397||||397|83.37|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|397||||397|60.9|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|397||||397|90.72|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|TRUSTMARK [2030]|STARMARK [203000]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|397||||397|190.36|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|UMR [2035]|UMR OPTIONS [203501]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|397||||397|61.93|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|397||||397|357.3|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|397||||397|38.79|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|397||||397|46.4|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|397||||397|62.14|369.21|38.79
33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|397||||397|198.5|369.21|38.79
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|AETNA [1015]|AETNA ACO WILCO [101532]|769||||769|0|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|769||||769|295|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|769||||769|99.85|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|769||||769|99.85|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|769||||769|286.5|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|769||||769|385.27|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|769||||769|269.92|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|769||||769|330.67|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|769||||769|327.59|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|769||||769|384.5|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|769||||769|499.85|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|CORESOURCE [1315]|CORESOURCE [131500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|769||||769|0|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|769||||769|284.53|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|GEHA [1415]|GEHA [141500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|769||||769|650.74|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HEALTHNET [1495]|HEALTHNET [149500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|769||||769|330.67|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|769||||769|715.17|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|769||||769|461.4|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|769||||769|315.15|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|769||||769|689.3|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|769||||769|96.44|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|769||||769|390.44|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|769||||769|295|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MULTIPLAN [1680]|HMA [168003]|769||||769|433.83|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MULTIPLAN [1680]|IHC HS [168011]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|769||||769|103.78|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|769||||769|315.15|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|Self-pay|Self-pay|769||||769|230.7|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|769||||769|161.49|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|769||||769|283.43|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|769||||769|422.26|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|TRUSTMARK [2030]|STARMARK [203000]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|769||||769|368.74|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|UMR [2035]|UMR OPTIONS [203501]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|769||||769|91.84|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|769||||769|692.1|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|769||||769|0|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|769||||769|284.53|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|769||||769|289.22|715.17|91.84
33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|769||||769|384.5|715.17|91.84
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64.12||||64.12|32.12|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.12||||64.12|22.51|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.12||||64.12|27.57|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64.12||||64.12|27.32|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64.12||||64.12|32.06|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.12||||64.12|41.68|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64.12||||64.12|23.72|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|GEHA [1415]|GEHA [141500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.12||||64.12|27.57|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|64.12||||64.12|59.63|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.12||||64.12|38.47|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MULTIPLAN [1680]|HMA [168003]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|Self-pay|Self-pay|64.12||||64.12|19.24|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.12||||64.12|13.47|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.12||||64.12|30.75|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|UMR [2035]|UMR OPTIONS [203501]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.12||||64.12|57.71|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64.12||||64.12|0|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64.12||||64.12|23.72|59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64.12||||64.12||59.63|13.47
33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64.12||||64.12|32.06|59.63|13.47
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|956||||956|158.88|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|956||||956|0|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|956||||956|0|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|956||||956|478.96|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|956||||956|335.56|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|956||||956|411.08|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|956||||956|407.26|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|956||||956|478|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|956||||956|621.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|956||||956|170.64|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|956||||956|353.72|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|GEHA [1415]|GEHA [141500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|956||||956|411.08|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|956||||956|889.08|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|956||||956|573.6|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|956||||956|478|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|956||||956|0|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MULTIPLAN [1680]|HMA [168003]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MULTIPLAN [1680]|IHC HS [168011]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|956||||956|0|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|Self-pay|Self-pay|956||||956|286.8|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|956||||956|200.76|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|TRUSTMARK [2030]|STARMARK [203000]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|956||||956|458.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|UMR [2035]|UMR OPTIONS [203501]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|956||||956|0|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|956||||956|860.4|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|956||||956|0|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|956||||956|353.72|889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|956||||956||889.08|158.88
33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDANCE RADIATION THERAPY FLDS PLACEMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|956||||956|478|889.08|158.88
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1185||||1185|57.51|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1185||||1185|120.44|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1185||||1185|149.24|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1185||||1185|149.24|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1185||||1185|116.97|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1185||||1185|593.69|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1185||||1185|415.94|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1185||||1185|509.55|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1185||||1185|504.81|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1185||||1185|592.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1185||||1185|770.25|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|CORESOURCE [1315]|CORESOURCE [131500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1185||||1185|86.15|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1185||||1185|438.45|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|GEHA [1415]|GEHA [141500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1185||||1185|265.67|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HEALTHNET [1495]|HEALTHNET [149500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1185||||1185|509.55|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1185||||1185|1102.05|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1185||||1185|711|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1185||||1185|128.66|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1185||||1185|295.85|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1185||||1185|144.14|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1185||||1185|159.4|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1185||||1185|120.44|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MULTIPLAN [1680]|HMA [168003]|1185||||1185|177.12|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MULTIPLAN [1680]|IHC HS [168011]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1185||||1185|155.12|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1185||||1185|128.66|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|Self-pay|Self-pay|1185||||1185|355.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1185||||1185|248.85|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1185||||1185|115.72|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1185||||1185|172.39|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|TRUSTMARK [2030]|STARMARK [203000]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1185||||1185|568.21|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|UMR [2035]|UMR OPTIONS [203501]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1185||||1185|137.27|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1185||||1185|1066.5|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1185||||1185|0|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1185||||1185|438.45|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1185||||1185|118.08|1102.05|57.51
33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1185||||1185|592.5|1102.05|57.51
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
33541|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001001|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001002|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001003|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001004|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001007|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001008|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001009|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001010|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001011|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001012|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001013|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001014|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001015|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001016|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001017|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001018|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001019|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001020|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001021|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001022|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34001023|EAP|0340 - NUCLEAR MEDICINE-GENERAL|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101001|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101002|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101003|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101004|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101007|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101008|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101009|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101010|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101011|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101014|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101015|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101016|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101017|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101019|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101020|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101021|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101022|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34101023|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1053||||1053|126.96|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1053||||1053|358|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1053||||1053|142.18|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1053||||1053|142.18|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1053||||1053|347.68|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1053||||1053|527.55|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1053||||1053|369.6|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1053||||1053|452.79|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1053||||1053|448.58|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1053||||1053|526.5|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1053||||1053|684.45|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|CORESOURCE [1315]|CORESOURCE [131500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1053||||1053|112.6|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1053||||1053|389.61|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|GEHA [1415]|GEHA [141500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1053||||1053|789.71|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HEALTHNET [1495]|HEALTHNET [149500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1053||||1053|452.79|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1053||||1053|979.29|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1053||||1053|631.8|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1053||||1053|382.45|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1053||||1053|844.93|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1053||||1053|137.33|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1053||||1053|473.82|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1053||||1053|358|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MULTIPLAN [1680]|HMA [168003]|1053||||1053|526.47|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MULTIPLAN [1680]|IHC HS [168011]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1053||||1053|147.78|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1053||||1053|382.45|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|Self-pay|Self-pay|1053||||1053|315.9|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1053||||1053|221.13|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1053||||1053|343.96|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1053||||1053|512.43|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|TRUSTMARK [2030]|STARMARK [203000]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1053||||1053|504.91|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|UMR [2035]|UMR OPTIONS [203501]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1053||||1053|130.79|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1053||||1053|947.7|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1053||||1053|0|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1053||||1053|389.61|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1053||||1053|350.98|979.29|112.6
34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1053||||1053|526.5|979.29|112.6
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|AETNA [1015]|AETNA ACO WILCO [101532]|401||||401|307.49|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|401||||401|358|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|401||||401|187.1|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|401||||401|187.1|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|401||||401|347.68|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|401||||401|200.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|401||||401|140.75|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|401||||401|172.43|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|401||||401|170.83|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|401||||401|200.5|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|401||||401|260.65|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|CORESOURCE [1315]|CORESOURCE [131500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|401||||401|245.37|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|401||||401|148.37|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|GEHA [1415]|GEHA [141500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|401||||401|401|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HEALTHNET [1495]|HEALTHNET [149500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|401||||401|172.43|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|401||||401|372.93|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|401||||401|240.6|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|401||||401|382.45|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|401||||401|401|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|401||||401|180.71|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|401||||401|401|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|401||||401|358|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MULTIPLAN [1680]|HMA [168003]|401||||401|401|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MULTIPLAN [1680]|IHC HS [168011]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|401||||401|194.47|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|401||||401|382.45|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|Self-pay|Self-pay|401||||401|120.3|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|401||||401|84.21|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|401||||401|343.96|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|401||||401|401|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|TRUSTMARK [2030]|STARMARK [203000]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|401||||401|192.28|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|UMR [2035]|UMR OPTIONS [203501]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|401||||401|172.1|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|401||||401|360.9|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|401||||401|0|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|401||||401|148.37|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|401||||401|350.98|401|84.21
34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|401||||401|200.5|401|84.21
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|3009||||3009|481.3|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3009||||3009|464.59|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3009||||3009|382.67|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3009||||3009|382.67|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3009||||3009|451.19|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3009||||3009|1507.51|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3009||||3009|1056.16|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3009||||3009|1293.87|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3009||||3009|1281.83|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3009||||3009|1504.5|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3009||||3009|1955.85|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|CORESOURCE [1315]|CORESOURCE [131500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3009||||3009|372.67|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3009||||3009|1113.33|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|GEHA [1415]|GEHA [141500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3009||||3009|1024.83|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HEALTHNET [1495]|HEALTHNET [149500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3009||||3009|1293.87|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3009||||3009|2798.37|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3009||||3009|1805.4|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3009||||3009|496.31|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3009||||3009|1088.8|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3009||||3009|369.6|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3009||||3009|614.9|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3009||||3009|464.59|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MULTIPLAN [1680]|HMA [168003]|3009||||3009|683.22|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MULTIPLAN [1680]|IHC HS [168011]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3009||||3009|397.74|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3009||||3009|496.31|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|Self-pay|Self-pay|3009||||3009|902.7|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3009||||3009|631.89|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3009||||3009|446.37|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3009||||3009|665|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|TRUSTMARK [2030]|STARMARK [203000]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3009||||3009|1442.82|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|UMR [2035]|UMR OPTIONS [203501]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3009||||3009|351.99|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3009||||3009|2708.1|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3009||||3009|0|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3009||||3009|1113.33|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3009||||3009|455.48|2798.37|351.99
34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3009||||3009|1504.5|2798.37|351.99
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|AETNA [1015]|AETNA ACO WILCO [101532]|1477||||1477|459.07|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1477||||1477|358|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1477||||1477|292.52|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1477||||1477|292.52|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1477||||1477|347.68|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1477||||1477|739.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1477||||1477|518.43|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1477||||1477|635.11|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1477||||1477|629.2|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1477||||1477|738.5|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1477||||1477|960.05|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|CORESOURCE [1315]|CORESOURCE [131500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1477||||1477|357.22|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1477||||1477|546.49|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|GEHA [1415]|GEHA [141500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1477||||1477|789.71|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HEALTHNET [1495]|HEALTHNET [149500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1477||||1477|635.11|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1477||||1477|1373.61|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1477||||1477|886.2|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1477||||1477|382.45|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1477||||1477|844.93|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1477||||1477|282.53|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1477||||1477|473.82|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1477||||1477|358|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MULTIPLAN [1680]|HMA [168003]|1477||||1477|526.47|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MULTIPLAN [1680]|IHC HS [168011]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1477||||1477|304.04|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1477||||1477|382.45|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|Self-pay|Self-pay|1477||||1477|443.1|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1477||||1477|310.17|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1477||||1477|343.96|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1477||||1477|512.43|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|TRUSTMARK [2030]|STARMARK [203000]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1477||||1477|708.22|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|UMR [2035]|UMR OPTIONS [203501]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1477||||1477|269.07|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1477||||1477|1329.3|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1477||||1477|0|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1477||||1477|546.49|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1477||||1477|350.98|1373.61|269.07
34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1477||||1477|738.5|1373.61|269.07
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|AETNA [1015]|AETNA ACO WILCO [101532]|4387||||4387|526.52|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4387||||4387|464.59|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4387||||4387|340.96|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4387||||4387|340.96|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4387||||4387|451.19|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4387||||4387|2197.89|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4387||||4387|1539.84|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4387||||4387|1886.41|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4387||||4387|1868.86|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4387||||4387|2193.5|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4387||||4387|2851.55|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4387||||4387|392.51|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4387||||4387|1623.19|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|GEHA [1415]|GEHA [141500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4387||||4387|1024.83|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4387||||4387|1886.41|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4387||||4387|4079.91|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4387||||4387|2632.2|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4387||||4387|496.31|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4387||||4387|1088.8|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4387||||4387|329.32|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4387||||4387|614.9|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4387||||4387|464.59|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MULTIPLAN [1680]|HMA [168003]|4387||||4387|683.22|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MULTIPLAN [1680]|IHC HS [168011]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4387||||4387|354.39|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4387||||4387|496.31|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|Self-pay|Self-pay|4387||||4387|1316.1|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4387||||4387|921.27|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4387||||4387|446.37|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4387||||4387|665|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4387||||4387|2103.57|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4387||||4387|313.63|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4387||||4387|3948.3|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4387||||4387|0|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4387||||4387|1623.19|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4387||||4387|455.48|4079.91|313.63
34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4387||||4387|2193.5|4079.91|313.63
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1705||||1705|301.37|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1705||||1705|358|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1705||||1705|383.62|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1705||||1705|383.62|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1705||||1705|347.68|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1705||||1705|854.21|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1705||||1705|598.46|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1705||||1705|733.15|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1705||||1705|726.33|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1705||||1705|852.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1705||||1705|1108.25|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1705||||1705|231.09|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1705||||1705|630.85|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|GEHA [1415]|GEHA [141500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1705||||1705|789.71|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1705||||1705|733.15|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1705||||1705|1585.65|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1705||||1705|1023|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1705||||1705|382.45|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1705||||1705|844.93|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1705||||1705|370.52|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1705||||1705|473.82|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1705||||1705|358|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MULTIPLAN [1680]|HMA [168003]|1705||||1705|526.47|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1705||||1705|398.73|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1705||||1705|382.45|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|Self-pay|Self-pay|1705||||1705|511.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1705||||1705|358.05|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1705||||1705|343.96|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1705||||1705|512.43|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1705||||1705|817.55|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|UMR [2035]|UMR OPTIONS [203501]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1705||||1705|352.87|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1705||||1705|1534.5|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1705||||1705|0|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1705||||1705|630.85|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1705||||1705|350.98|1585.65|231.09
34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1705||||1705|852.5|1585.65|231.09
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|1657||||1657|519.19|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1657||||1657|358|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1657||||1657|372.59|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1657||||1657|372.59|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1657||||1657|347.68|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1657||||1657|830.16|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1657||||1657|581.61|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1657||||1657|712.51|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1657||||1657|705.88|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1657||||1657|828.5|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1657||||1657|1077.05|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1657||||1657|386.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1657||||1657|613.09|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|GEHA [1415]|GEHA [141500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1657||||1657|789.71|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1657||||1657|712.51|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1657||||1657|1541.01|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1657||||1657|994.2|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1657||||1657|382.45|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1657||||1657|844.93|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1657||||1657|359.87|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1657||||1657|473.82|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1657||||1657|358|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MULTIPLAN [1680]|HMA [168003]|1657||||1657|526.47|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1657||||1657|387.26|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1657||||1657|382.45|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|Self-pay|Self-pay|1657||||1657|497.1|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1657||||1657|347.97|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1657||||1657|343.96|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1657||||1657|512.43|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1657||||1657|794.53|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1657||||1657|342.72|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1657||||1657|1491.3|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1657||||1657|0|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1657||||1657|613.09|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1657||||1657|350.98|1541.01|342.72
34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1657||||1657|828.5|1541.01|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|AETNA [1015]|AETNA ACO WILCO [101532]|1930||||1930|710.11|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1930||||1930|464.59|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1930||||1930|372.59|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1930||||1930|372.59|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1930||||1930|451.19|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1930||||1930|966.93|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1930||||1930|677.43|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1930||||1930|829.9|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1930||||1930|822.18|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1930||||1930|965|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1930||||1930|1254.5|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|CORESOURCE [1315]|CORESOURCE [131500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1930||||1930|537.19|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1930||||1930|714.1|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|GEHA [1415]|GEHA [141500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1930||||1930|1024.83|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HEALTHNET [1495]|HEALTHNET [149500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1930||||1930|829.9|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1930||||1930|1794.9|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1930||||1930|1158|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1930||||1930|496.31|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1930||||1930|1088.8|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1930||||1930|359.87|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1930||||1930|614.9|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1930||||1930|464.59|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MULTIPLAN [1680]|HMA [168003]|1930||||1930|683.22|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MULTIPLAN [1680]|IHC HS [168011]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1930||||1930|387.26|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1930||||1930|496.31|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|Self-pay|Self-pay|1930||||1930|579|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1930||||1930|405.3|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1930||||1930|446.37|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1930||||1930|665|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|TRUSTMARK [2030]|STARMARK [203000]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1930||||1930|925.44|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|UMR [2035]|UMR OPTIONS [203501]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1930||||1930|342.72|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1930||||1930|1737|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1930||||1930|0|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1930||||1930|714.1|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1930||||1930|455.48|1794.9|342.72
34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1930||||1930|965|1794.9|342.72
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|AETNA [1015]|AETNA ACO WILCO [101532]|1277||||1277|368|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1277||||1277|326.37|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1277||||1277|326.37|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1277||||1277|639.78|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1277||||1277|448.23|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1277||||1277|549.11|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1277||||1277|544|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1277||||1277|638.5|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1277||||1277|830.05|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|CORESOURCE [1315]|CORESOURCE [131500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1277||||1277|288.46|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1277||||1277|472.49|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|GEHA [1415]|GEHA [141500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HEALTHNET [1495]|HEALTHNET [149500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1277||||1277|549.11|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1277||||1277|1187.61|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1277||||1277|766.2|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1277||||1277|844.93|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1277||||1277|315.22|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MULTIPLAN [1680]|HMA [168003]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MULTIPLAN [1680]|IHC HS [168011]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1277||||1277|339.22|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|Self-pay|Self-pay|1277||||1277|383.1|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1277||||1277|268.17|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|TRUSTMARK [2030]|STARMARK [203000]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1277||||1277|612.32|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|UMR [2035]|UMR OPTIONS [203501]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1277||||1277|300.2|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1277||||1277|1149.3|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1277||||1277|0|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1277||||1277|472.49|1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1277||||1277||1187.61|268.17
34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1277||||1277|638.5|1187.61|268.17
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|AETNA [1015]|AETNA ACO WILCO [101532]|1814||||1814|523.46|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1814||||1814|358|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1814||||1814|326.37|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1814||||1814|326.37|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1814||||1814|347.68|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1814||||1814|908.81|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1814||||1814|636.71|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1814||||1814|780.02|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1814||||1814|772.76|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1814||||1814|907|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1814||||1814|1179.1|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|CORESOURCE [1315]|CORESOURCE [131500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1814||||1814|396.95|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1814||||1814|671.18|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|GEHA [1415]|GEHA [141500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1814||||1814|789.71|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HEALTHNET [1495]|HEALTHNET [149500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1814||||1814|780.02|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1814||||1814|1687.02|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1814||||1814|1088.4|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1814||||1814|382.45|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1814||||1814|844.93|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1814||||1814|315.22|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1814||||1814|473.82|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1814||||1814|358|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MULTIPLAN [1680]|HMA [168003]|1814||||1814|526.47|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MULTIPLAN [1680]|IHC HS [168011]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1814||||1814|339.22|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1814||||1814|382.45|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|Self-pay|Self-pay|1814||||1814|544.2|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1814||||1814|380.94|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1814||||1814|343.96|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1814||||1814|512.43|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|TRUSTMARK [2030]|STARMARK [203000]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1814||||1814|869.81|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|UMR [2035]|UMR OPTIONS [203501]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1814||||1814|300.2|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1814||||1814|1632.6|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1814||||1814|0|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1814||||1814|671.18|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1814||||1814|350.98|1687.02|300.2
34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1814||||1814|907|1687.02|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1660||||1660|530.8|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1660||||1660|358|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1660||||1660|326.37|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1660||||1660|326.37|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1660||||1660|347.68|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1660||||1660|831.66|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1660||||1660|582.66|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1660||||1660|713.8|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1660||||1660|707.16|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1660||||1660|830|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1660||||1660|1079|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|CORESOURCE [1315]|CORESOURCE [131500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1660||||1660|414.58|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1660||||1660|614.2|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|GEHA [1415]|GEHA [141500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1660||||1660|789.71|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HEALTHNET [1495]|HEALTHNET [149500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1660||||1660|713.8|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1660||||1660|1543.8|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1660||||1660|996|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1660||||1660|382.45|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1660||||1660|844.93|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1660||||1660|315.22|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1660||||1660|473.82|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1660||||1660|358|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MULTIPLAN [1680]|HMA [168003]|1660||||1660|526.47|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MULTIPLAN [1680]|IHC HS [168011]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1660||||1660|339.22|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1660||||1660|382.45|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|Self-pay|Self-pay|1660||||1660|498|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1660||||1660|348.6|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1660||||1660|343.96|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1660||||1660|512.43|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|TRUSTMARK [2030]|STARMARK [203000]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1660||||1660|795.97|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|UMR [2035]|UMR OPTIONS [203501]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1660||||1660|300.2|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1660||||1660|1494|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1660||||1660|0|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1660||||1660|614.2|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1660||||1660|350.98|1543.8|300.2
34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1660||||1660|830|1543.8|300.2
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1052||||1052|525.31|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1052||||1052|326.37|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1052||||1052|326.37|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1052||||1052|527.05|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1052||||1052|369.25|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1052||||1052|452.36|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1052||||1052|448.15|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1052||||1052|526|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1052||||1052|683.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|CORESOURCE [1315]|CORESOURCE [131500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1052||||1052|330.7|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1052||||1052|389.24|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|GEHA [1415]|GEHA [141500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HEALTHNET [1495]|HEALTHNET [149500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1052||||1052|452.36|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1052||||1052|978.36|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1052||||1052|631.2|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1052||||1052|844.93|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1052||||1052|315.22|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MULTIPLAN [1680]|HMA [168003]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MULTIPLAN [1680]|IHC HS [168011]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1052||||1052|339.22|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|Self-pay|Self-pay|1052||||1052|315.6|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1052||||1052|220.92|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|TRUSTMARK [2030]|STARMARK [203000]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1052||||1052|504.43|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|UMR [2035]|UMR OPTIONS [203501]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1052||||1052|300.2|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1052||||1052|946.8|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1052||||1052|0|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1052||||1052|389.24|978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1052||||1052||978.36|220.92
34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1052||||1052|526|978.36|220.92
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|AETNA [1015]|AETNA ACO WILCO [101532]|1626||||1626|423.01|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1626||||1626|358|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1626||||1626|326.43|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1626||||1626|326.43|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1626||||1626|347.68|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1626||||1626|814.63|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1626||||1626|570.73|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1626||||1626|699.18|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1626||||1626|692.68|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1626||||1626|813|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1626||||1626|1056.9|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|CORESOURCE [1315]|CORESOURCE [131500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1626||||1626|319.02|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1626||||1626|601.62|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|GEHA [1415]|GEHA [141500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1626||||1626|789.71|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HEALTHNET [1495]|HEALTHNET [149500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1626||||1626|699.18|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1626||||1626|1512.18|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1626||||1626|975.6|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1626||||1626|382.45|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1626||||1626|844.93|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1626||||1626|315.27|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1626||||1626|473.82|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1626||||1626|358|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MULTIPLAN [1680]|HMA [168003]|1626||||1626|526.47|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MULTIPLAN [1680]|IHC HS [168011]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1626||||1626|339.28|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1626||||1626|382.45|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|Self-pay|Self-pay|1626||||1626|487.8|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1626||||1626|341.46|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1626||||1626|343.96|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1626||||1626|512.43|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|TRUSTMARK [2030]|STARMARK [203000]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1626||||1626|779.67|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|UMR [2035]|UMR OPTIONS [203501]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1626||||1626|300.25|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1626||||1626|1463.4|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1626||||1626|0|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1626||||1626|601.62|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1626||||1626|350.98|1512.18|300.25
34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1626||||1626|813|1512.18|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1988||||1988|459.68|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1988||||1988|358|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1988||||1988|326.43|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1988||||1988|326.43|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1988||||1988|347.68|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1988||||1988|995.99|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1988||||1988|697.79|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1988||||1988|854.84|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1988||||1988|846.89|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1988||||1988|994|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1988||||1988|1292.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|CORESOURCE [1315]|CORESOURCE [131500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1988||||1988|345.54|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1988||||1988|735.56|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|GEHA [1415]|GEHA [141500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1988||||1988|789.71|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HEALTHNET [1495]|HEALTHNET [149500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1988||||1988|854.84|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1988||||1988|1848.84|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1988||||1988|1192.8|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1988||||1988|382.45|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1988||||1988|844.93|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1988||||1988|315.27|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1988||||1988|473.82|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1988||||1988|358|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MULTIPLAN [1680]|HMA [168003]|1988||||1988|526.47|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MULTIPLAN [1680]|IHC HS [168011]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1988||||1988|339.28|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1988||||1988|382.45|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|Self-pay|Self-pay|1988||||1988|596.4|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1988||||1988|417.48|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1988||||1988|343.96|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1988||||1988|512.43|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|TRUSTMARK [2030]|STARMARK [203000]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1988||||1988|953.25|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|UMR [2035]|UMR OPTIONS [203501]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1988||||1988|300.25|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1988||||1988|1789.2|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1988||||1988|0|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1988||||1988|735.56|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1988||||1988|350.98|1848.84|300.25
34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1988||||1988|994|1848.84|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2187||||2187|524.07|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2187||||2187|358|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2187||||2187|326.43|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2187||||2187|326.43|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2187||||2187|347.68|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2187||||2187|1095.69|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2187||||2187|767.64|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2187||||2187|940.41|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2187||||2187|931.66|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2187||||2187|1093.5|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2187||||2187|1421.55|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|CORESOURCE [1315]|CORESOURCE [131500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2187||||2187|411.73|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2187||||2187|809.19|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|GEHA [1415]|GEHA [141500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2187||||2187|789.71|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HEALTHNET [1495]|HEALTHNET [149500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2187||||2187|940.41|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2187||||2187|2033.91|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2187||||2187|1312.2|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2187||||2187|382.45|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2187||||2187|844.93|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2187||||2187|315.27|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2187||||2187|473.82|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2187||||2187|358|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MULTIPLAN [1680]|HMA [168003]|2187||||2187|526.47|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MULTIPLAN [1680]|IHC HS [168011]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2187||||2187|339.28|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2187||||2187|382.45|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|Self-pay|Self-pay|2187||||2187|656.1|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2187||||2187|459.27|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2187||||2187|343.96|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2187||||2187|512.43|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|TRUSTMARK [2030]|STARMARK [203000]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2187||||2187|1048.67|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|UMR [2035]|UMR OPTIONS [203501]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2187||||2187|300.25|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2187||||2187|1968.3|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2187||||2187|0|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2187||||2187|809.19|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2187||||2187|350.98|2033.91|300.25
34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2187||||2187|1093.5|2033.91|300.25
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|AETNA [1015]|AETNA ACO WILCO [101532]|5900||||5900|695.65|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5900||||5900|1239.75|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5900||||5900|1022.55|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5900||||5900|1022.55|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5900||||5900|1204|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5900||||5900|2955.9|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5900||||5900|2070.9|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5900||||5900|2537|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5900||||5900|2513.4|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5900||||5900|2950|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5900||||5900|3835|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|CORESOURCE [1315]|CORESOURCE [131500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5900||||5900|621.32|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5900||||5900|2183|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|GEHA [1415]|GEHA [141500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5900||||5900|2734.74|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HEALTHNET [1495]|HEALTHNET [149500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5900||||5900|2537|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5900||||5900|5487|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5900||||5900|3540|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5900||||5900|1324.4|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5900||||5900|2938.52|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5900||||5900|987.62|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5900||||5900|1640.84|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5900||||5900|1239.75|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MULTIPLAN [1680]|HMA [168003]|5900||||5900|1823.16|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MULTIPLAN [1680]|IHC HS [168011]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5900||||5900|1062.81|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5900||||5900|1324.4|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|Self-pay|Self-pay|5900||||5900|1770|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5900||||5900|1239|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5900||||5900|1191.13|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5900||||5900|1774.54|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|TRUSTMARK [2030]|STARMARK [203000]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5900||||5900|2829.05|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|UMR [2035]|UMR OPTIONS [203501]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5900||||5900|940.56|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5900||||5900|5310|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5900||||5900|0|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5900||||5900|2183|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5900||||5900|1215.44|5487|621.32
34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5900||||5900|2950|5487|621.32
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1552||||1552|319.71|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1552||||1552|358|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1552||||1552|403.42|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1552||||1552|403.42|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1552||||1552|347.68|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1552||||1552|777.55|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1552||||1552|544.75|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1552||||1552|667.36|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1552||||1552|661.15|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1552||||1552|776|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1552||||1552|1008.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|CORESOURCE [1315]|CORESOURCE [131500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1552||||1552|271.77|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1552||||1552|574.24|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|GEHA [1415]|GEHA [141500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1552||||1552|789.71|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HEALTHNET [1495]|HEALTHNET [149500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1552||||1552|667.36|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1552||||1552|1443.36|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1552||||1552|931.2|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1552||||1552|382.45|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1552||||1552|844.93|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1552||||1552|389.64|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1552||||1552|473.82|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1552||||1552|358|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MULTIPLAN [1680]|HMA [168003]|1552||||1552|526.47|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MULTIPLAN [1680]|IHC HS [168011]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1552||||1552|419.3|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1552||||1552|382.45|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|Self-pay|Self-pay|1552||||1552|465.6|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1552||||1552|325.92|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1552||||1552|343.96|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1552||||1552|512.43|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|TRUSTMARK [2030]|STARMARK [203000]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1552||||1552|744.18|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|UMR [2035]|UMR OPTIONS [203501]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1552||||1552|371.08|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1552||||1552|1396.8|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1552||||1552|0|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1552||||1552|574.24|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1552||||1552|350.98|1443.36|271.77
34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1552||||1552|776|1443.36|271.77
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1359||||1359|286.49|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1359||||1359|257.09|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1359||||1359|257.09|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1359||||1359|680.86|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1359||||1359|477.01|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1359||||1359|584.37|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1359||||1359|578.93|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1359||||1359|679.5|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1359||||1359|883.35|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|CORESOURCE [1315]|CORESOURCE [131500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1359||||1359|243.71|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1359||||1359|502.83|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|GEHA [1415]|GEHA [141500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HEALTHNET [1495]|HEALTHNET [149500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1359||||1359|584.37|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1359||||1359|1263.87|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1359||||1359|815.4|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1359||||1359|844.93|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1359||||1359|248.3|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MULTIPLAN [1680]|HMA [168003]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MULTIPLAN [1680]|IHC HS [168011]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1359||||1359|267.21|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|Self-pay|Self-pay|1359||||1359|407.7|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1359||||1359|285.39|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|TRUSTMARK [2030]|STARMARK [203000]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1359||||1359|651.64|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|UMR [2035]|UMR OPTIONS [203501]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1359||||1359|236.47|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1359||||1359|1223.1|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1359||||1359|0|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1359||||1359|502.83|1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1359||||1359||1263.87|236.47
34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1359||||1359|679.5|1263.87|236.47
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2824||||2824|498.41|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2824||||2824|464.59|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2824||||2824|401.78|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2824||||2824|401.78|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2824||||2824|451.19|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2824||||2824|1414.82|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2824||||2824|991.22|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2824||||2824|1214.32|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2824||||2824|1203.02|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2824||||2824|1412|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2824||||2824|1835.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|CORESOURCE [1315]|CORESOURCE [131500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2824||||2824|425.29|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2824||||2824|1044.88|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|GEHA [1415]|GEHA [141500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2824||||2824|1024.83|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HEALTHNET [1495]|HEALTHNET [149500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2824||||2824|1214.32|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2824||||2824|2626.32|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2824||||2824|1694.4|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2824||||2824|496.31|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2824||||2824|1088.8|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2824||||2824|388.06|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2824||||2824|614.9|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2824||||2824|464.59|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MULTIPLAN [1680]|HMA [168003]|2824||||2824|683.22|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MULTIPLAN [1680]|IHC HS [168011]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2824||||2824|417.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2824||||2824|496.31|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|Self-pay|Self-pay|2824||||2824|847.2|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2824||||2824|593.04|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2824||||2824|446.37|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2824||||2824|665|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|TRUSTMARK [2030]|STARMARK [203000]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2824||||2824|1354.11|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|UMR [2035]|UMR OPTIONS [203501]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2824||||2824|369.57|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2824||||2824|2541.6|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2824||||2824|0|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2824||||2824|1044.88|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2824||||2824|455.48|2626.32|369.57
34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2824||||2824|1412|2626.32|369.57
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|995||||995|292.6|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|995||||995|257.09|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|995||||995|257.09|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|995||||995|498.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|995||||995|349.25|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|995||||995|427.85|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|995||||995|423.87|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|995||||995|497.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|995||||995|646.75|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|995||||995|269.62|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|995||||995|368.15|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|GEHA [1415]|GEHA [141500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|995||||995|427.85|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|995||||995|925.35|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|995||||995|597|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|995||||995|844.93|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|995||||995|248.3|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MULTIPLAN [1680]|HMA [168003]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|995||||995|267.21|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|Self-pay|Self-pay|995||||995|298.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|995||||995|208.95|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|995||||995|477.1|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|995||||995|236.47|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|995||||995|895.5|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|995||||995|0|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|995||||995|368.15|925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|995||||995||925.35|208.95
34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|995||||995|497.5|925.35|208.95
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|2181||||2181|467.23|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2181||||2181|464.59|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2181||||2181|401.78|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2181||||2181|401.78|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2181||||2181|451.19|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2181||||2181|1092.68|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2181||||2181|765.53|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2181||||2181|937.83|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2181||||2181|929.11|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2181||||2181|1090.5|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2181||||2181|1417.65|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2181||||2181|404.56|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2181||||2181|806.97|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|GEHA [1415]|GEHA [141500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2181||||2181|1024.83|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2181||||2181|937.83|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2181||||2181|2028.33|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2181||||2181|1308.6|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2181||||2181|496.31|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2181||||2181|1088.8|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2181||||2181|388.06|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2181||||2181|614.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2181||||2181|464.59|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MULTIPLAN [1680]|HMA [168003]|2181||||2181|683.22|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2181||||2181|417.6|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2181||||2181|496.31|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|Self-pay|Self-pay|2181||||2181|654.3|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2181||||2181|458.01|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2181||||2181|446.37|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2181||||2181|665|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2181||||2181|1045.79|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2181||||2181|369.57|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2181||||2181|1962.9|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2181||||2181|0|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2181||||2181|806.97|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2181||||2181|455.48|2028.33|369.57
34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2181||||2181|1090.5|2028.33|369.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|717||||717|282.43|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|717||||717|259.5|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|717||||717|259.5|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|717||||717|359.22|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|717||||717|251.67|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|717||||717|308.31|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|717||||717|305.44|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|717||||717|358.5|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|717||||717|466.05|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|717||||717|174.7|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|717||||717|265.29|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|GEHA [1415]|GEHA [141500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|717||||717|308.31|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|717||||717|666.81|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|717||||717|430.2|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|717||||717|717|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|717||||717|250.63|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MULTIPLAN [1680]|HMA [168003]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|717||||717|269.72|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|Self-pay|Self-pay|717||||717|215.1|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|717||||717|150.57|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|717||||717|343.8|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|UMR [2035]|UMR OPTIONS [203501]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|717||||717|238.69|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|717||||717|645.3|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|717||||717|0|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|717||||717|265.29|717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|717||||717||717|150.57
34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|717||||717|358.5|717|150.57
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1593||||1593|537.53|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1593||||1593|464.59|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1593||||1593|763.39|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1593||||1593|763.39|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1593||||1593|451.19|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1593||||1593|798.09|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1593||||1593|559.14|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1593||||1593|684.99|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1593||||1593|678.62|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1593||||1593|796.5|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1593||||1593|1035.45|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|CORESOURCE [1315]|CORESOURCE [131500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1593||||1593|403.19|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1593||||1593|589.41|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|GEHA [1415]|GEHA [141500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1593||||1593|1024.83|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HEALTHNET [1495]|HEALTHNET [149500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1593||||1593|684.99|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1593||||1593|1481.49|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1593||||1593|955.8|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1593||||1593|496.31|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1593||||1593|1088.8|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1593||||1593|737.32|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1593||||1593|614.9|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1593||||1593|464.59|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MULTIPLAN [1680]|HMA [168003]|1593||||1593|683.22|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MULTIPLAN [1680]|IHC HS [168011]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1593||||1593|793.45|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1593||||1593|496.31|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|Self-pay|Self-pay|1593||||1593|477.9|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1593||||1593|334.53|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1593||||1593|446.37|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1593||||1593|665|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|TRUSTMARK [2030]|STARMARK [203000]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1593||||1593|763.84|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|UMR [2035]|UMR OPTIONS [203501]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1593||||1593|702.19|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1593||||1593|1433.7|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1593||||1593|0|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1593||||1593|589.41|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1593||||1593|455.48|1481.49|334.53
34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1593||||1593|796.5|1481.49|334.53
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|AETNA [1015]|AETNA ACO WILCO [101532]|2052||||2052|328.87|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2052||||2052|464.59|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2052||||2052|428.81|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2052||||2052|428.81|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2052||||2052|451.19|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2052||||2052|1028.05|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2052||||2052|720.25|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2052||||2052|882.36|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2052||||2052|874.15|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2052||||2052|1026|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2052||||2052|1333.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|CORESOURCE [1315]|CORESOURCE [131500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2052||||2052|276.66|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2052||||2052|759.24|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|GEHA [1415]|GEHA [141500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2052||||2052|1024.83|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HEALTHNET [1495]|HEALTHNET [149500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2052||||2052|882.36|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2052||||2052|1908.36|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2052||||2052|1231.2|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2052||||2052|496.31|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2052||||2052|1088.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2052||||2052|414.16|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2052||||2052|614.9|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2052||||2052|464.59|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MULTIPLAN [1680]|HMA [168003]|2052||||2052|683.22|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MULTIPLAN [1680]|IHC HS [168011]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2052||||2052|445.69|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2052||||2052|496.31|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|Self-pay|Self-pay|2052||||2052|615.6|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2052||||2052|430.92|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2052||||2052|446.37|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2052||||2052|665|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|TRUSTMARK [2030]|STARMARK [203000]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2052||||2052|983.93|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|UMR [2035]|UMR OPTIONS [203501]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2052||||2052|394.43|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2052||||2052|1846.8|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2052||||2052|0|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2052||||2052|759.24|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2052||||2052|455.48|1908.36|276.66
34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2052||||2052|1026|1908.36|276.66
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|2084||||2084|496.57|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2084||||2084|1239.75|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2084||||2084|673.37|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2084||||2084|673.37|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2084||||2084|1204|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2084||||2084|1044.08|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2084||||2084|731.48|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2084||||2084|896.12|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2084||||2084|887.78|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2084||||2084|1042|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2084||||2084|1354.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2084||||2084|385.29|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2084||||2084|771.08|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|GEHA [1415]|GEHA [141500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2084||||2084|2084|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2084||||2084|896.12|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2084||||2084|1938.12|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2084||||2084|1250.4|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2084||||2084|1324.4|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2084||||2084|2084|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2084||||2084|650.37|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2084||||2084|1640.84|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2084||||2084|1239.75|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MULTIPLAN [1680]|HMA [168003]|2084||||2084|1823.16|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2084||||2084|699.88|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2084||||2084|1324.4|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|Self-pay|Self-pay|2084||||2084|625.2|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2084||||2084|437.64|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2084||||2084|1191.13|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2084||||2084|1774.54|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2084||||2084|999.28|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2084||||2084|619.38|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2084||||2084|1875.6|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2084||||2084|0|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2084||||2084|771.08|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2084||||2084|1215.44|2084|385.29
34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLANAR WHOLE BODY SINGLE DAY IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2084||||2084|1042|2084|385.29
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|3147||||3147|510.02|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3147||||3147|1239.75|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3147||||3147|673.37|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3147||||3147|673.37|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3147||||3147|1204|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3147||||3147|1576.65|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3147||||3147|1104.6|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3147||||3147|1353.21|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3147||||3147|1340.62|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3147||||3147|1573.5|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3147||||3147|2045.55|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3147||||3147|406.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3147||||3147|1164.39|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|GEHA [1415]|GEHA [141500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3147||||3147|2734.74|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3147||||3147|1353.21|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3147||||3147|2926.71|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3147||||3147|1888.2|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3147||||3147|1324.4|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3147||||3147|1088.8|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3147||||3147|650.37|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3147||||3147|1640.84|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3147||||3147|1239.75|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MULTIPLAN [1680]|HMA [168003]|3147||||3147|1823.16|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3147||||3147|699.88|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3147||||3147|1324.4|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|Self-pay|Self-pay|3147||||3147|944.1|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3147||||3147|660.87|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3147||||3147|1191.13|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3147||||3147|1774.54|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3147||||3147|1508.99|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3147||||3147|619.38|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3147||||3147|2832.3|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3147||||3147|0|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3147||||3147|1164.39|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3147||||3147|1215.44|2926.71|406.44
34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3147||||3147|1573.5|2926.71|406.44
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1851||||1851|91.96|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1851||||1851|63.38|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1851||||1851|67.32|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1851||||1851|67.32|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1851||||1851|927.35|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1851||||1851|649.7|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1851||||1851|71.83|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1851||||1851|788.53|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1851||||1851|925.5|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1851||||1851|1203.15|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1851||||1851|0|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1851||||1851|46.4|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|GEHA [1415]|GEHA [141500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1851||||1851|139.82|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1851||||1851|71.83|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1851||||1851|1721.43|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1851||||1851|1110.6|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1851||||1851|68.35|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1851||||1851|925.5|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1851||||1851|65.03|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1851||||1851|83.89|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1851||||1851|63.38|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MULTIPLAN [1680]|HMA [168003]|1851||||1851|93.21|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MULTIPLAN [1680]|IHC HS [168011]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1851||||1851|69.97|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1851||||1851|68.35|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|Self-pay|Self-pay|1851||||1851|555.3|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1851||||1851|388.71|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1851||||1851|60.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1851||||1851|90.72|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|TRUSTMARK [2030]|STARMARK [203000]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1851||||1851|887.55|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|UMR [2035]|UMR OPTIONS [203501]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1851||||1851|61.93|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1851||||1851|1665.9|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1851||||1851|38.79|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1851||||1851|46.4|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1851||||1851|62.14|1721.43|38.79
34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1851||||1851|925.5|1721.43|38.79
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201001|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201002|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201003|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201004|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201007|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201008|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201009|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201010|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201011|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201012|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201013|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201014|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201015|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201016|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201017|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201018|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201019|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201020|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201021|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201022|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34201023|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|AETNA [1015]|AETNA ACO WILCO [101532]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131.98||||131.98|66.12|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131.98||||131.98|46.32|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131.98||||131.98|56.75|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131.98||||131.98|56.22|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131.98||||131.98|65.99|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131.98||||131.98|85.79|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|CORESOURCE [1315]|CORESOURCE [131500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|CORVEL CORP [2235]|CORVEL CORP [223500]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131.98||||131.98|48.83|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|GEHA [1415]|GEHA [141500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HEALTHNET [1495]|HEALTHNET [149500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131.98||||131.98|56.75|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART [150501]|131.98||||131.98|122.74|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131.98||||131.98|79.19|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MULTIPLAN [1680]|HMA [168003]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MULTIPLAN [1680]|IHC HS [168011]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|Self-pay|Self-pay|131.98||||131.98|39.59|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131.98||||131.98|27.72|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|TRUSTMARK [2030]|STARMARK [203000]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131.98||||131.98|63.28|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|UMR [2035]|UMR OPTIONS [203501]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131.98||||131.98|118.78|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131.98||||131.98|0|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131.98||||131.98|48.83|122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131.98||||131.98||122.74|27.72
3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|15 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131.98||||131.98|65.99|122.74|27.72
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|AETNA [1015]|AETNA ACO WILCO [101532]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|223.31||||223.31|111.88|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223.31||||223.31|78.38|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223.31||||223.31|96.02|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|223.31||||223.31|95.13|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|223.31||||223.31|111.66|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223.31||||223.31|145.15|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|CORESOURCE [1315]|CORESOURCE [131500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|CORVEL CORP [2235]|CORVEL CORP [223500]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|223.31||||223.31|82.62|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|GEHA [1415]|GEHA [141500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HEALTHNET [1495]|HEALTHNET [149500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223.31||||223.31|96.02|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HEALTHSMART [1505]|HEALTHSMART [150501]|223.31||||223.31|207.68|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223.31||||223.31|133.99|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MULTIPLAN [1680]|HMA [168003]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MULTIPLAN [1680]|IHC HS [168011]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|Self-pay|Self-pay|223.31||||223.31|66.99|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223.31||||223.31|46.9|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|TRUSTMARK [2030]|STARMARK [203000]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223.31||||223.31|107.08|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|UMR [2035]|UMR OPTIONS [203501]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223.31||||223.31|200.98|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|223.31||||223.31|0|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|223.31||||223.31|82.62|207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|223.31||||223.31||207.68|46.9
3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|30 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|223.31||||223.31|111.66|207.68|46.9
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|AETNA [1015]|AETNA ACO WILCO [101532]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104.13||||104.13|52.17|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.13||||104.13|36.55|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.13||||104.13|44.78|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104.13||||104.13|44.36|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104.13||||104.13|52.07|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.13||||104.13|67.68|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|CORESOURCE [1315]|CORESOURCE [131500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104.13||||104.13|38.53|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|GEHA [1415]|GEHA [141500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HEALTHNET [1495]|HEALTHNET [149500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.13||||104.13|44.78|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|104.13||||104.13|96.84|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.13||||104.13|62.48|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MULTIPLAN [1680]|HMA [168003]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MULTIPLAN [1680]|IHC HS [168011]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|Self-pay|Self-pay|104.13||||104.13|31.24|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.13||||104.13|21.87|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|TRUSTMARK [2030]|STARMARK [203000]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.13||||104.13|49.93|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|UMR [2035]|UMR OPTIONS [203501]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.13||||104.13|93.72|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104.13||||104.13|0|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104.13||||104.13|38.53|96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104.13||||104.13||96.84|21.87
3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|3.5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104.13||||104.13|52.07|96.84|21.87
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|AETNA [1015]|AETNA ACO WILCO [101532]|3290||||3290|86.62|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3290||||3290|236.97|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3290||||3290|287.74|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3290||||3290|287.74|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3290||||3290|230.14|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3290||||3290|1648.29|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3290||||3290|1154.79|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3290||||3290|1414.7|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3290||||3290|1401.54|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3290||||3290|1645|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3290||||3290|2138.5|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|CORESOURCE [1315]|CORESOURCE [131500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3290||||3290|183.64|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3290||||3290|1217.3|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|GEHA [1415]|GEHA [141500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3290||||3290|522.73|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HEALTHNET [1495]|HEALTHNET [149500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3290||||3290|1414.7|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3290||||3290|3059.7|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3290||||3290|1974|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3290||||3290|253.15|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3290||||3290|551.87|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3290||||3290|277.9|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3290||||3290|313.64|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3290||||3290|236.97|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MULTIPLAN [1680]|HMA [168003]|3290||||3290|348.49|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MULTIPLAN [1680]|IHC HS [168011]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3290||||3290|299.07|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3290||||3290|253.15|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|Self-pay|Self-pay|3290||||3290|987|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3290||||3290|690.9|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3290||||3290|227.68|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3290||||3290|339.2|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|TRUSTMARK [2030]|STARMARK [203000]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3290||||3290|1577.56|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|UMR [2035]|UMR OPTIONS [203501]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3290||||3290|264.66|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3290||||3290|2961|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3290||||3290|0|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3290||||3290|1217.3|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3290||||3290|232.33|3059.7|86.62
34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3290||||3290|1645|3059.7|86.62
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|1425||||1425|85.78|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1425||||1425|236.97|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1425||||1425|287.74|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1425||||1425|287.74|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1425||||1425|230.14|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1425||||1425|713.93|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1425||||1425|500.18|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1425||||1425|612.75|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1425||||1425|607.05|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1425||||1425|712.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1425||||1425|926.25|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|CORESOURCE [1315]|CORESOURCE [131500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1425||||1425|197.55|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1425||||1425|527.25|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|GEHA [1415]|GEHA [141500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1425||||1425|522.73|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HEALTHNET [1495]|HEALTHNET [149500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1425||||1425|612.75|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1425||||1425|1325.25|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1425||||1425|855|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1425||||1425|253.15|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1425||||1425|551.87|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1425||||1425|277.9|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1425||||1425|313.64|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1425||||1425|236.97|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MULTIPLAN [1680]|HMA [168003]|1425||||1425|348.49|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MULTIPLAN [1680]|IHC HS [168011]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1425||||1425|299.07|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1425||||1425|253.15|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|Self-pay|Self-pay|1425||||1425|427.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1425||||1425|299.25|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1425||||1425|227.68|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1425||||1425|339.2|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|TRUSTMARK [2030]|STARMARK [203000]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1425||||1425|683.29|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|UMR [2035]|UMR OPTIONS [203501]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1425||||1425|264.66|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1425||||1425|1282.5|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1425||||1425|0|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1425||||1425|527.25|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1425||||1425|232.33|1325.25|85.78
34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1425||||1425|712.5|1325.25|85.78
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51.3||||51.3|25.7|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51.3||||51.3|18.01|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51.3||||51.3|22.06|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51.3||||51.3|21.85|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51.3||||51.3|25.65|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51.3||||51.3|33.35|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51.3||||51.3|18.98|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51.3||||51.3|22.06|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|51.3||||51.3|47.71|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51.3||||51.3|30.78|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|Self-pay|Self-pay|51.3||||51.3|15.39|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51.3||||51.3|10.77|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51.3||||51.3|24.6|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51.3||||51.3|46.17|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51.3||||51.3|0|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51.3||||51.3|18.98|47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51.3||||51.3||47.71|10.77
3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51.3||||51.3|25.65|47.71|10.77
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001001|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001002|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001003|EAP|0350 - CT SCAN-GENERAL|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001004|EAP|0350 - CT SCAN-GENERAL|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001007|EAP|0350 - CT SCAN-GENERAL|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001008|EAP|0350 - CT SCAN-GENERAL|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001009|EAP|0350 - CT SCAN-GENERAL|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001010|EAP|0350 - CT SCAN-GENERAL|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001011|EAP|0350 - CT SCAN-GENERAL|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001012|EAP|0350 - CT SCAN-GENERAL|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001013|EAP|0350 - CT SCAN-GENERAL|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001014|EAP|0350 - CT SCAN-GENERAL|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001015|EAP|0350 - CT SCAN-GENERAL|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001016|EAP|0350 - CT SCAN-GENERAL|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001017|EAP|0350 - CT SCAN-GENERAL|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001018|EAP|0350 - CT SCAN-GENERAL|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001019|EAP|0350 - CT SCAN-GENERAL|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001020|EAP|0350 - CT SCAN-GENERAL|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001021|EAP|0350 - CT SCAN-GENERAL|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001022|EAP|0350 - CT SCAN-GENERAL|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35001023|EAP|0350 - CT SCAN-GENERAL|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1217||||1217|415.32|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1217||||1217|169.5|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1217||||1217|391.86|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1217||||1217|391.86|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1217||||1217|164.61|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1217||||1217|609.72|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1217||||1217|427.17|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1217||||1217|523.31|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1217||||1217|518.44|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1217||||1217|608.5|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1217||||1217|791.05|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1217||||1217|626.14|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1217||||1217|383.35|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|GEHA [1415]|GEHA [141500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1217||||1217|373.9|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1217||||1217|523.31|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1217||||1217|1131.81|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1217||||1217|730.2|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1217||||1217|181.08|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1217||||1217|482.2|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1217||||1217|378.48|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1217||||1217|224.34|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1217||||1217|169.5|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MULTIPLAN [1680]|HMA [168003]|1217||||1217|249.27|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MULTIPLAN [1680]|IHC HS [168011]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1217||||1217|407.29|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1217||||1217|181.08|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|Self-pay|Self-pay|1217||||1217|365.1|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1217||||1217|255.57|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1217||||1217|162.85|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1217||||1217|242.62|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|TRUSTMARK [2030]|STARMARK [203000]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1217||||1217|583.55|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|UMR [2035]|UMR OPTIONS [203501]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1217||||1217|360.44|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1217||||1217|1095.3|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1217||||1217|0|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1217||||1217|383.35|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1217||||1217|166.18|1131.81|162.85
35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1217||||1217|608.5|1131.81|162.85
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1217||||1217|316.42|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|1217||||1217|1217|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1217||||1217|316.42|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1217||||1217|0|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1217||||1217|0|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1217||||1217|609.72|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1217||||1217|427.17|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1217||||1217|523.31|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1217||||1217|518.44|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1217||||1217|608.5|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1217||||1217|791.05|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1217||||1217|871.93|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1217||||1217|542.15|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|GEHA [1415]|GEHA [141500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1217||||1217|523.31|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1217||||1217|1131.81|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1217||||1217|730.2|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1217||||1217|608.5|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1217||||1217|0|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MULTIPLAN [1680]|HMA [168003]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1217||||1217|0|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|Self-pay|Self-pay|1217||||1217|365.1|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1217||||1217|255.57|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1217||||1217|755.76|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1217||||1217|583.55|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1217||||1217|0|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1217||||1217|1095.3|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1217||||1217|0|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1217||||1217|912.75|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1217||||1217|542.15|1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1217||||1217||1217|255.57
35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1217||||1217|608.5|1217|255.57
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|AETNA [1015]|AETNA ACO WILCO [101532]|940||||940|27.68|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|940||||940|0|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|940||||940|0|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|940||||940|470.94|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|940||||940|329.94|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|940||||940|404.2|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|940||||940|400.44|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|940||||940|470|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|940||||940|611|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|CORESOURCE [1315]|CORESOURCE [131500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|940||||940|128.91|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|940||||940|78.93|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|GEHA [1415]|GEHA [141500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HEALTHNET [1495]|HEALTHNET [149500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|940||||940|404.2|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|940||||940|874.2|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|940||||940|564|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|940||||940|470|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|940||||940|0|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MULTIPLAN [1680]|HMA [168003]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MULTIPLAN [1680]|IHC HS [168011]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|940||||940|0|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|Self-pay|Self-pay|940||||940|282|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|940||||940|197.4|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|TRUSTMARK [2030]|STARMARK [203000]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|940||||940|450.73|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|UMR [2035]|UMR OPTIONS [203501]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|940||||940|0|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|940||||940|846|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|940||||940|0|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|940||||940|78.93|874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|940||||940||874.2|27.68
35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|940||||940|470|874.2|27.68
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|AETNA [1015]|AETNA ACO WILCO [101532]|937||||937|65.48|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|937||||937|0|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|937||||937|0|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|937||||937|469.44|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|937||||937|328.89|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|937||||937|402.91|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|937||||937|399.16|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|937||||937|468.5|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|937||||937|609.05|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|CORESOURCE [1315]|CORESOURCE [131500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|937||||937|168.29|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|937||||937|103.04|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|GEHA [1415]|GEHA [141500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HEALTHNET [1495]|HEALTHNET [149500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|937||||937|402.91|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|937||||937|871.41|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|937||||937|562.2|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|937||||937|468.5|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|937||||937|0|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MULTIPLAN [1680]|HMA [168003]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MULTIPLAN [1680]|IHC HS [168011]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|937||||937|0|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|Self-pay|Self-pay|937||||937|281.1|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|937||||937|196.77|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|TRUSTMARK [2030]|STARMARK [203000]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|937||||937|449.29|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|UMR [2035]|UMR OPTIONS [203501]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|937||||937|0|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|937||||937|843.3|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|937||||937|0|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|937||||937|103.04|871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|937||||937||871.41|65.48
35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|937||||937|468.5|871.41|65.48
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|3184||||3184|161.1|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3184||||3184|0|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3184||||3184|0|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3184||||3184|1595.18|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3184||||3184|1117.58|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3184||||3184|1369.12|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3184||||3184|1356.38|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3184||||3184|1592|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3184||||3184|2069.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|CORESOURCE [1315]|CORESOURCE [131500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3184||||3184|356.36|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3184||||3184|218.18|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|GEHA [1415]|GEHA [141500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HEALTHNET [1495]|HEALTHNET [149500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3184||||3184|1369.12|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3184||||3184|2961.12|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3184||||3184|1910.4|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3184||||3184|1592|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3184||||3184|0|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MULTIPLAN [1680]|HMA [168003]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MULTIPLAN [1680]|IHC HS [168011]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3184||||3184|0|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|Self-pay|Self-pay|3184||||3184|955.2|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3184||||3184|668.64|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|TRUSTMARK [2030]|STARMARK [203000]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3184||||3184|1526.73|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|UMR [2035]|UMR OPTIONS [203501]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3184||||3184|0|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3184||||3184|2865.6|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3184||||3184|0|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3184||||3184|218.18|2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3184||||3184||2961.12|161.1
35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3184||||3184|1592|2961.12|161.1
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|2666||||2666|732.54|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2666||||2666|0|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2666||||2666|0|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2666||||2666|1335.67|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2666||||2666|935.77|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2666||||2666|1146.38|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2666||||2666|1135.72|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2666||||2666|1333|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2666||||2666|1732.9|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|CORESOURCE [1315]|CORESOURCE [131500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2666||||2666|626.14|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2666||||2666|383.35|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|GEHA [1415]|GEHA [141500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HEALTHNET [1495]|HEALTHNET [149500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2666||||2666|1146.38|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2666||||2666|2479.38|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2666||||2666|1599.6|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2666||||2666|1333|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2666||||2666|0|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MULTIPLAN [1680]|HMA [168003]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MULTIPLAN [1680]|IHC HS [168011]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2666||||2666|0|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|Self-pay|Self-pay|2666||||2666|799.8|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2666||||2666|559.86|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|TRUSTMARK [2030]|STARMARK [203000]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2666||||2666|1278.35|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|UMR [2035]|UMR OPTIONS [203501]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2666||||2666|0|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2666||||2666|2399.4|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2666||||2666|0|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2666||||2666|383.35|2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2666||||2666||2479.38|383.35
35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2666||||2666|1333|2479.38|383.35
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101001|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101002|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101003|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101004|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101007|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101008|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101009|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101010|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101011|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101012|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101013|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101014|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101015|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101016|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101017|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101018|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101019|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101020|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101021|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101022|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35101023|EAP|0351 - CT SCAN-HEAD SCAN|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2577||||2577|152.21|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2577||||2577|103.45|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2577||||2577|257.35|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2577||||2577|257.35|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2577||||2577|100.46|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2577||||2577|1291.08|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2577||||2577|904.53|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2577||||2577|1108.11|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2577||||2577|1097.8|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2577||||2577|1288.5|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2577||||2577|1675.05|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2577||||2577|230.08|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2577||||2577|140.87|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2577||||2577|228.19|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2577||||2577|1108.11|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2577||||2577|2396.61|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2577||||2577|1546.2|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2577||||2577|110.51|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2577||||2577|268.93|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2577||||2577|248.57|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2577||||2577|136.91|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2577||||2577|102.28|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2577||||2577|152.13|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2577||||2577|267.48|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2577||||2577|110.51|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|Self-pay|Self-pay|2577||||2577|773.1|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2577||||2577|541.17|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2577||||2577|99.39|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2577||||2577|148.07|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2577||||2577|1235.67|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2577||||2577|236.72|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2577||||2577|2319.3|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2577||||2577|0|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2577||||2577|140.87|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2577||||2577|101.42|2396.61|99.39
35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2577||||2577|1288.5|2396.61|99.39
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3142||||3142|221.88|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3142||||3142|169.5|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3142||||3142|391.86|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3142||||3142|391.86|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3142||||3142|164.61|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3142||||3142|1574.14|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3142||||3142|1102.84|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3142||||3142|1351.06|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3142||||3142|1338.49|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3142||||3142|1571|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3142||||3142|2042.3|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3142||||3142|285.09|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3142||||3142|174.54|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3142||||3142|373.9|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3142||||3142|1351.06|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3142||||3142|2922.06|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3142||||3142|1885.2|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3142||||3142|181.08|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3142||||3142|482.2|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3142||||3142|378.48|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3142||||3142|224.34|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3142||||3142|169.5|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3142||||3142|249.27|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3142||||3142|407.29|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3142||||3142|181.08|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|Self-pay|Self-pay|3142||||3142|942.6|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3142||||3142|659.82|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3142||||3142|162.85|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3142||||3142|242.62|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3142||||3142|1506.59|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3142||||3142|360.44|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3142||||3142|2827.8|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3142||||3142|0|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3142||||3142|174.54|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3142||||3142|166.18|2922.06|162.85
35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3142||||3142|1571|2922.06|162.85
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3785||||3785|265.61|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3785||||3785|169.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3785||||3785|440.01|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3785||||3785|440.01|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3785||||3785|164.61|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3785||||3785|1896.29|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3785||||3785|1328.54|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3785||||3785|1627.55|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3785||||3785|1612.41|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3785||||3785|1892.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3785||||3785|2460.25|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3785||||3785|339.84|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3785||||3785|208.07|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3785||||3785|373.9|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3785||||3785|1627.55|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3785||||3785|3520.05|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3785||||3785|2271|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3785||||3785|181.08|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3785||||3785|482.2|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3785||||3785|424.98|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3785||||3785|224.34|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3785||||3785|169.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3785||||3785|249.27|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3785||||3785|457.34|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3785||||3785|181.08|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|Self-pay|Self-pay|3785||||3785|1135.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3785||||3785|794.85|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3785||||3785|161.02|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3785||||3785|242.62|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3785||||3785|1814.91|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3785||||3785|404.73|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3785||||3785|3406.5|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3785||||3785|0|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3785||||3785|208.07|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3785||||3785|166.18|3520.05|161.02
35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3785||||3785|1892.5|3520.05|161.02
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2524||||2524|232.25|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2524||||2524|103.45|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2524||||2524|257.35|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2524||||2524|257.35|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2524||||2524|100.46|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2524||||2524|1264.52|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2524||||2524|885.92|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2524||||2524|1085.32|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2524||||2524|1075.22|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2524||||2524|1262|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2524||||2524|1640.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2524||||2524|326.18|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2524||||2524|199.7|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2524||||2524|228.19|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2524||||2524|1085.32|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2524||||2524|2347.32|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2524||||2524|1514.4|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2524||||2524|110.51|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2524||||2524|268.93|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2524||||2524|248.57|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2524||||2524|136.91|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2524||||2524|103.45|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2524||||2524|152.13|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2524||||2524|267.48|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2524||||2524|110.51|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|Self-pay|Self-pay|2524||||2524|757.2|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2524||||2524|530.04|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2524||||2524|98.27|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2524||||2524|148.07|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2524||||2524|1210.26|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2524||||2524|236.72|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2524||||2524|2271.6|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2524||||2524|0|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2524||||2524|199.7|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2524||||2524|101.42|2347.32|98.27
35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2524||||2524|1262|2347.32|98.27
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3308||||3308|415.32|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3308||||3308|169.5|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3308||||3308|391.86|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3308||||3308|391.86|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3308||||3308|164.61|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3308||||3308|1657.31|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3308||||3308|1161.11|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3308||||3308|1422.44|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3308||||3308|1409.21|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3308||||3308|1654|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3308||||3308|2150.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3308||||3308|379.53|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3308||||3308|232.37|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3308||||3308|373.9|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3308||||3308|1422.44|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3308||||3308|3076.44|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3308||||3308|1984.8|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3308||||3308|181.08|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3308||||3308|482.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3308||||3308|378.48|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3308||||3308|224.34|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3308||||3308|169.5|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3308||||3308|249.27|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3308||||3308|407.29|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3308||||3308|181.08|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|Self-pay|Self-pay|3308||||3308|992.4|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3308||||3308|694.68|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3308||||3308|162.85|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3308||||3308|242.62|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3308||||3308|1586.19|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3308||||3308|360.44|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3308||||3308|2977.2|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3308||||3308|0|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3308||||3308|232.37|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3308||||3308|166.18|3076.44|162.85
35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3308||||3308|1654|3076.44|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|AETNA [1015]|AETNA ACO WILCO [101532]|3431||||3431|415.58|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3431||||3431|169.5|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3431||||3431|440.01|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3431||||3431|440.01|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3431||||3431|164.61|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3431||||3431|1718.93|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3431||||3431|1204.28|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3431||||3431|1475.33|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3431||||3431|1461.61|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3431||||3431|1715.5|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3431||||3431|2230.15|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|CORESOURCE [1315]|CORESOURCE [131500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3431||||3431|432.26|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3431||||3431|264.65|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|GEHA [1415]|GEHA [141500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3431||||3431|373.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HEALTHNET [1495]|HEALTHNET [149500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3431||||3431|1475.33|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3431||||3431|3190.83|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3431||||3431|2058.6|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3431||||3431|181.08|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3431||||3431|482.2|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3431||||3431|424.98|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3431||||3431|224.34|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3431||||3431|169.5|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MULTIPLAN [1680]|HMA [168003]|3431||||3431|249.27|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MULTIPLAN [1680]|IHC HS [168011]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3431||||3431|457.34|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3431||||3431|181.08|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|Self-pay|Self-pay|3431||||3431|1029.3|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3431||||3431|720.51|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3431||||3431|162.85|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3431||||3431|242.62|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|TRUSTMARK [2030]|STARMARK [203000]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3431||||3431|1645.16|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|UMR [2035]|UMR OPTIONS [203501]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3431||||3431|404.73|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3431||||3431|3087.9|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3431||||3431|0|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3431||||3431|264.65|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3431||||3431|166.18|3190.83|162.85
35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3431||||3431|1715.5|3190.83|162.85
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2566||||2566|200.38|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2566||||2566|103.45|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2566||||2566|257.35|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2566||||2566|257.35|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2566||||2566|100.46|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2566||||2566|1285.57|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2566||||2566|900.67|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2566||||2566|1103.38|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2566||||2566|1093.12|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2566||||2566|1283|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2566||||2566|1667.9|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2566||||2566|275.27|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2566||||2566|168.53|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2566||||2566|228.19|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2566||||2566|1103.38|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2566||||2566|2386.38|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2566||||2566|1539.6|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2566||||2566|100.27|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2566||||2566|110.51|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2566||||2566|268.93|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2566||||2566|248.57|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2566||||2566|136.91|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2566||||2566|103.45|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2566||||2566|152.13|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2566||||2566|267.48|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2566||||2566|110.51|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|Self-pay|Self-pay|2566||||2566|769.8|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2566||||2566|538.86|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2566||||2566|98.27|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2566||||2566|148.07|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2566||||2566|1230.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2566||||2566|236.72|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2566||||2566|2309.4|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2566||||2566|0|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2566||||2566|168.53|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2566||||2566|101.42|2386.38|98.27
35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2566||||2566|1283|2386.38|98.27
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4038||||4038|230.77|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4038||||4038|169.5|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4038||||4038|391.86|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4038||||4038|391.86|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4038||||4038|164.61|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4038||||4038|2023.04|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4038||||4038|1417.34|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4038||||4038|1736.34|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4038||||4038|1720.19|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4038||||4038|2019|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4038||||4038|2624.7|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4038||||4038|332.1|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4038||||4038|203.32|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|GEHA [1415]|GEHA [141500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4038||||4038|373.9|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4038||||4038|1736.34|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4038||||4038|3755.34|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4038||||4038|2422.8|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4038||||4038|181.08|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4038||||4038|482.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4038||||4038|378.48|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4038||||4038|224.34|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4038||||4038|169.5|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4038||||4038|249.27|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4038||||4038|407.29|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4038||||4038|181.08|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|Self-pay|Self-pay|4038||||4038|1211.4|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4038||||4038|847.98|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4038||||4038|162.85|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4038||||4038|242.62|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4038||||4038|1936.22|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4038||||4038|360.44|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4038||||4038|3634.2|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4038||||4038|0|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4038||||4038|203.32|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4038||||4038|166.18|3755.34|162.85
35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4038||||4038|2019|3755.34|162.85
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2688||||2688|208.54|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2688||||2688|103.45|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2688||||2688|257.35|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2688||||2688|257.35|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2688||||2688|100.46|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2688||||2688|1346.69|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2688||||2688|943.49|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2688||||2688|1155.84|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2688||||2688|1145.09|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2688||||2688|1344|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2688||||2688|1747.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2688||||2688|282.3|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2688||||2688|172.84|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2688||||2688|228.19|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2688||||2688|1155.84|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2688||||2688|2499.84|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2688||||2688|1612.8|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2688||||2688|110.51|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2688||||2688|268.93|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2688||||2688|248.57|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2688||||2688|136.91|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2688||||2688|103.45|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2688||||2688|152.13|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2688||||2688|267.48|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2688||||2688|110.51|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|Self-pay|Self-pay|2688||||2688|806.4|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2688||||2688|564.48|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2688||||2688|99.39|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2688||||2688|148.07|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2688||||2688|1288.9|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2688||||2688|236.72|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2688||||2688|2419.2|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2688||||2688|0|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2688||||2688|172.84|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2688||||2688|101.42|2499.84|99.39
35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2688||||2688|1344|2499.84|99.39
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3123||||3123|277.46|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3123||||3123|169.5|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3123||||3123|391.86|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3123||||3123|391.86|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3123||||3123|164.61|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3123||||3123|1564.62|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3123||||3123|1096.17|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3123||||3123|1342.89|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3123||||3123|1330.4|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3123||||3123|1561.5|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3123||||3123|2029.95|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3123||||3123|340.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3123||||3123|208.59|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|GEHA [1415]|GEHA [141500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3123||||3123|373.9|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3123||||3123|1342.89|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3123||||3123|2904.39|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3123||||3123|1873.8|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3123||||3123|181.08|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3123||||3123|482.2|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3123||||3123|378.48|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3123||||3123|224.34|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3123||||3123|169.5|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3123||||3123|249.27|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3123||||3123|407.29|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3123||||3123|181.08|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|Self-pay|Self-pay|3123||||3123|936.9|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3123||||3123|655.83|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3123||||3123|162.85|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3123||||3123|242.62|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3123||||3123|1497.48|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3123||||3123|360.44|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3123||||3123|2810.7|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3123||||3123|0|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3123||||3123|208.59|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3123||||3123|166.18|2904.39|162.85
35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3123||||3123|1561.5|2904.39|162.85
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3724||||3724|339.72|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3724||||3724|167.59|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3724||||3724|440.01|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3724||||3724|440.01|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3724||||3724|164.61|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3724||||3724|1865.72|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3724||||3724|1307.12|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3724||||3724|1601.32|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3724||||3724|1586.42|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3724||||3724|1862|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3724||||3724|2420.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3724||||3724|402.94|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3724||||3724|246.7|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3724||||3724|369.68|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3724||||3724|1601.32|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3724||||3724|3463.32|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3724||||3724|2234.4|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3724||||3724|181.08|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3724||||3724|482.2|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3724||||3724|424.98|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3724||||3724|221.81|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3724||||3724|167.59|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3724||||3724|246.45|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3724||||3724|457.34|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3724||||3724|181.08|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|Self-pay|Self-pay|3724||||3724|1117.2|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3724||||3724|782.04|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3724||||3724|161.02|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3724||||3724|239.88|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3724||||3724|1785.66|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3724||||3724|404.73|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3724||||3724|3351.6|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3724||||3724|0|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3724||||3724|246.7|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3724||||3724|164.3|3463.32|161.02
35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3724||||3724|1862|3463.32|161.02
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4391||||4391|415.58|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4391||||4391|169.5|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4391||||4391|449.17|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4391||||4391|449.17|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4391||||4391|164.61|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4391||||4391|2199.89|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4391||||4391|1541.24|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4391||||4391|1888.13|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4391||||4391|1870.57|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4391||||4391|2195.5|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4391||||4391|2854.15|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4391||||4391|493.43|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4391||||4391|302.1|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4391||||4391|373.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4391||||4391|1888.13|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4391||||4391|4083.63|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4391||||4391|2634.6|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4391||||4391|181.08|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4391||||4391|482.2|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4391||||4391|433.82|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4391||||4391|224.34|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4391||||4391|169.5|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4391||||4391|249.27|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4391||||4391|466.86|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4391||||4391|181.08|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|Self-pay|Self-pay|4391||||4391|1317.3|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4391||||4391|922.11|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4391||||4391|162.85|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4391||||4391|242.62|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4391||||4391|2105.48|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4391||||4391|413.15|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4391||||4391|3951.9|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4391||||4391|0|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4391||||4391|302.1|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4391||||4391|166.18|4083.63|162.85
35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4391||||4391|2195.5|4083.63|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4040||||4040|415.58|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4040||||4040|169.5|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4040||||4040|449.17|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4040||||4040|449.17|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4040||||4040|164.61|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4040||||4040|2024.04|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4040||||4040|1418.04|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4040||||4040|1737.2|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4040||||4040|1721.04|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4040||||4040|2020|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4040||||4040|2626|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4040||||4040|503.45|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4040||||4040|308.24|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4040||||4040|373.9|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4040||||4040|1737.2|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4040||||4040|3757.2|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4040||||4040|2424|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4040||||4040|181.08|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4040||||4040|482.2|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4040||||4040|433.82|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4040||||4040|224.34|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4040||||4040|169.5|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4040||||4040|249.27|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4040||||4040|466.86|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4040||||4040|181.08|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|Self-pay|Self-pay|4040||||4040|1212|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4040||||4040|848.4|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4040||||4040|162.85|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4040||||4040|242.62|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4040||||4040|1937.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4040||||4040|413.15|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4040||||4040|3636|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4040||||4040|0|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4040||||4040|308.24|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4040||||4040|166.18|3757.2|162.85
35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4040||||4040|2020|3757.2|162.85
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201001|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201002|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201003|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201004|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201007|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201008|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201009|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201010|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201011|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201012|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201013|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201014|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201015|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201016|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201017|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201018|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201019|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201020|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201021|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201022|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35201023|EAP|0352 - CT SCAN-BODY SCAN|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|AETNA [1015]|AETNA ACO WILCO [101532]|2849||||2849|208.54|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2849||||2849|103.45|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2849||||2849|257.35|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2849||||2849|257.35|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2849||||2849|100.46|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2849||||2849|1427.35|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2849||||2849|1000|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2849||||2849|1225.07|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2849||||2849|1213.67|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2849||||2849|1424.5|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2849||||2849|1851.85|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|CORESOURCE [1315]|CORESOURCE [131500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2849||||2849|278.8|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2849||||2849|170.69|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|GEHA [1415]|GEHA [141500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2849||||2849|228.19|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HEALTHNET [1495]|HEALTHNET [149500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2849||||2849|1225.07|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2849||||2849|2649.57|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2849||||2849|1709.4|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2849||||2849|110.51|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2849||||2849|268.93|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2849||||2849|248.57|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2849||||2849|136.91|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2849||||2849|103.45|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MULTIPLAN [1680]|HMA [168003]|2849||||2849|152.13|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MULTIPLAN [1680]|IHC HS [168011]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2849||||2849|267.48|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2849||||2849|110.51|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|Self-pay|Self-pay|2849||||2849|854.7|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2849||||2849|598.29|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2849||||2849|99.39|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2849||||2849|148.07|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|TRUSTMARK [2030]|STARMARK [203000]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2849||||2849|1366.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|UMR [2035]|UMR OPTIONS [203501]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2849||||2849|236.72|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2849||||2849|2564.1|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2849||||2849|0|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2849||||2849|170.69|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2849||||2849|101.42|2649.57|99.39
35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/O CON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2849||||2849|1424.5|2649.57|99.39
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3380||||3380|278.95|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3380||||3380|169.5|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3380||||3380|391.86|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3380||||3380|391.86|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3380||||3380|164.61|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3380||||3380|1693.38|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3380||||3380|1186.38|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3380||||3380|1453.4|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3380||||3380|1439.88|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3380||||3380|1690|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3380||||3380|2197|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3380||||3380|339.52|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3380||||3380|207.87|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|GEHA [1415]|GEHA [141500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3380||||3380|373.9|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3380||||3380|1453.4|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3380||||3380|3143.4|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3380||||3380|2028|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3380||||3380|181.08|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3380||||3380|482.2|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3380||||3380|378.48|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3380||||3380|224.34|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3380||||3380|169.5|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3380||||3380|249.27|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3380||||3380|407.29|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3380||||3380|181.08|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|Self-pay|Self-pay|3380||||3380|1014|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3380||||3380|709.8|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3380||||3380|162.85|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3380||||3380|242.62|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3380||||3380|1620.71|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3380||||3380|360.44|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3380||||3380|3042|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3380||||3380|0|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3380||||3380|207.87|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3380||||3380|166.18|3143.4|162.85
35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W/ CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3380||||3380|1690|3143.4|162.85
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3900||||3900|340.46|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3900||||3900|167.59|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3900||||3900|440.01|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3900||||3900|440.01|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3900||||3900|164.61|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3900||||3900|1953.9|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3900||||3900|1368.9|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3900||||3900|1677|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3900||||3900|1661.4|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3900||||3900|1950|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3900||||3900|2535|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3900||||3900|408.09|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3900||||3900|249.85|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|GEHA [1415]|GEHA [141500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3900||||3900|369.68|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3900||||3900|1677|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3900||||3900|3627|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3900||||3900|2340|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3900||||3900|181.08|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3900||||3900|482.2|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3900||||3900|424.98|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3900||||3900|221.81|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3900||||3900|167.59|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3900||||3900|246.45|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3900||||3900|457.34|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3900||||3900|181.08|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|Self-pay|Self-pay|3900||||3900|1170|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3900||||3900|819|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3900||||3900|161.02|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3900||||3900|242.62|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3900||||3900|1870.05|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3900||||3900|404.73|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3900||||3900|3510|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3900||||3900|0|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3900||||3900|249.85|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3900||||3900|164.3|3627|161.02
35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX DX W & WO CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3900||||3900|1950|3627|161.02
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3888||||3888|415.58|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3888||||3888|169.5|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3888||||3888|449.17|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3888||||3888|449.17|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3888||||3888|164.61|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3888||||3888|1947.89|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3888||||3888|1364.69|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3888||||3888|1671.84|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3888||||3888|1656.29|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3888||||3888|1944|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3888||||3888|2527.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3888||||3888|443.94|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3888||||3888|271.8|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3888||||3888|373.9|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3888||||3888|1671.84|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3888||||3888|3615.84|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3888||||3888|2332.8|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3888||||3888|181.08|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3888||||3888|482.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3888||||3888|433.82|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3888||||3888|224.34|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3888||||3888|169.5|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3888||||3888|249.27|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3888||||3888|466.86|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3888||||3888|181.08|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|Self-pay|Self-pay|3888||||3888|1166.4|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3888||||3888|816.48|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3888||||3888|162.85|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3888||||3888|242.62|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3888||||3888|1864.3|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3888||||3888|413.15|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3888||||3888|3499.2|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3888||||3888|0|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3888||||3888|271.8|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3888||||3888|166.18|3615.84|162.85
35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3888||||3888|1944|3615.84|162.85
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3144||||3144|231.51|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3144||||3144|103.45|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3144||||3144|257.35|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3144||||3144|257.35|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3144||||3144|100.46|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3144||||3144|1575.14|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3144||||3144|1103.54|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3144||||3144|1351.92|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3144||||3144|1339.34|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3144||||3144|1572|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3144||||3144|2043.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3144||||3144|289|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3144||||3144|176.94|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3144||||3144|228.19|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3144||||3144|1351.92|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3144||||3144|2923.92|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3144||||3144|1886.4|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3144||||3144|110.51|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3144||||3144|268.93|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3144||||3144|248.57|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3144||||3144|136.91|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3144||||3144|102.28|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3144||||3144|152.13|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3144||||3144|267.48|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3144||||3144|110.51|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|Self-pay|Self-pay|3144||||3144|943.2|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3144||||3144|660.24|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3144||||3144|99.39|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3144||||3144|148.07|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3144||||3144|1507.55|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3144||||3144|236.72|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3144||||3144|2829.6|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3144||||3144|0|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3144||||3144|176.94|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3144||||3144|101.42|2923.92|99.39
35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3144||||3144|1572|2923.92|99.39
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3672||||3672|345.65|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3672||||3672|349.46|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3672||||3672|391.86|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3672||||3672|391.86|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3672||||3672|339.38|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3672||||3672|1839.67|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3672||||3672|1288.87|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3672||||3672|1578.96|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3672||||3672|1564.27|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3672||||3672|1836|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3672||||3672|2386.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3672||||3672|341.34|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3672||||3672|208.98|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3672||||3672|770.86|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3672||||3672|1578.96|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3672||||3672|3414.96|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3672||||3672|2203.2|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3672||||3672|373.32|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3672||||3672|922.36|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3672||||3672|378.48|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3672||||3672|462.52|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3672||||3672|349.46|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3672||||3672|513.91|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3672||||3672|407.29|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3672||||3672|373.32|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|Self-pay|Self-pay|3672||||3672|1101.6|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3672||||3672|771.12|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3672||||3672|335.75|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3672||||3672|500.2|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3672||||3672|1760.72|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3672||||3672|360.44|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3672||||3672|3304.8|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3672||||3672|0|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3672||||3672|208.98|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3672||||3672|342.61|3414.96|208.98
35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3672||||3672|1836|3414.96|208.98
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4920||||4920|415.32|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4920||||4920|167.59|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4920||||4920|440.01|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4920||||4920|440.01|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4920||||4920|164.61|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4920||||4920|2464.92|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4920||||4920|1726.92|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4920||||4920|2115.6|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4920||||4920|2095.92|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4920||||4920|2460|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4920||||4920|3198|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4920||||4920|410.77|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4920||||4920|251.49|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4920||||4920|369.68|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4920||||4920|2115.6|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4920||||4920|4575.6|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4920||||4920|2952|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4920||||4920|181.08|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4920||||4920|482.2|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4920||||4920|424.98|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4920||||4920|221.81|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4920||||4920|167.59|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4920||||4920|246.45|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4920||||4920|457.34|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4920||||4920|181.08|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|Self-pay|Self-pay|4920||||4920|1476|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4920||||4920|1033.2|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4920||||4920|161.02|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4920||||4920|239.88|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4920||||4920|2359.14|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4920||||4920|404.73|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4920||||4920|4428|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4920||||4920|0|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4920||||4920|251.49|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4920||||4920|164.3|4575.6|161.02
35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4920||||4920|2460|4575.6|161.02
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3005||||3005|231.51|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3005||||3005|102.28|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3005||||3005|257.35|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3005||||3005|257.35|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3005||||3005|100.46|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3005||||3005|1505.51|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3005||||3005|1054.76|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3005||||3005|1292.15|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3005||||3005|1280.13|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3005||||3005|1502.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3005||||3005|1953.25|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3005||||3005|288.22|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3005||||3005|176.46|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3005||||3005|225.62|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3005||||3005|1292.15|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3005||||3005|2794.65|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3005||||3005|1803|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3005||||3005|101.42|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3005||||3005|110.51|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3005||||3005|268.93|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3005||||3005|248.57|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3005||||3005|136.91|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3005||||3005|102.28|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3005||||3005|150.41|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3005||||3005|267.48|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3005||||3005|110.51|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|Self-pay|Self-pay|3005||||3005|901.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3005||||3005|631.05|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3005||||3005|98.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3005||||3005|146.4|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3005||||3005|1440.9|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3005||||3005|236.72|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3005||||3005|2704.5|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3005||||3005|0|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3005||||3005|176.46|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3005||||3005|100.27|2794.65|98.27
35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3005||||3005|1502.5|2794.65|98.27
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3845||||3845|348.61|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3845||||3845|169.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3845||||3845|391.86|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3845||||3845|391.86|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3845||||3845|164.61|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3845||||3845|1926.35|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3845||||3845|1349.6|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3845||||3845|1653.35|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3845||||3845|1637.97|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3845||||3845|1922.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3845||||3845|2499.25|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3845||||3845|341.39|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3845||||3845|209.01|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3845||||3845|373.9|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3845||||3845|1653.35|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3845||||3845|3575.85|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3845||||3845|2307|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3845||||3845|181.08|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3845||||3845|482.2|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3845||||3845|378.48|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3845||||3845|224.34|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3845||||3845|169.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3845||||3845|249.27|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3845||||3845|407.29|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3845||||3845|181.08|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|Self-pay|Self-pay|3845||||3845|1153.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3845||||3845|807.45|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3845||||3845|162.85|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3845||||3845|242.62|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3845||||3845|1843.68|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3845||||3845|360.44|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3845||||3845|3460.5|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3845||||3845|0|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3845||||3845|209.01|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3845||||3845|166.18|3575.85|162.85
35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3845||||3845|1922.5|3575.85|162.85
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3014||||3014|231.51|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3014||||3014|103.45|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3014||||3014|257.35|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3014||||3014|257.35|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3014||||3014|100.46|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3014||||3014|1510.01|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3014||||3014|1057.91|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3014||||3014|1296.02|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3014||||3014|1283.96|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3014||||3014|1507|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3014||||3014|1959.1|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3014||||3014|287.74|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3014||||3014|176.17|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3014||||3014|228.19|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3014||||3014|1296.02|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3014||||3014|2803.02|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3014||||3014|1808.4|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3014||||3014|110.51|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3014||||3014|268.93|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3014||||3014|248.57|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3014||||3014|136.91|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3014||||3014|103.45|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3014||||3014|152.13|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3014||||3014|267.48|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3014||||3014|110.51|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|Self-pay|Self-pay|3014||||3014|904.2|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3014||||3014|632.94|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3014||||3014|99.39|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3014||||3014|148.07|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3014||||3014|1445.21|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3014||||3014|236.72|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3014||||3014|2712.6|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3014||||3014|0|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3014||||3014|176.17|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3014||||3014|101.42|2803.02|99.39
35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3014||||3014|1507|2803.02|99.39
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3485||||3485|346.39|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3485||||3485|349.46|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3485||||3485|391.86|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3485||||3485|391.86|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3485||||3485|339.38|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3485||||3485|1745.99|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3485||||3485|1223.24|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3485||||3485|1498.55|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3485||||3485|1484.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3485||||3485|1742.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3485||||3485|2265.25|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3485||||3485|341.17|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3485||||3485|208.88|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3485||||3485|770.86|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3485||||3485|1498.55|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3485||||3485|3241.05|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3485||||3485|2091|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3485||||3485|373.32|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3485||||3485|922.36|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3485||||3485|378.48|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3485||||3485|462.52|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3485||||3485|345.51|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3485||||3485|513.91|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3485||||3485|407.29|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3485||||3485|373.32|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|Self-pay|Self-pay|3485||||3485|1045.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3485||||3485|731.85|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3485||||3485|335.75|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3485||||3485|500.2|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3485||||3485|1671.06|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3485||||3485|360.44|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3485||||3485|3136.5|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3485||||3485|0|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3485||||3485|208.88|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3485||||3485|342.61|3241.05|208.88
35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3485||||3485|1742.5|3241.05|208.88
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4199||||4199|415.32|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4199||||4199|167.59|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4199||||4199|440.01|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4199||||4199|440.01|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4199||||4199|164.61|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4199||||4199|2103.7|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4199||||4199|1473.85|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4199||||4199|1805.57|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4199||||4199|1788.77|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4199||||4199|2099.5|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4199||||4199|2729.35|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4199||||4199|411.35|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4199||||4199|251.85|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4199||||4199|369.68|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4199||||4199|1805.57|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4199||||4199|3905.07|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4199||||4199|2519.4|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4199||||4199|181.08|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4199||||4199|482.2|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4199||||4199|424.98|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4199||||4199|221.81|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4199||||4199|167.59|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4199||||4199|246.45|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4199||||4199|457.34|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4199||||4199|181.08|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|Self-pay|Self-pay|4199||||4199|1259.7|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4199||||4199|881.79|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4199||||4199|161.02|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4199||||4199|239.88|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4199||||4199|2013.42|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4199||||4199|404.73|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4199||||4199|3779.1|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4199||||4199|0|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4199||||4199|251.85|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4199||||4199|164.3|3905.07|161.02
35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4199||||4199|2099.5|3905.07|161.02
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4101||||4101|415.58|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4101||||4101|169.5|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4101||||4101|449.17|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4101||||4101|449.17|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4101||||4101|164.61|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4101||||4101|2054.6|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4101||||4101|1439.45|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4101||||4101|1763.43|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4101||||4101|1747.03|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4101||||4101|2050.5|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4101||||4101|2665.65|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|CORESOURCE [1315]|CORESOURCE [131500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4101||||4101|448.36|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4101||||4101|274.51|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|GEHA [1415]|GEHA [141500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4101||||4101|373.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHNET [1495]|HEALTHNET [149500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4101||||4101|1763.43|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4101||||4101|3813.93|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4101||||4101|2460.6|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4101||||4101|181.08|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4101||||4101|482.2|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4101||||4101|433.82|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4101||||4101|224.34|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4101||||4101|169.5|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|HMA [168003]|4101||||4101|249.27|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|IHC HS [168011]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4101||||4101|466.86|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4101||||4101|181.08|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|Self-pay|Self-pay|4101||||4101|1230.3|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4101||||4101|861.21|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4101||||4101|162.85|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4101||||4101|242.62|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|TRUSTMARK [2030]|STARMARK [203000]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4101||||4101|1966.43|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|UMR [2035]|UMR OPTIONS [203501]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4101||||4101|413.15|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4101||||4101|3690.9|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4101||||4101|0|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4101||||4101|274.51|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4101||||4101|166.18|3813.93|162.85
35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4101||||4101|2050.5|3813.93|162.85
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3017||||3017|189.27|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3017||||3017|103.45|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3017||||3017|257.35|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3017||||3017|257.35|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3017||||3017|100.46|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3017||||3017|1511.52|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3017||||3017|1058.97|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3017||||3017|1297.31|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3017||||3017|1285.24|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3017||||3017|1508.5|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3017||||3017|1961.05|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3017||||3017|278.88|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3017||||3017|170.74|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3017||||3017|228.19|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3017||||3017|1297.31|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3017||||3017|2805.81|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3017||||3017|1810.2|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3017||||3017|110.51|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3017||||3017|268.93|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3017||||3017|248.57|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3017||||3017|136.91|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3017||||3017|103.45|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3017||||3017|152.13|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3017||||3017|267.48|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3017||||3017|110.51|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|Self-pay|Self-pay|3017||||3017|905.1|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3017||||3017|633.57|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3017||||3017|99.39|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3017||||3017|148.07|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3017||||3017|1446.65|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3017||||3017|236.72|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3017||||3017|2715.3|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3017||||3017|0|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3017||||3017|170.74|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3017||||3017|101.42|2805.81|99.39
35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3017||||3017|1508.5|2805.81|99.39
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3523||||3523|365.66|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3523||||3523|169.5|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3523||||3523|391.86|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3523||||3523|391.86|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3523||||3523|164.61|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3523||||3523|1765.02|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3523||||3523|1236.57|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3523||||3523|1514.89|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3523||||3523|1500.8|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3523||||3523|1761.5|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3523||||3523|2289.95|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3523||||3523|331.56|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3523||||3523|203|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3523||||3523|373.9|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3523||||3523|1514.89|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3523||||3523|3276.39|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3523||||3523|2113.8|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3523||||3523|181.08|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3523||||3523|482.2|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3523||||3523|378.48|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3523||||3523|224.34|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3523||||3523|169.5|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3523||||3523|249.27|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3523||||3523|407.29|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3523||||3523|181.08|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|Self-pay|Self-pay|3523||||3523|1056.9|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3523||||3523|739.83|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3523||||3523|162.85|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3523||||3523|242.62|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3523||||3523|1689.28|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3523||||3523|360.44|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3523||||3523|3170.7|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3523||||3523|0|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3523||||3523|203|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3523||||3523|166.18|3276.39|162.85
35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3523||||3523|1761.5|3276.39|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4302||||4302|415.32|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4302||||4302|169.5|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4302||||4302|440.01|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4302||||4302|440.01|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4302||||4302|164.61|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4302||||4302|2155.3|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4302||||4302|1510|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4302||||4302|1849.86|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4302||||4302|1832.65|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4302||||4302|2151|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4302||||4302|2796.3|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4302||||4302|392.23|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4302||||4302|240.14|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4302||||4302|373.9|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4302||||4302|1849.86|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4302||||4302|4000.86|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4302||||4302|2581.2|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4302||||4302|181.08|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4302||||4302|482.2|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4302||||4302|424.98|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4302||||4302|224.34|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4302||||4302|169.5|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4302||||4302|249.27|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4302||||4302|457.34|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4302||||4302|181.08|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|Self-pay|Self-pay|4302||||4302|1290.6|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4302||||4302|903.42|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4302||||4302|162.85|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4302||||4302|239.88|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4302||||4302|2062.81|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4302||||4302|404.73|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4302||||4302|3871.8|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4302||||4302|0|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4302||||4302|240.14|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4302||||4302|166.18|4000.86|162.85
35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4302||||4302|2151|4000.86|162.85
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2520||||2520|345.43|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2520||||2520|103.45|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2520||||2520|257.35|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2520||||2520|257.35|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2520||||2520|100.46|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2520||||2520|1262.52|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2520||||2520|884.52|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2520||||2520|1083.6|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2520||||2520|1073.52|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2520||||2520|1260|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2520||||2520|1638|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2520||||2520|263.33|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2520||||2520|161.22|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2520||||2520|228.19|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2520||||2520|1083.6|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2520||||2520|2343.6|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2520||||2520|1512|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2520||||2520|110.51|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2520||||2520|268.93|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2520||||2520|248.57|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2520||||2520|136.91|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2520||||2520|102.28|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2520||||2520|152.13|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2520||||2520|267.48|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2520||||2520|110.51|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|Self-pay|Self-pay|2520||||2520|756|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2520||||2520|529.2|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2520||||2520|99.39|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2520||||2520|148.07|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2520||||2520|1208.34|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2520||||2520|236.72|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2520||||2520|2268|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2520||||2520|0|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2520||||2520|161.22|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2520||||2520|101.42|2343.6|99.39
35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2520||||2520|1260|2343.6|99.39
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3372||||3372|342.69|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3372||||3372|349.46|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3372||||3372|391.86|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3372||||3372|391.86|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3372||||3372|339.38|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3372||||3372|1689.37|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3372||||3372|1183.57|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3372||||3372|1449.96|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3372||||3372|1436.47|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3372||||3372|1686|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3372||||3372|2191.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3372||||3372|322.26|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3372||||3372|197.3|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3372||||3372|770.86|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3372||||3372|1449.96|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3372||||3372|3135.96|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3372||||3372|2023.2|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3372||||3372|338.74|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3372||||3372|373.32|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3372||||3372|922.36|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3372||||3372|378.48|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3372||||3372|462.52|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3372||||3372|345.51|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3372||||3372|513.91|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3372||||3372|407.29|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3372||||3372|373.32|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|Self-pay|Self-pay|3372||||3372|1011.6|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3372||||3372|708.12|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3372||||3372|331.97|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3372||||3372|494.56|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3372||||3372|1616.87|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3372||||3372|360.44|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3372||||3372|3034.8|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3372||||3372|0|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3372||||3372|197.3|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3372||||3372|342.61|3135.96|197.3
35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3372||||3372|1686|3135.96|197.3
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|AETNA [1015]|AETNA ACO WILCO [101532]|3167||||3167|415.58|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3167||||3167|169.5|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3167||||3167|449.17|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3167||||3167|449.17|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3167||||3167|164.61|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3167||||3167|1586.67|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3167||||3167|1111.62|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3167||||3167|1361.81|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3167||||3167|1349.14|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3167||||3167|1583.5|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3167||||3167|2058.55|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|CORESOURCE [1315]|CORESOURCE [131500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3167||||3167|470.69|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3167||||3167|288.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|GEHA [1415]|GEHA [141500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3167||||3167|373.9|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HEALTHNET [1495]|HEALTHNET [149500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3167||||3167|1361.81|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3167||||3167|2945.31|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3167||||3167|1900.2|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3167||||3167|181.08|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3167||||3167|482.2|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3167||||3167|433.82|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3167||||3167|224.34|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3167||||3167|169.5|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MULTIPLAN [1680]|HMA [168003]|3167||||3167|249.27|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MULTIPLAN [1680]|IHC HS [168011]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3167||||3167|466.86|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3167||||3167|181.08|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|Self-pay|Self-pay|3167||||3167|950.1|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3167||||3167|665.07|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3167||||3167|162.85|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3167||||3167|242.62|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|TRUSTMARK [2030]|STARMARK [203000]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3167||||3167|1518.58|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|UMR [2035]|UMR OPTIONS [203501]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3167||||3167|413.15|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3167||||3167|2850.3|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3167||||3167|0|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3167||||3167|288.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3167||||3167|166.18|2945.31|162.85
35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3167||||3167|1583.5|2945.31|162.85
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2744||||2744|231.51|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2744||||2744|103.45|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2744||||2744|257.35|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2744||||2744|257.35|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2744||||2744|100.46|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2744||||2744|1374.74|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2744||||2744|963.14|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2744||||2744|1179.92|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2744||||2744|1168.94|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2744||||2744|1372|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2744||||2744|1783.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2744||||2744|263.77|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2744||||2744|161.49|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2744||||2744|228.19|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2744||||2744|1179.92|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2744||||2744|2551.92|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2744||||2744|1646.4|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2744||||2744|110.51|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2744||||2744|268.93|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2744||||2744|248.57|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2744||||2744|136.91|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2744||||2744|103.45|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2744||||2744|152.13|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2744||||2744|267.48|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2744||||2744|110.51|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|Self-pay|Self-pay|2744||||2744|823.2|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2744||||2744|576.24|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2744||||2744|98.27|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2744||||2744|148.07|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2744||||2744|1315.75|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2744||||2744|236.72|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2744||||2744|2469.6|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2744||||2744|0|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2744||||2744|161.49|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2744||||2744|101.42|2551.92|98.27
35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2744||||2744|1372|2551.92|98.27
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3372||||3372|348.61|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3372||||3372|169.5|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3372||||3372|391.86|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3372||||3372|391.86|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3372||||3372|164.61|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3372||||3372|1689.37|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3372||||3372|1183.57|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3372||||3372|1449.96|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3372||||3372|1436.47|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3372||||3372|1686|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3372||||3372|2191.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3372||||3372|324.14|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3372||||3372|198.45|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3372||||3372|373.9|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3372||||3372|1449.96|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3372||||3372|3135.96|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3372||||3372|2023.2|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3372||||3372|181.08|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3372||||3372|482.2|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3372||||3372|378.48|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3372||||3372|224.34|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3372||||3372|167.59|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3372||||3372|249.27|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3372||||3372|407.29|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3372||||3372|181.08|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|Self-pay|Self-pay|3372||||3372|1011.6|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3372||||3372|708.12|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3372||||3372|162.85|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3372||||3372|242.62|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3372||||3372|1616.87|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3372||||3372|360.44|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3372||||3372|3034.8|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3372||||3372|0|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3372||||3372|198.45|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3372||||3372|166.18|3135.96|162.85
35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3372||||3372|1686|3135.96|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3483||||3483|414.85|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3483||||3483|169.5|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3483||||3483|449.17|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3483||||3483|449.17|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3483||||3483|164.61|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3483||||3483|1744.98|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3483||||3483|1222.53|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3483||||3483|1497.69|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3483||||3483|1483.76|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3483||||3483|1741.5|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3483||||3483|2263.95|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|CORESOURCE [1315]|CORESOURCE [131500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3483||||3483|501.87|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3483||||3483|307.27|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|GEHA [1415]|GEHA [141500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3483||||3483|373.9|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHNET [1495]|HEALTHNET [149500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3483||||3483|1497.69|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3483||||3483|3239.19|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3483||||3483|2089.8|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3483||||3483|181.08|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3483||||3483|482.2|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3483||||3483|433.82|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3483||||3483|224.34|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3483||||3483|169.5|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|HMA [168003]|3483||||3483|249.27|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|IHC HS [168011]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3483||||3483|466.86|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3483||||3483|181.08|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|Self-pay|Self-pay|3483||||3483|1044.9|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3483||||3483|731.43|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3483||||3483|162.85|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3483||||3483|242.62|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|TRUSTMARK [2030]|STARMARK [203000]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3483||||3483|1670.1|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|UMR [2035]|UMR OPTIONS [203501]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3483||||3483|413.15|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3483||||3483|3134.7|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3483||||3483|0|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3483||||3483|307.27|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3483||||3483|166.18|3239.19|162.85
35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3483||||3483|1741.5|3239.19|162.85
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3039||||3039|187.04|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3039||||3039|102.28|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3039||||3039|257.35|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3039||||3039|257.35|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3039||||3039|100.46|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3039||||3039|1522.54|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3039||||3039|1066.69|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3039||||3039|1306.77|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3039||||3039|1294.61|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3039||||3039|1519.5|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3039||||3039|1975.35|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3039||||3039|269.56|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3039||||3039|165.04|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3039||||3039|225.62|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3039||||3039|1306.77|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3039||||3039|2826.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3039||||3039|1823.4|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3039||||3039|101.42|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3039||||3039|110.51|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3039||||3039|268.93|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3039||||3039|248.57|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3039||||3039|135.37|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3039||||3039|102.28|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3039||||3039|150.41|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3039||||3039|267.48|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3039||||3039|110.51|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|Self-pay|Self-pay|3039||||3039|911.7|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3039||||3039|638.19|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3039||||3039|98.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3039||||3039|148.07|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3039||||3039|1457.2|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3039||||3039|236.72|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3039||||3039|2735.1|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3039||||3039|0|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3039||||3039|165.04|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3039||||3039|100.27|2826.27|98.27
35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3039||||3039|1519.5|2826.27|98.27
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3516||||3516|364.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3516||||3516|169.5|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3516||||3516|391.86|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3516||||3516|391.86|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3516||||3516|164.61|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3516||||3516|1761.52|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3516||||3516|1234.12|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3516||||3516|1511.88|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3516||||3516|1497.82|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3516||||3516|1758|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3516||||3516|2285.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3516||||3516|340.73|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3516||||3516|208.61|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|GEHA [1415]|GEHA [141500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3516||||3516|373.9|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3516||||3516|1511.88|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3516||||3516|3269.88|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3516||||3516|2109.6|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3516||||3516|181.08|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3516||||3516|482.2|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3516||||3516|378.48|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3516||||3516|224.34|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3516||||3516|169.5|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3516||||3516|249.27|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3516||||3516|407.29|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3516||||3516|181.08|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|Self-pay|Self-pay|3516||||3516|1054.8|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3516||||3516|738.36|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3516||||3516|162.85|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3516||||3516|242.62|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3516||||3516|1685.92|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3516||||3516|360.44|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3516||||3516|3164.4|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3516||||3516|0|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3516||||3516|208.61|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3516||||3516|166.18|3269.88|162.85
35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3516||||3516|1758|3269.88|162.85
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4254||||4254|415.32|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4254||||4254|169.5|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4254||||4254|440.01|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4254||||4254|440.01|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4254||||4254|164.61|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4254||||4254|2131.25|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4254||||4254|1493.15|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4254||||4254|1829.22|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4254||||4254|1812.2|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4254||||4254|2127|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4254||||4254|2765.1|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4254||||4254|424.38|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4254||||4254|259.83|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4254||||4254|369.68|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4254||||4254|1829.22|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4254||||4254|3956.22|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4254||||4254|2552.4|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4254||||4254|166.18|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4254||||4254|181.08|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4254||||4254|482.2|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4254||||4254|424.98|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4254||||4254|224.34|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4254||||4254|167.59|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4254||||4254|246.45|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4254||||4254|457.34|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4254||||4254|181.08|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|Self-pay|Self-pay|4254||||4254|1276.2|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4254||||4254|893.34|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4254||||4254|161.02|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4254||||4254|242.62|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4254||||4254|2039.79|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4254||||4254|404.73|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4254||||4254|3828.6|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4254||||4254|0|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4254||||4254|259.83|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4254||||4254|164.3|3956.22|161.02
35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4254||||4254|2127|3956.22|161.02
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5381||||5381|597.91|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5381||||5381|349.46|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5381||||5381|737.34|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5381||||5381|737.34|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5381||||5381|339.38|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5381||||5381|2695.88|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5381||||5381|1888.73|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5381||||5381|2313.83|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5381||||5381|2292.31|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5381||||5381|2690.5|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5381||||5381|3497.65|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|CORESOURCE [1315]|CORESOURCE [131500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5381||||5381|600.51|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5381||||5381|367.66|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|GEHA [1415]|GEHA [141500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5381||||5381|770.86|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHNET [1495]|HEALTHNET [149500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5381||||5381|2313.83|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5381||||5381|5004.33|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5381||||5381|3228.6|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5381||||5381|373.32|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5381||||5381|922.36|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5381||||5381|712.15|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5381||||5381|462.52|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5381||||5381|349.46|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|HMA [168003]|5381||||5381|513.91|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|IHC HS [168011]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5381||||5381|766.37|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5381||||5381|373.32|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|Self-pay|Self-pay|5381||||5381|1614.3|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5381||||5381|1130.01|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5381||||5381|335.75|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5381||||5381|500.2|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|TRUSTMARK [2030]|STARMARK [203000]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5381||||5381|2580.19|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|UMR [2035]|UMR OPTIONS [203501]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5381||||5381|678.22|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5381||||5381|4842.9|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5381||||5381|0|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5381||||5381|367.66|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5381||||5381|342.61|5004.33|335.75
35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5381||||5381|2690.5|5004.33|335.75
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4058||||4058|415.58|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4058||||4058|167.59|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4058||||4058|449.17|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4058||||4058|449.17|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4058||||4058|164.61|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4058||||4058|2033.06|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4058||||4058|1424.36|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4058||||4058|1744.94|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4058||||4058|1728.71|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4058||||4058|2029|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4058||||4058|2637.7|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|CORESOURCE [1315]|CORESOURCE [131500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4058||||4058|451.77|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4058||||4058|276.6|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|GEHA [1415]|GEHA [141500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4058||||4058|369.68|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHNET [1495]|HEALTHNET [149500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4058||||4058|1744.94|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4058||||4058|3773.94|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4058||||4058|2434.8|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4058||||4058|181.08|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4058||||4058|482.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4058||||4058|433.82|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4058||||4058|221.81|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4058||||4058|167.59|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|HMA [168003]|4058||||4058|246.45|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MULTIPLAN [1680]|IHC HS [168011]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4058||||4058|466.86|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4058||||4058|181.08|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|Self-pay|Self-pay|4058||||4058|1217.4|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4058||||4058|852.18|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4058||||4058|161.02|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4058||||4058|239.88|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|TRUSTMARK [2030]|STARMARK [203000]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4058||||4058|1945.81|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|UMR [2035]|UMR OPTIONS [203501]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4058||||4058|413.15|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4058||||4058|3652.2|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4058||||4058|0|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4058||||4058|276.6|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4058||||4058|164.3|3773.94|161.02
35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4058||||4058|2029|3773.94|161.02
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6054||||6054|214.18|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|6054||||6054|235.22|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6054||||6054|218.46|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6054||||6054|250.28|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6054||||6054|250.28|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6054||||6054|212.16|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6054||||6054|3033.05|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6054||||6054|2124.95|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6054||||6054|2603.22|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6054||||6054|2579|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6054||||6054|3027|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6054||||6054|3935.1|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6054||||6054|249.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6054||||6054|152.82|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6054||||6054|476.46|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6054||||6054|2603.22|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6054||||6054|5630.22|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6054||||6054|3632.4|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6054||||6054|214.18|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6054||||6054|233.38|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6054||||6054|551.1|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6054||||6054|241.72|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6054||||6054|289.14|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6054||||6054|218.46|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|6054||||6054|321.27|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6054||||6054|260.13|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6054||||6054|233.38|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|Self-pay|Self-pay|6054||||6054|1816.2|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6054||||6054|1271.34|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6054||||6054|214.18|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6054||||6054|209.89|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6054||||6054|312.7|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6054||||6054|2902.89|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6054||||6054|230.21|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6054||||6054|5448.6|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6054||||6054|0|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6054||||6054|152.82|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6054||||6054|211.76|5630.22|152.82
35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6054||||6054|3027|5630.22|152.82
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7039||||7039|342.61|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|7039||||7039|473.87|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7039||||7039|349.46|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7039||||7039|387.09|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7039||||7039|387.09|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7039||||7039|339.38|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7039||||7039|3526.54|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7039||||7039|2470.69|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7039||||7039|3026.77|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7039||||7039|2998.61|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7039||||7039|3519.5|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7039||||7039|4575.35|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7039||||7039|342.61|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7039||||7039|385.99|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7039||||7039|236.68|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|GEHA [1415]|GEHA [141500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7039||||7039|762.16|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7039||||7039|3026.77|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7039||||7039|6546.27|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7039||||7039|4223.4|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7039||||7039|342.61|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7039||||7039|373.32|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7039||||7039|342.61|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7039||||7039|922.36|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7039||||7039|373.87|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7039||||7039|462.52|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7039||||7039|349.46|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|7039||||7039|513.91|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7039||||7039|402.33|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7039||||7039|373.32|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|Self-pay|Self-pay|7039||||7039|2111.7|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7039||||7039|1478.19|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7039||||7039|342.61|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7039||||7039|335.75|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7039||||7039|500.2|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7039||||7039|3375.2|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7039||||7039|356.06|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7039||||7039|6335.1|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7039||||7039|0|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7039||||7039|236.68|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7039||||7039|338.74|6546.27|236.68
35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7039||||7039|3519.5|6546.27|236.68
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|8556||||8556|541.59|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8556||||8556|349.46|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8556||||8556|431.54|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8556||||8556|431.54|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8556||||8556|339.38|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8556||||8556|4286.56|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8556||||8556|3003.16|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8556||||8556|3679.08|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8556||||8556|3644.86|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8556||||8556|4278|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8556||||8556|5561.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8556||||8556|487.29|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8556||||8556|298.34|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|GEHA [1415]|GEHA [141500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8556||||8556|770.86|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8556||||8556|3679.08|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8556||||8556|7957.08|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8556||||8556|5133.6|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8556||||8556|373.32|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8556||||8556|922.36|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8556||||8556|416.81|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8556||||8556|462.52|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8556||||8556|349.46|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|8556||||8556|513.91|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8556||||8556|448.53|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8556||||8556|373.32|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|Self-pay|Self-pay|8556||||8556|2566.8|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8556||||8556|1796.76|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8556||||8556|331.97|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8556||||8556|500.2|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8556||||8556|4102.6|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8556||||8556|396.95|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8556||||8556|7700.4|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8556||||8556|0|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8556||||8556|298.34|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8556||||8556|342.61|7957.08|298.34
35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8556||||8556|4278|7957.08|298.34
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|AETNA [1015]|AETNA ACO WILCO [101532]|540||||540|128.48|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|540||||540|76.8|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|540||||540|38.69|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|540||||540|38.69|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|540||||540|74.59|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|540||||540|270.54|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|540||||540|189.54|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|540||||540|232.2|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|540||||540|230.04|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|540||||540|270|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|540||||540|351|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|CORESOURCE [1315]|CORESOURCE [131500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|540||||540|236.12|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|540||||540|144.56|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|GEHA [1415]|GEHA [141500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|540||||540|169.41|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HEALTHNET [1495]|HEALTHNET [149500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|540||||540|232.2|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|540||||540|502.2|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|540||||540|324|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|540||||540|82.04|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|540||||540|148.92|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|540||||540|37.37|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|540||||540|100.5|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|540||||540|76.8|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MULTIPLAN [1680]|HMA [168003]|540||||540|112.94|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MULTIPLAN [1680]|IHC HS [168011]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|540||||540|40.21|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|540||||540|82.04|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|Self-pay|Self-pay|540||||540|162|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|540||||540|113.4|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|540||||540|73.79|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|540||||540|109.93|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|TRUSTMARK [2030]|STARMARK [203000]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|540||||540|258.93|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|UMR [2035]|UMR OPTIONS [203501]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|540||||540|35.59|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|540||||540|486|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|540||||540|0|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|540||||540|144.56|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|540||||540|75.29|502.2|35.59
35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART QUANT EVAL CORONRY CALCIUM W/O CONT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|540||||540|270|502.2|35.59
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|677||||677|374.83|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|677||||677|169.5|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|677||||677|355.08|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|677||||677|355.08|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|677||||677|164.61|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|677||||677|339.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|677||||677|237.63|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|677||||677|291.11|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|677||||677|288.4|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|677||||677|338.5|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|677||||677|440.05|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|677||||677|415.32|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|677||||677|254.28|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|GEHA [1415]|GEHA [141500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|677||||677|373.9|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|677||||677|291.11|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|677||||677|629.61|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|677||||677|406.2|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|677||||677|181.08|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|677||||677|482.2|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|677||||677|342.95|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|677||||677|224.34|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|677||||677|169.5|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|677||||677|249.27|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|677||||677|369.06|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|677||||677|181.08|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|Self-pay|Self-pay|677||||677|203.1|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|677||||677|142.17|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|677||||677|162.85|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|677||||677|242.62|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|677||||677|324.62|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|677||||677|326.61|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|677||||677|609.3|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|677||||677|0|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|677||||677|254.28|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|677||||677|166.18|629.61|142.17
35275572|EAP|0352 - CT SCAN-BODY SCAN|HC HEART STRUCTURE&MORPH W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|677||||677|338.5|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|AETNA [1015]|AETNA ACO WILCO [101532]|677||||677|415.58|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|677||||677|169.5|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|677||||677|355.08|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|677||||677|355.08|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|677||||677|164.61|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|677||||677|339.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|677||||677|237.63|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|677||||677|291.11|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|677||||677|288.4|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|677||||677|338.5|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|677||||677|440.05|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|CORESOURCE [1315]|CORESOURCE [131500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|677||||677|566.54|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|677||||677|346.86|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|GEHA [1415]|GEHA [141500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|677||||677|373.9|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HEALTHNET [1495]|HEALTHNET [149500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|677||||677|291.11|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|677||||677|629.61|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|677||||677|406.2|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|677||||677|181.08|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|677||||677|482.2|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|677||||677|342.95|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|677||||677|224.34|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|677||||677|169.5|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MULTIPLAN [1680]|HMA [168003]|677||||677|249.27|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MULTIPLAN [1680]|IHC HS [168011]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|677||||677|369.06|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|677||||677|181.08|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|Self-pay|Self-pay|677||||677|203.1|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|677||||677|142.17|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|677||||677|162.85|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|677||||677|242.62|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|TRUSTMARK [2030]|STARMARK [203000]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|677||||677|324.62|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|UMR [2035]|UMR OPTIONS [203501]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|677||||677|326.61|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|677||||677|609.3|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|677||||677|0|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|677||||677|346.86|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|677||||677|166.18|629.61|142.17
35275573|EAP|0352 - CT SCAN-BODY SCAN|HC HEART (CONG HRT DIS) STRUCT&MORPH W/CONT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|677||||677|338.5|629.61|142.17
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|4806||||4806|415.58|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4806||||4806|169.5|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4806||||4806|355.08|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4806||||4806|355.08|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4806||||4806|164.61|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4806||||4806|2407.81|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4806||||4806|1686.91|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4806||||4806|2066.58|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4806||||4806|2047.36|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4806||||4806|2403|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4806||||4806|3123.9|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|CORESOURCE [1315]|CORESOURCE [131500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4806||||4806|599.32|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4806||||4806|366.93|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|GEHA [1415]|GEHA [141500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4806||||4806|373.9|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HEALTHNET [1495]|HEALTHNET [149500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4806||||4806|2066.58|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4806||||4806|4469.58|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4806||||4806|2883.6|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4806||||4806|181.08|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4806||||4806|482.2|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4806||||4806|342.95|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4806||||4806|224.34|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4806||||4806|169.5|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MULTIPLAN [1680]|HMA [168003]|4806||||4806|249.27|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MULTIPLAN [1680]|IHC HS [168011]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4806||||4806|369.06|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4806||||4806|181.08|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|Self-pay|Self-pay|4806||||4806|1441.8|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4806||||4806|1009.26|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4806||||4806|162.85|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4806||||4806|242.62|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|TRUSTMARK [2030]|STARMARK [203000]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4806||||4806|2304.48|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|UMR [2035]|UMR OPTIONS [203501]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4806||||4806|326.61|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4806||||4806|4325.4|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4806||||4806|0|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4806||||4806|366.93|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4806||||4806|166.18|4469.58|162.85
35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4806||||4806|2403|4469.58|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4123||||4123|415.58|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4123||||4123|169.5|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4123||||4123|449.17|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4123||||4123|449.17|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4123||||4123|164.61|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4123||||4123|2065.62|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4123||||4123|1447.17|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4123||||4123|1772.89|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4123||||4123|1756.4|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4123||||4123|2061.5|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4123||||4123|2679.95|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|CORESOURCE [1315]|CORESOURCE [131500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4123||||4123|560.1|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4123||||4123|342.92|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|GEHA [1415]|GEHA [141500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4123||||4123|373.9|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HEALTHNET [1495]|HEALTHNET [149500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4123||||4123|1772.89|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4123||||4123|3834.39|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4123||||4123|2473.8|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4123||||4123|181.08|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4123||||4123|482.2|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4123||||4123|433.82|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4123||||4123|224.34|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4123||||4123|167.59|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MULTIPLAN [1680]|HMA [168003]|4123||||4123|249.27|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MULTIPLAN [1680]|IHC HS [168011]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4123||||4123|466.86|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4123||||4123|181.08|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|Self-pay|Self-pay|4123||||4123|1236.9|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4123||||4123|865.83|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4123||||4123|162.85|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4123||||4123|242.62|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|TRUSTMARK [2030]|STARMARK [203000]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4123||||4123|1976.98|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|UMR [2035]|UMR OPTIONS [203501]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4123||||4123|413.15|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4123||||4123|3710.7|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4123||||4123|0|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4123||||4123|342.92|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4123||||4123|166.18|3834.39|162.85
35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4123||||4123|2061.5|3834.39|162.85
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.07|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.96|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.96
3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.96
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|AETNA [1015]|AETNA ACO WILCO [101532]|3191||||3191|0|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3191||||3191|596.75|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3191||||3191|640.29|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3191||||3191|640.29|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3191||||3191|1598.69|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3191||||3191|1120.04|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3191||||3191|1372.13|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3191||||3191|1359.37|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3191||||3191|1595.5|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3191||||3191|2074.15|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|CORESOURCE [1315]|CORESOURCE [131500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3191||||3191|2095.21|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3191||||3191|812.57|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|GEHA [1415]|GEHA [141500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3191||||3191|1316.37|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HEALTHNET [1495]|HEALTHNET [149500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3191||||3191|1372.13|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3191||||3191|2967.63|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3191||||3191|1914.6|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3191||||3191|643.56|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3191||||3191|1431.31|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3191||||3191|618.38|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3191||||3191|789.82|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3191||||3191|596.75|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MULTIPLAN [1680]|HMA [168003]|3191||||3191|877.58|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MULTIPLAN [1680]|IHC HS [168011]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3191||||3191|665.5|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3191||||3191|643.56|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|Self-pay|Self-pay|3191||||3191|957.3|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3191||||3191|670.11|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3191||||3191|573.35|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3191||||3191|854.18|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|TRUSTMARK [2030]|STARMARK [203000]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3191||||3191|1530.08|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|UMR [2035]|UMR OPTIONS [203501]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3191||||3191|588.94|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3191||||3191|2871.9|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3191||||3191|0|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3191||||3191|812.57|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3191||||3191|585.05|2967.63|573.35
36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3191||||3191|1595.5|2967.63|573.35
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2542||||2542|1273.54|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2542||||2542|892.24|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2542||||2542|1093.06|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2542||||2542|1082.89|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2542||||2542|1271|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2542||||2542|1652.3|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|CORESOURCE [1315]|CORESOURCE [131500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2542||||2542|1669.08|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2542||||2542|940.54|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|GEHA [1415]|GEHA [141500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HEALTHNET [1495]|HEALTHNET [149500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2542||||2542|1093.06|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2542||||2542|2364.06|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2542||||2542|1525.2|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2542||||2542|1271|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MULTIPLAN [1680]|HMA [168003]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MULTIPLAN [1680]|IHC HS [168011]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|Self-pay|Self-pay|2542||||2542|762.6|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2542||||2542|533.82|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|TRUSTMARK [2030]|STARMARK [203000]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2542||||2542|1218.89|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|UMR [2035]|UMR OPTIONS [203501]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2542||||2542|2287.8|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2542||||2542|0|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2542||||2542|940.54|2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2542||||2542||2364.06|533.82
36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2542||||2542|1271|2364.06|533.82
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|8781||||8781|0|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8781||||8781|4399.28|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8781||||8781|3082.13|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8781||||8781|3775.83|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8781||||8781|3740.71|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8781||||8781|4390.5|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8781||||8781|5707.65|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|CORESOURCE [1315]|CORESOURCE [131500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8781||||8781|5765.6|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|GEHA [1415]|GEHA [141500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HEALTHNET [1495]|HEALTHNET [149500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8781||||8781|3775.83|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8781||||8781|8166.33|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8781||||8781|5268.6|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8781||||8781|8781|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MULTIPLAN [1680]|HMA [168003]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MULTIPLAN [1680]|IHC HS [168011]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|Self-pay|Self-pay|8781||||8781|2634.3|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8781||||8781|1844.01|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|TRUSTMARK [2030]|STARMARK [203000]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8781||||8781|4210.49|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|UMR [2035]|UMR OPTIONS [203501]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8781||||8781|7902.9|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8781||||8781|0|8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8781||||8781||8781|1844.01
36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8781||||8781|4390.5|8781|1844.01
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4189||||4189|578.87|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|AETNA [1015]|AETNA ACO WILCO [101532]|4189||||4189|0|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4189||||4189|583.78|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4189||||4189|764.3|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4189||||4189|764.3|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4189||||4189|573.42|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4189||||4189|2098.69|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4189||||4189|1470.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4189||||4189|1801.27|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4189||||4189|1784.51|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4189||||4189|2094.5|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4189||||4189|2722.85|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|CORESOURCE [1315]|CORESOURCE [131500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4189||||4189|2750.5|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4189||||4189|793.01|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|GEHA [1415]|GEHA [141500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4189||||4189|1287.76|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HEALTHNET [1495]|HEALTHNET [149500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4189||||4189|1801.27|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4189||||4189|3895.77|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4189||||4189|2513.4|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4189||||4189|578.87|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4189||||4189|630.76|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4189||||4189|1384.76|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4189||||4189|0|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4189||||4189|772.66|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4189||||4189|583.78|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MULTIPLAN [1680]|HMA [168003]|4189||||4189|858.51|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MULTIPLAN [1680]|IHC HS [168011]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4189||||4189|794.39|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4189||||4189|630.76|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|Self-pay|Self-pay|4189||||4189|1256.7|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4189||||4189|879.69|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4189||||4189|567.29|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4189||||4189|845.15|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|TRUSTMARK [2030]|STARMARK [203000]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4189||||4189|2008.63|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|UMR [2035]|UMR OPTIONS [203501]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4189||||4189|0|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4189||||4189|3770.1|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4189||||4189|0|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4189||||4189|793.01|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4189||||4189|572.34|3895.77|567.29
36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4189||||4189|2094.5|3895.77|567.29
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|AETNA [1015]|AETNA ACO WILCO [101532]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2850||||2850|1427.85|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2850||||2850|1000.35|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2850||||2850|1225.5|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2850||||2850|1214.1|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2850||||2850|1425|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2850||||2850|1852.5|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|CORESOURCE [1315]|CORESOURCE [131500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2850||||2850|1871.31|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2850||||2850|160.06|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|GEHA [1415]|GEHA [141500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HEALTHNET [1495]|HEALTHNET [149500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2850||||2850|1225.5|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2850||||2850|2650.5|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2850||||2850|1710|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MULTIPLAN [1680]|HMA [168003]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MULTIPLAN [1680]|IHC HS [168011]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|Self-pay|Self-pay|2850||||2850|855|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2850||||2850|598.5|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|TRUSTMARK [2030]|STARMARK [203000]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2850||||2850|1366.58|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|UMR [2035]|UMR OPTIONS [203501]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2850||||2850|2565|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2850||||2850|0|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2850||||2850|160.06|2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2850||||2850||2650.5|160.06
36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2850||||2850|1425|2650.5|160.06
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|AETNA [1015]|AETNA ACO WILCO [101532]|3916||||3916|0|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3916||||3916|590.45|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3916||||3916|195.37|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3916||||3916|195.37|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3916||||3916|573.42|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3916||||3916|1961.92|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3916||||3916|1374.52|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3916||||3916|1683.88|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3916||||3916|1668.22|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3916||||3916|1958|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3916||||3916|2545.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|CORESOURCE [1315]|CORESOURCE [131500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3916||||3916|2571.25|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3916||||3916|793.01|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|GEHA [1415]|GEHA [141500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3916||||3916|1302.45|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HEALTHNET [1495]|HEALTHNET [149500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3916||||3916|1683.88|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3916||||3916|3641.88|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3916||||3916|2349.6|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3916||||3916|630.76|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3916||||3916|1384.76|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3916||||3916|188.68|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3916||||3916|781.47|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3916||||3916|590.45|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MULTIPLAN [1680]|HMA [168003]|3916||||3916|868.3|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MULTIPLAN [1680]|IHC HS [168011]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3916||||3916|203.06|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3916||||3916|630.76|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|Self-pay|Self-pay|3916||||3916|1174.8|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3916||||3916|822.36|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3916||||3916|567.29|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3916||||3916|845.15|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|TRUSTMARK [2030]|STARMARK [203000]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3916||||3916|1877.72|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|UMR [2035]|UMR OPTIONS [203501]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3916||||3916|179.7|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3916||||3916|3524.4|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3916||||3916|0|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3916||||3916|793.01|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3916||||3916|578.87|3641.88|179.7
36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3916||||3916|1958|3641.88|179.7
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|AETNA [1015]|AETNA ACO WILCO [101532]|8613||||8613|1933|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8613||||8613|1335.69|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8613||||8613|1122.4|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8613||||8613|1122.4|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8613||||8613|1297.17|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8613||||8613|4315.11|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8613||||8613|3023.16|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8613||||8613|3703.59|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8613||||8613|3669.14|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8613||||8613|4306.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8613||||8613|5598.45|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|CORESOURCE [1315]|CORESOURCE [131500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8613||||8613|5655.3|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8613||||8613|1784.38|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|GEHA [1415]|GEHA [141500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8613||||8613|2946.37|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HEALTHNET [1495]|HEALTHNET [149500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8613||||8613|3703.59|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8613||||8613|8010.09|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8613||||8613|5167.8|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8613||||8613|1426.89|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8613||||8613|3287.78|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8613||||8613|1084|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8613||||8613|1767.82|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8613||||8613|1335.69|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MULTIPLAN [1680]|HMA [168003]|8613||||8613|1964.25|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MULTIPLAN [1680]|IHC HS [168011]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8613||||8613|1166.59|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8613||||8613|1426.89|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|Self-pay|Self-pay|8613||||8613|2583.9|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8613||||8613|1808.73|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8613||||8613|1283.31|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8613||||8613|1911.87|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|TRUSTMARK [2030]|STARMARK [203000]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8613||||8613|4129.93|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|UMR [2035]|UMR OPTIONS [203501]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8613||||8613|1032.39|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8613||||8613|7751.7|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8613||||8613|0|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8613||||8613|1784.38|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8613||||8613|1309.5|8010.09|1032.39
36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8613||||8613|4306.5|8010.09|1032.39
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|AETNA [1015]|AETNA ACO WILCO [101532]|938||||938|0|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|938||||938|328.31|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|938||||938|129.45|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|938||||938|129.45|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|938||||938|318.85|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|938||||938|469.94|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|938||||938|329.24|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|938||||938|403.34|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|938||||938|399.59|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|938||||938|469|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|938||||938|609.7|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|CORESOURCE [1315]|CORESOURCE [131500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|938||||938|615.89|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|938||||938|415.36|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|GEHA [1415]|GEHA [141500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|938||||938|724.22|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HEALTHNET [1495]|HEALTHNET [149500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|938||||938|403.34|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|938||||938|872.34|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|938||||938|562.8|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|938||||938|350.73|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|938||||938|750.73|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|938||||938|125.02|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|938||||938|434.53|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|938||||938|328.31|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MULTIPLAN [1680]|HMA [168003]|938||||938|482.81|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MULTIPLAN [1680]|IHC HS [168011]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|938||||938|134.55|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|938||||938|350.73|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|Self-pay|Self-pay|938||||938|281.4|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|938||||938|196.98|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|938||||938|315.44|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|938||||938|469.94|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|TRUSTMARK [2030]|STARMARK [203000]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|938||||938|449.77|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|UMR [2035]|UMR OPTIONS [203501]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|938||||938|119.07|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|938||||938|844.2|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|938||||938|0|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|938||||938|415.36|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|938||||938|321.88|872.34|119.07
36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|938||||938|469|872.34|119.07
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|AETNA [1015]|AETNA ACO WILCO [101532]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5479||||5479|394.71|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5479||||5479|394.71|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5479||||5479|2744.98|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5479||||5479|1923.13|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5479||||5479|2355.97|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5479||||5479|2334.05|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5479||||5479|2739.5|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5479||||5479|3561.35|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|CORESOURCE [1315]|CORESOURCE [131500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5479||||5479|3597.51|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5479||||5479|2027.23|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|GEHA [1415]|GEHA [141500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HEALTHNET [1495]|HEALTHNET [149500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5479||||5479|2355.97|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5479||||5479|5095.47|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5479||||5479|3287.4|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5479||||5479|1154.23|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MULTIPLAN [1680]|HMA [168003]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MULTIPLAN [1680]|IHC HS [168011]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|Self-pay|Self-pay|5479||||5479|1643.7|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5479||||5479|1150.59|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|TRUSTMARK [2030]|STARMARK [203000]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5479||||5479|2627.18|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|UMR [2035]|UMR OPTIONS [203501]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5479||||5479|4931.1|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5479||||5479|0|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5479||||5479|2027.23|5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5479||||5479||5095.47|394.71
36012020|EAP|0450 - EMERGENCY ROOM-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5479||||5479|2739.5|5095.47|394.71
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2520||||2520|0|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2520||||2520|1335.69|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2520||||2520|694.91|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2520||||2520|694.91|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2520||||2520|1297.17|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2520||||2520|1262.52|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2520||||2520|884.52|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2520||||2520|1083.6|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2520||||2520|1073.52|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2520||||2520|1260|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2520||||2520|1638|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|CORESOURCE [1315]|CORESOURCE [131500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2520||||2520|1654.63|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2520||||2520|1784.38|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|GEHA [1415]|GEHA [141500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2520||||2520|2520|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HEALTHNET [1495]|HEALTHNET [149500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2520||||2520|1083.6|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2520||||2520|2343.6|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2520||||2520|1512|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2520||||2520|1426.89|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2520||||2520|2520|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2520||||2520|671.13|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2520||||2520|1767.82|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2520||||2520|1335.69|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MULTIPLAN [1680]|HMA [168003]|2520||||2520|1964.25|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MULTIPLAN [1680]|IHC HS [168011]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2520||||2520|722.27|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2520||||2520|1426.89|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|Self-pay|Self-pay|2520||||2520|756|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2520||||2520|529.2|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2520||||2520|1283.31|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2520||||2520|1911.87|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|TRUSTMARK [2030]|STARMARK [203000]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2520||||2520|1208.34|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|UMR [2035]|UMR OPTIONS [203501]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2520||||2520|639.18|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2520||||2520|2268|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2520||||2520|0|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2520||||2520|1784.38|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2520||||2520|1309.5|2520|529.2
36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2520||||2520|1260|2520|529.2
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1898||||1898|0|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1898||||1898|1335.69|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1898||||1898|729.45|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1898||||1898|729.45|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1898||||1898|1297.17|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1898||||1898|950.9|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1898||||1898|666.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1898||||1898|816.14|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1898||||1898|808.55|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1898||||1898|949|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1898||||1898|1233.7|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1898||||1898|1246.23|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1898||||1898|1784.38|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|GEHA [1415]|GEHA [141500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1898||||1898|1898|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1898||||1898|816.14|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1898||||1898|1765.14|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1898||||1898|1138.8|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1898||||1898|1426.89|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1898||||1898|1898|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1898||||1898|704.49|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1898||||1898|1767.82|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1898||||1898|1335.69|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MULTIPLAN [1680]|HMA [168003]|1898||||1898|1898|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MULTIPLAN [1680]|IHC HS [168011]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1898||||1898|758.17|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1898||||1898|1426.89|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|Self-pay|Self-pay|1898||||1898|569.4|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1898||||1898|398.58|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1898||||1898|1283.31|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1898||||1898|1898|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|TRUSTMARK [2030]|STARMARK [203000]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1898||||1898|910.09|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|UMR [2035]|UMR OPTIONS [203501]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1898||||1898|670.95|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1898||||1898|1708.2|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1898||||1898|0|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1898||||1898|1784.38|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1898||||1898|1309.5|1898|398.58
36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1898||||1898|949|1898|398.58
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|AETNA [1015]|AETNA ACO WILCO [101532]|5635||||5635|0|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5635||||5635|1335.69|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5635||||5635|1556|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5635||||5635|1556|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5635||||5635|1297.17|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5635||||5635|2823.14|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5635||||5635|1977.89|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5635||||5635|2423.05|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5635||||5635|2400.51|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5635||||5635|2817.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5635||||5635|3662.75|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|CORESOURCE [1315]|CORESOURCE [131500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5635||||5635|3699.94|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5635||||5635|1784.38|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|GEHA [1415]|GEHA [141500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5635||||5635|2946.37|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HEALTHNET [1495]|HEALTHNET [149500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5635||||5635|2423.05|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5635||||5635|5240.55|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5635||||5635|3381|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5635||||5635|1426.89|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5635||||5635|3287.78|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5635||||5635|1502.77|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5635||||5635|1767.82|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5635||||5635|1335.69|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MULTIPLAN [1680]|HMA [168003]|5635||||5635|1964.25|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MULTIPLAN [1680]|IHC HS [168011]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5635||||5635|1617.27|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5635||||5635|1426.89|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|Self-pay|Self-pay|5635||||5635|1690.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5635||||5635|1183.35|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5635||||5635|1283.31|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5635||||5635|1911.87|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|TRUSTMARK [2030]|STARMARK [203000]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5635||||5635|2701.98|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|UMR [2035]|UMR OPTIONS [203501]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5635||||5635|1431.21|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5635||||5635|5071.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5635||||5635|0|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5635||||5635|1784.38|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5635||||5635|1309.5|5240.55|1183.35
36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5635||||5635|2817.5|5240.55|1183.35
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|AETNA [1015]|AETNA ACO WILCO [101532]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|990||||990|495.99|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|990||||990|347.49|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|990||||990|425.7|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|990||||990|421.74|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|990||||990|495|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|990||||990|643.5|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|CORESOURCE [1315]|CORESOURCE [131500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|990||||990|650.03|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|990||||990|330.1|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|GEHA [1415]|GEHA [141500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HEALTHNET [1495]|HEALTHNET [149500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|990||||990|425.7|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|990||||990|920.7|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|990||||990|594|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|990||||990|495|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MULTIPLAN [1680]|HMA [168003]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MULTIPLAN [1680]|IHC HS [168011]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|Self-pay|Self-pay|990||||990|297|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|990||||990|207.9|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|TRUSTMARK [2030]|STARMARK [203000]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|990||||990|474.71|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|UMR [2035]|UMR OPTIONS [203501]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|990||||990|891|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|990||||990|0|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|990||||990|330.1|920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|990||||990||920.7|207.9
36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|990||||990|495|920.7|207.9
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|AETNA [1015]|AETNA ACO WILCO [101532]|817||||817|0|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|817||||817|245.6|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|817||||817|227.28|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|817||||817|227.28|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|817||||817|409.32|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|817||||817|286.77|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|817||||817|351.31|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|817||||817|348.04|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|817||||817|408.5|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|817||||817|531.05|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|CORESOURCE [1315]|CORESOURCE [131500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|817||||817|536.44|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|817||||817|340.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|GEHA [1415]|GEHA [141500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|817||||817|541.75|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HEALTHNET [1495]|HEALTHNET [149500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|817||||817|351.31|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|817||||817|759.81|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|817||||817|490.2|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|817||||817|264.86|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|817||||817|591.53|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|817||||817|219.5|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|817||||817|325.05|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|817||||817|245.6|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MULTIPLAN [1680]|HMA [168003]|817||||817|361.17|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MULTIPLAN [1680]|IHC HS [168011]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|817||||817|236.23|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|817||||817|264.86|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|Self-pay|Self-pay|817||||817|245.1|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|817||||817|171.57|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|817||||817|235.96|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|817||||817|351.54|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|TRUSTMARK [2030]|STARMARK [203000]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|817||||817|391.75|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|UMR [2035]|UMR OPTIONS [203501]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|817||||817|209.05|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|817||||817|735.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|817||||817|0|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|817||||817|340.3|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|817||||817|240.78|759.81|171.57
36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|817||||817|408.5|759.81|171.57
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1180||||1180|0|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1180||||1180|245.6|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1180||||1180|227.28|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1180||||1180|227.28|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1180||||1180|591.18|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1180||||1180|414.18|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1180||||1180|507.4|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1180||||1180|502.68|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1180||||1180|590|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1180||||1180|767|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1180||||1180|774.79|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1180||||1180|340.3|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|GEHA [1415]|GEHA [141500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1180||||1180|541.75|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1180||||1180|507.4|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1180||||1180|1097.4|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1180||||1180|708|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1180||||1180|264.86|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1180||||1180|591.53|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1180||||1180|219.5|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1180||||1180|325.05|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1180||||1180|245.6|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MULTIPLAN [1680]|HMA [168003]|1180||||1180|361.17|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MULTIPLAN [1680]|IHC HS [168011]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1180||||1180|236.23|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1180||||1180|264.86|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|Self-pay|Self-pay|1180||||1180|354|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1180||||1180|247.8|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1180||||1180|235.96|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1180||||1180|351.54|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|TRUSTMARK [2030]|STARMARK [203000]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1180||||1180|565.81|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|UMR [2035]|UMR OPTIONS [203501]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1180||||1180|209.05|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1180||||1180|1062|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1180||||1180|0|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1180||||1180|340.3|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1180||||1180|240.78|1097.4|209.05
36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1180||||1180|590|1097.4|209.05
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|926||||926|0|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|926||||926|463.93|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|926||||926|325.03|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|926||||926|398.18|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|926||||926|394.48|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|926||||926|463|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|926||||926|601.9|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|CORESOURCE [1315]|CORESOURCE [131500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|926||||926|608.01|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|GEHA [1415]|GEHA [141500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HEALTHNET [1495]|HEALTHNET [149500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|926||||926|398.18|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|926||||926|861.18|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|926||||926|555.6|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|926||||926|591.53|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MULTIPLAN [1680]|HMA [168003]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MULTIPLAN [1680]|IHC HS [168011]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|Self-pay|Self-pay|926||||926|277.8|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|926||||926|194.46|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|TRUSTMARK [2030]|STARMARK [203000]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|926||||926|444.02|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|UMR [2035]|UMR OPTIONS [203501]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|926||||926|833.4|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|926||||926|0|861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|926||||926||861.18|194.46
36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|926||||926|463|861.18|194.46
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|1509||||1509|1509|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1509||||1509|245.6|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1509||||1509|227.28|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1509||||1509|227.28|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1509||||1509|756.01|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1509||||1509|529.66|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1509||||1509|648.87|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1509||||1509|642.83|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1509||||1509|754.5|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1509||||1509|980.85|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1509||||1509|990.81|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1509||||1509|340.3|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|GEHA [1415]|GEHA [141500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1509||||1509|541.75|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1509||||1509|648.87|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1509||||1509|1403.37|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1509||||1509|905.4|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1509||||1509|264.86|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1509||||1509|591.53|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1509||||1509|219.5|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1509||||1509|325.05|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1509||||1509|245.6|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MULTIPLAN [1680]|HMA [168003]|1509||||1509|361.17|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MULTIPLAN [1680]|IHC HS [168011]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1509||||1509|236.23|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1509||||1509|264.86|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|Self-pay|Self-pay|1509||||1509|452.7|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1509||||1509|316.89|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1509||||1509|235.96|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1509||||1509|351.54|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|TRUSTMARK [2030]|STARMARK [203000]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1509||||1509|723.57|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|UMR [2035]|UMR OPTIONS [203501]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1509||||1509|209.05|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1509||||1509|1358.1|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1509||||1509|0|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1509||||1509|340.3|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1509||||1509|240.78|1509|209.05
36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1509||||1509|754.5|1509|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1509||||1509|0|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1509||||1509|245.6|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1509||||1509|227.28|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1509||||1509|227.28|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1509||||1509|756.01|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1509||||1509|529.66|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1509||||1509|648.87|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1509||||1509|642.83|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1509||||1509|754.5|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1509||||1509|980.85|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|CORESOURCE [1315]|CORESOURCE [131500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1509||||1509|990.81|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1509||||1509|340.3|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|GEHA [1415]|GEHA [141500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1509||||1509|541.75|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HEALTHNET [1495]|HEALTHNET [149500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1509||||1509|648.87|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1509||||1509|1403.37|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1509||||1509|905.4|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1509||||1509|264.86|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1509||||1509|591.53|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1509||||1509|219.5|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1509||||1509|325.05|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1509||||1509|245.6|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MULTIPLAN [1680]|HMA [168003]|1509||||1509|361.17|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MULTIPLAN [1680]|IHC HS [168011]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1509||||1509|236.23|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1509||||1509|264.86|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|Self-pay|Self-pay|1509||||1509|452.7|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1509||||1509|316.89|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1509||||1509|235.96|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1509||||1509|351.54|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|TRUSTMARK [2030]|STARMARK [203000]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1509||||1509|723.57|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|UMR [2035]|UMR OPTIONS [203501]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1509||||1509|209.05|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1509||||1509|1358.1|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1509||||1509|0|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1509||||1509|340.3|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1509||||1509|240.78|1403.37|209.05
36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1509||||1509|754.5|1403.37|209.05
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|AETNA [1015]|AETNA ACO WILCO [101532]|955||||955|0|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|955||||955|245.6|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|955||||955|227.28|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|955||||955|227.28|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|955||||955|478.46|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|955||||955|335.21|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|955||||955|410.65|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|955||||955|406.83|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|955||||955|477.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|955||||955|620.75|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|CORESOURCE [1315]|CORESOURCE [131500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|955||||955|627.05|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|955||||955|340.3|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|GEHA [1415]|GEHA [141500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|955||||955|541.75|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HEALTHNET [1495]|HEALTHNET [149500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|955||||955|410.65|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|955||||955|888.15|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|955||||955|573|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|955||||955|264.86|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|955||||955|591.53|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|955||||955|219.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|955||||955|325.05|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|955||||955|245.6|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MULTIPLAN [1680]|HMA [168003]|955||||955|361.17|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MULTIPLAN [1680]|IHC HS [168011]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|955||||955|236.23|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|955||||955|264.86|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|Self-pay|Self-pay|955||||955|286.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|955||||955|200.55|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|955||||955|235.96|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|955||||955|351.54|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|TRUSTMARK [2030]|STARMARK [203000]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|955||||955|457.92|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|UMR [2035]|UMR OPTIONS [203501]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|955||||955|209.05|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|955||||955|859.5|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|955||||955|0|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|955||||955|340.3|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|955||||955|240.78|888.15|200.55
36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|955||||955|477.5|888.15|200.55
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|AETNA [1015]|AETNA ACO WILCO [101532]|1536||||1536|0|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1536||||1536|245.6|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1536||||1536|278.54|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1536||||1536|278.54|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1536||||1536|769.54|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1536||||1536|539.14|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1536||||1536|660.48|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1536||||1536|654.34|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1536||||1536|768|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1536||||1536|998.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|CORESOURCE [1315]|CORESOURCE [131500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1536||||1536|1008.54|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1536||||1536|340.3|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|GEHA [1415]|GEHA [141500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1536||||1536|541.75|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HEALTHNET [1495]|HEALTHNET [149500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1536||||1536|660.48|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1536||||1536|1428.48|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1536||||1536|921.6|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1536||||1536|264.86|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1536||||1536|591.53|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1536||||1536|269.01|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1536||||1536|325.05|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1536||||1536|245.6|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MULTIPLAN [1680]|HMA [168003]|1536||||1536|361.17|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MULTIPLAN [1680]|IHC HS [168011]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1536||||1536|289.51|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1536||||1536|264.86|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|Self-pay|Self-pay|1536||||1536|460.8|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1536||||1536|322.56|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1536||||1536|235.96|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1536||||1536|351.54|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|TRUSTMARK [2030]|STARMARK [203000]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1536||||1536|736.51|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|UMR [2035]|UMR OPTIONS [203501]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1536||||1536|256.2|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1536||||1536|1382.4|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1536||||1536|0|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1536||||1536|340.3|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1536||||1536|240.78|1428.48|235.96
36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1536||||1536|768|1428.48|235.96
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|AETNA [1015]|AETNA ACO WILCO [101532]|1268||||1268|1268|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1268||||1268|245.6|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1268||||1268|227.28|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1268||||1268|227.28|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1268||||1268|635.27|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1268||||1268|445.07|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1268||||1268|545.24|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1268||||1268|540.17|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1268||||1268|634|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1268||||1268|824.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|CORESOURCE [1315]|CORESOURCE [131500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1268||||1268|832.57|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1268||||1268|340.3|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|GEHA [1415]|GEHA [141500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1268||||1268|541.75|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HEALTHNET [1495]|HEALTHNET [149500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1268||||1268|545.24|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1268||||1268|1179.24|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1268||||1268|760.8|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1268||||1268|264.86|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1268||||1268|591.53|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1268||||1268|219.5|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1268||||1268|325.05|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1268||||1268|245.6|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MULTIPLAN [1680]|HMA [168003]|1268||||1268|361.17|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MULTIPLAN [1680]|IHC HS [168011]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1268||||1268|236.23|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1268||||1268|264.86|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|Self-pay|Self-pay|1268||||1268|380.4|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1268||||1268|266.28|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1268||||1268|235.96|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1268||||1268|351.54|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|TRUSTMARK [2030]|STARMARK [203000]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1268||||1268|608.01|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|UMR [2035]|UMR OPTIONS [203501]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1268||||1268|209.05|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1268||||1268|1141.2|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1268||||1268|0|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1268||||1268|340.3|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1268||||1268|240.78|1268|209.05
36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/O US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1268||||1268|634|1268|209.05
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|AETNA [1015]|AETNA ACO WILCO [101532]|2445||||2445|0|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2445||||2445|596.75|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2445||||2445|278.54|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2445||||2445|278.54|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2445||||2445|1224.95|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2445||||2445|858.2|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2445||||2445|1051.35|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2445||||2445|1041.57|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2445||||2445|1222.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2445||||2445|1589.25|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|CORESOURCE [1315]|CORESOURCE [131500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2445||||2445|1605.39|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2445||||2445|812.57|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|GEHA [1415]|GEHA [141500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2445||||2445|1316.37|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HEALTHNET [1495]|HEALTHNET [149500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2445||||2445|1051.35|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2445||||2445|2273.85|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2445||||2445|1467|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2445||||2445|643.56|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2445||||2445|1431.31|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2445||||2445|269.01|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2445||||2445|789.82|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2445||||2445|596.75|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MULTIPLAN [1680]|HMA [168003]|2445||||2445|877.58|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MULTIPLAN [1680]|IHC HS [168011]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2445||||2445|289.51|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2445||||2445|643.56|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|Self-pay|Self-pay|2445||||2445|733.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2445||||2445|513.45|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2445||||2445|573.35|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2445||||2445|854.18|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|TRUSTMARK [2030]|STARMARK [203000]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2445||||2445|1172.38|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|UMR [2035]|UMR OPTIONS [203501]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2445||||2445|256.2|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2445||||2445|2200.5|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2445||||2445|0|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2445||||2445|812.57|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2445||||2445|585.05|2273.85|256.2
36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2445||||2445|1222.5|2273.85|256.2
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|AETNA [1015]|AETNA ACO WILCO [101532]|2223||||2223|0|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2223||||2223|245.6|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2223||||2223|227.28|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2223||||2223|227.28|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2223||||2223|1113.72|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2223||||2223|780.27|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2223||||2223|955.89|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2223||||2223|947|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2223||||2223|1111.5|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2223||||2223|1444.95|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|CORESOURCE [1315]|CORESOURCE [131500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2223||||2223|1459.62|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2223||||2223|340.3|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|GEHA [1415]|GEHA [141500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2223||||2223|541.75|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HEALTHNET [1495]|HEALTHNET [149500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2223||||2223|955.89|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2223||||2223|2067.39|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2223||||2223|1333.8|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2223||||2223|264.86|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2223||||2223|591.53|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2223||||2223|219.5|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2223||||2223|325.05|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2223||||2223|245.6|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MULTIPLAN [1680]|HMA [168003]|2223||||2223|361.17|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MULTIPLAN [1680]|IHC HS [168011]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2223||||2223|236.23|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2223||||2223|264.86|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|Self-pay|Self-pay|2223||||2223|666.9|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2223||||2223|466.83|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2223||||2223|235.96|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2223||||2223|351.54|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|TRUSTMARK [2030]|STARMARK [203000]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2223||||2223|1065.93|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|UMR [2035]|UMR OPTIONS [203501]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2223||||2223|209.05|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2223||||2223|2000.7|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2223||||2223|0|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2223||||2223|340.3|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2223||||2223|240.78|2067.39|209.05
36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2223||||2223|1111.5|2067.39|209.05
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|AETNA [1015]|AETNA ACO WILCO [101532]|2691||||2691|0|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2691||||2691|245.6|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2691||||2691|278.54|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2691||||2691|278.54|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2691||||2691|1348.19|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2691||||2691|944.54|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2691||||2691|1157.13|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2691||||2691|1146.37|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2691||||2691|1345.5|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2691||||2691|1749.15|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|CORESOURCE [1315]|CORESOURCE [131500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2691||||2691|1766.91|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2691||||2691|340.3|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|GEHA [1415]|GEHA [141500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2691||||2691|541.75|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HEALTHNET [1495]|HEALTHNET [149500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2691||||2691|1157.13|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2691||||2691|2502.63|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2691||||2691|1614.6|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2691||||2691|264.86|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2691||||2691|591.53|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2691||||2691|269.01|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2691||||2691|325.05|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2691||||2691|245.6|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MULTIPLAN [1680]|HMA [168003]|2691||||2691|361.17|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MULTIPLAN [1680]|IHC HS [168011]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2691||||2691|289.51|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2691||||2691|264.86|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|Self-pay|Self-pay|2691||||2691|807.3|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2691||||2691|565.11|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2691||||2691|235.96|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2691||||2691|351.54|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|TRUSTMARK [2030]|STARMARK [203000]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2691||||2691|1290.33|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|UMR [2035]|UMR OPTIONS [203501]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2691||||2691|256.2|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2691||||2691|2421.9|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2691||||2691|0|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2691||||2691|340.3|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2691||||2691|240.78|2502.63|235.96
36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2691||||2691|1345.5|2502.63|235.96
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|11400||||11400|0|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11400||||11400|2686.94|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11400||||11400|3431.56|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11400||||11400|3431.56|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11400||||11400|2609.46|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11400||||11400|5711.4|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11400||||11400|4001.4|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11400||||11400|4902|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11400||||11400|4856.4|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11400||||11400|5700|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11400||||11400|7410|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|CORESOURCE [1315]|CORESOURCE [131500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11400||||11400|7485.24|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11400||||11400|3558.69|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|GEHA [1415]|GEHA [141500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11400||||11400|5927.07|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HEALTHNET [1495]|HEALTHNET [149500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11400||||11400|4902|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11400||||11400|10602|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11400||||11400|6840|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11400||||11400|2870.4|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11400||||11400|6270.42|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11400||||11400|3314.15|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11400||||11400|3556.24|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11400||||11400|2686.94|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MULTIPLAN [1680]|HMA [168003]|11400||||11400|3951.38|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MULTIPLAN [1680]|IHC HS [168011]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11400||||11400|3566.68|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11400||||11400|2870.4|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|Self-pay|Self-pay|11400||||11400|3420|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11400||||11400|2394|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11400||||11400|2581.57|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11400||||11400|3846.01|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|TRUSTMARK [2030]|STARMARK [203000]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11400||||11400|5466.3|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|UMR [2035]|UMR OPTIONS [203501]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11400||||11400|3156.34|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11400||||11400|10260|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11400||||11400|0|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11400||||11400|3558.69|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11400||||11400|2634.25|10602|2394
36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11400||||11400|5700|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|11400||||11400|0|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11400||||11400|2686.94|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11400||||11400|3431.56|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11400||||11400|3431.56|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11400||||11400|2609.46|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11400||||11400|5711.4|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11400||||11400|4001.4|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11400||||11400|4902|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11400||||11400|4856.4|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11400||||11400|5700|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11400||||11400|7410|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|CORESOURCE [1315]|CORESOURCE [131500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11400||||11400|7485.24|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11400||||11400|3558.69|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|GEHA [1415]|GEHA [141500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11400||||11400|5927.07|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HEALTHNET [1495]|HEALTHNET [149500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11400||||11400|4902|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11400||||11400|10602|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11400||||11400|6840|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11400||||11400|2870.4|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11400||||11400|6270.42|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11400||||11400|3314.15|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11400||||11400|3556.24|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11400||||11400|2686.94|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MULTIPLAN [1680]|HMA [168003]|11400||||11400|3951.38|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MULTIPLAN [1680]|IHC HS [168011]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11400||||11400|3566.68|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11400||||11400|2870.4|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|Self-pay|Self-pay|11400||||11400|3420|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11400||||11400|2394|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11400||||11400|2581.57|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11400||||11400|3846.01|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|TRUSTMARK [2030]|STARMARK [203000]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11400||||11400|5466.3|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|UMR [2035]|UMR OPTIONS [203501]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11400||||11400|3156.34|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11400||||11400|10260|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11400||||11400|0|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11400||||11400|3558.69|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11400||||11400|2634.25|10602|2394
36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11400||||11400|5700|10602|2394
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12199||||12199|6111.7|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12199||||12199|4281.85|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12199||||12199|5245.57|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12199||||12199|5196.77|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12199||||12199|6099.5|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12199||||12199|7929.35|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|CORESOURCE [1315]|CORESOURCE [131500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|12199||||12199|8009.86|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12199||||12199|2552.08|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|GEHA [1415]|GEHA [141500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HEALTHNET [1495]|HEALTHNET [149500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12199||||12199|5245.57|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|12199||||12199|11345.07|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12199||||12199|7319.4|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12199||||12199|6099.5|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MULTIPLAN [1680]|HMA [168003]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MULTIPLAN [1680]|IHC HS [168011]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|Self-pay|Self-pay|12199||||12199|3659.7|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12199||||12199|2561.79|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|TRUSTMARK [2030]|STARMARK [203000]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12199||||12199|5849.42|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|UMR [2035]|UMR OPTIONS [203501]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12199||||12199|10979.1|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12199||||12199|0|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12199||||12199|2552.08|11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12199||||12199||11345.07|2552.08
36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12199||||12199|6099.5|11345.07|2552.08
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3207||||3207|1606.71|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3207||||3207|1125.66|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3207||||3207|1379.01|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3207||||3207|1366.18|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3207||||3207|1603.5|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3207||||3207|2084.55|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|CORESOURCE [1315]|CORESOURCE [131500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3207||||3207|2105.72|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3207||||3207|361.78|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|GEHA [1415]|GEHA [141500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HEALTHNET [1495]|HEALTHNET [149500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3207||||3207|1379.01|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3207||||3207|2982.51|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3207||||3207|1924.2|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3207||||3207|1603.5|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MULTIPLAN [1680]|HMA [168003]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MULTIPLAN [1680]|IHC HS [168011]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|Self-pay|Self-pay|3207||||3207|962.1|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3207||||3207|673.47|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|TRUSTMARK [2030]|STARMARK [203000]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3207||||3207|1537.76|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|UMR [2035]|UMR OPTIONS [203501]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3207||||3207|2886.3|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3207||||3207|0|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3207||||3207|361.78|2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3207||||3207||2982.51|361.78
36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3207||||3207|1603.5|2982.51|361.78
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|AETNA [1015]|AETNA ACO WILCO [101532]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1607||||1607|805.11|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1607||||1607|564.06|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1607||||1607|691.01|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1607||||1607|684.58|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1607||||1607|803.5|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1607||||1607|1044.55|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|CORESOURCE [1315]|CORESOURCE [131500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1607||||1607|1055.16|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1607||||1607|447.89|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|GEHA [1415]|GEHA [141500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HEALTHNET [1495]|HEALTHNET [149500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1607||||1607|691.01|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1607||||1607|1494.51|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1607||||1607|964.2|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1607||||1607|803.5|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MULTIPLAN [1680]|HMA [168003]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MULTIPLAN [1680]|IHC HS [168011]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|Self-pay|Self-pay|1607||||1607|482.1|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1607||||1607|337.47|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|TRUSTMARK [2030]|STARMARK [203000]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1607||||1607|770.56|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|UMR [2035]|UMR OPTIONS [203501]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1607||||1607|1446.3|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1607||||1607|0|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1607||||1607|447.89|1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1607||||1607||1494.51|337.47
36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1607||||1607|803.5|1494.51|337.47
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|AETNA [1015]|AETNA ACO WILCO [101532]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|823||||823|412.32|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|823||||823|288.87|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|823||||823|353.89|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|823||||823|350.6|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|823||||823|411.5|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|823||||823|534.95|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|CORESOURCE [1315]|CORESOURCE [131500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|823||||823|540.38|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|823||||823|521.17|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|GEHA [1415]|GEHA [141500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HEALTHNET [1495]|HEALTHNET [149500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|823||||823|353.89|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|823||||823|765.39|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|823||||823|493.8|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|823||||823|411.5|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MULTIPLAN [1680]|HMA [168003]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MULTIPLAN [1680]|IHC HS [168011]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|Self-pay|Self-pay|823||||823|246.9|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|823||||823|172.83|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|TRUSTMARK [2030]|STARMARK [203000]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|823||||823|394.63|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|UMR [2035]|UMR OPTIONS [203501]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|823||||823|740.7|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|823||||823|0|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|823||||823|521.17|765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|823||||823||765.39|172.83
36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|823||||823|411.5|765.39|172.83
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|AETNA [1015]|AETNA ACO WILCO [101532]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|886||||886|443.89|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|886||||886|310.99|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|886||||886|380.98|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|886||||886|377.44|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|886||||886|443|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|886||||886|575.9|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|CORESOURCE [1315]|CORESOURCE [131500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|886||||886|581.75|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|886||||886|380.02|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|GEHA [1415]|GEHA [141500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HEALTHNET [1495]|HEALTHNET [149500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|886||||886|380.98|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|886||||886|823.98|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|886||||886|531.6|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MULTIPLAN [1680]|HMA [168003]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MULTIPLAN [1680]|IHC HS [168011]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|Self-pay|Self-pay|886||||886|265.8|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|886||||886|186.06|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|TRUSTMARK [2030]|STARMARK [203000]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|886||||886|424.84|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|UMR [2035]|UMR OPTIONS [203501]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|886||||886|797.4|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|886||||886|0|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|886||||886|380.02|823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|886||||886||823.98|186.06
36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|886||||886|443|823.98|186.06
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|AETNA [1015]|AETNA ACO WILCO [101532]|528||||528|0|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|528||||528|93.71|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|528||||528|93.71|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|528||||528|264.53|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|528||||528|185.33|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|528||||528|227.04|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|528||||528|224.93|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|528||||528|264|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|528||||528|343.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|CORESOURCE [1315]|CORESOURCE [131500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|528||||528|346.68|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|GEHA [1415]|GEHA [141500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HEALTHNET [1495]|HEALTHNET [149500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|528||||528|227.04|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|528||||528|491.04|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|528||||528|316.8|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|528||||528|321.78|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|528||||528|90.51|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MULTIPLAN [1680]|HMA [168003]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MULTIPLAN [1680]|IHC HS [168011]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|528||||528|97.4|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|Self-pay|Self-pay|528||||528|158.4|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|528||||528|110.88|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|TRUSTMARK [2030]|STARMARK [203000]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|528||||528|253.18|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|UMR [2035]|UMR OPTIONS [203501]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|528||||528|86.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|528||||528|475.2|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|528||||528|0|491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|528||||528||491.04|86.2
36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|528||||528|264|491.04|86.2
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|988||||988|0|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|988||||988|494.99|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|988||||988|346.79|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|988||||988|424.84|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|988||||988|420.89|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|988||||988|494|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|988||||988|642.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|CORESOURCE [1315]|CORESOURCE [131500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|988||||988|648.72|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|GEHA [1415]|GEHA [141500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HEALTHNET [1495]|HEALTHNET [149500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|988||||988|424.84|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|988||||988|918.84|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|988||||988|592.8|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|988||||988|492.73|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MULTIPLAN [1680]|HMA [168003]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MULTIPLAN [1680]|IHC HS [168011]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|Self-pay|Self-pay|988||||988|296.4|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|988||||988|207.48|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|TRUSTMARK [2030]|STARMARK [203000]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|988||||988|473.75|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|UMR [2035]|UMR OPTIONS [203501]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|988||||988|889.2|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|988||||988|0|918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|988||||988||918.84|207.48
36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|988||||988|494|918.84|207.48
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|AETNA [1015]|AETNA ACO WILCO [101532]|537||||537|0|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|537||||537|269.04|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|537||||537|188.49|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|537||||537|230.91|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|537||||537|228.76|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|537||||537|268.5|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|537||||537|349.05|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|CORESOURCE [1315]|CORESOURCE [131500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|537||||537|352.59|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|GEHA [1415]|GEHA [141500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HEALTHNET [1495]|HEALTHNET [149500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|537||||537|230.91|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|537||||537|499.41|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|537||||537|322.2|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|537||||537|391.93|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MULTIPLAN [1680]|HMA [168003]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MULTIPLAN [1680]|IHC HS [168011]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|Self-pay|Self-pay|537||||537|161.1|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|537||||537|112.77|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|TRUSTMARK [2030]|STARMARK [203000]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|537||||537|257.49|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|UMR [2035]|UMR OPTIONS [203501]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|537||||537|483.3|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|537||||537|0|499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|537||||537||499.41|112.77
36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|537||||537|268.5|499.41|112.77
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1239||||1239|0|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1239||||1239|354.06|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1239||||1239|392.33|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1239||||1239|392.33|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1239||||1239|620.74|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1239||||1239|434.89|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1239||||1239|532.77|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1239||||1239|527.81|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1239||||1239|619.5|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1239||||1239|805.35|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|CORESOURCE [1315]|CORESOURCE [131500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1239||||1239|813.53|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1239||||1239|491.26|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|GEHA [1415]|GEHA [141500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1239||||1239|781.02|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HEALTHNET [1495]|HEALTHNET [149500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1239||||1239|532.77|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1239||||1239|1152.27|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1239||||1239|743.4|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1239||||1239|381.83|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1239||||1239|923.84|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1239||||1239|378.91|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1239||||1239|468.61|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1239||||1239|354.06|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MULTIPLAN [1680]|HMA [168003]|1239||||1239|520.68|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MULTIPLAN [1680]|IHC HS [168011]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1239||||1239|407.78|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1239||||1239|381.83|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|Self-pay|Self-pay|1239||||1239|371.7|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1239||||1239|260.19|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1239||||1239|340.18|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1239||||1239|506.8|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|TRUSTMARK [2030]|STARMARK [203000]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1239||||1239|594.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|UMR [2035]|UMR OPTIONS [203501]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1239||||1239|360.87|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1239||||1239|1115.1|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1239||||1239|0|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1239||||1239|491.26|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1239||||1239|347.12|1152.27|260.19
36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1239||||1239|619.5|1152.27|260.19
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|AETNA [1015]|AETNA ACO WILCO [101532]|2928||||2928|2240|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2928||||2928|1420.54|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2928||||2928|922.23|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2928||||2928|922.23|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2928||||2928|1379.58|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2928||||2928|1466.93|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2928||||2928|1027.73|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2928||||2928|1259.04|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2928||||2928|1247.33|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2928||||2928|1464|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2928||||2928|1903.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|CORESOURCE [1315]|CORESOURCE [131500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2928||||2928|1922.52|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2928||||2928|1859.79|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|GEHA [1415]|GEHA [141500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2928||||2928|2928|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HEALTHNET [1495]|HEALTHNET [149500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2928||||2928|1259.04|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2928||||2928|2723.04|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2928||||2928|1756.8|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2928||||2928|1517.54|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2928||||2928|2928|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2928||||2928|890.68|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2928||||2928|1880.13|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2928||||2928|1420.54|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MULTIPLAN [1680]|HMA [168003]|2928||||2928|2089.04|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MULTIPLAN [1680]|IHC HS [168011]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2928||||2928|958.54|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2928||||2928|1517.54|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|Self-pay|Self-pay|2928||||2928|878.4|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2928||||2928|614.88|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2928||||2928|1364.84|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2928||||2928|2033.33|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|TRUSTMARK [2030]|STARMARK [203000]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2928||||2928|1403.98|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|UMR [2035]|UMR OPTIONS [203501]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2928||||2928|848.27|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2928||||2928|2635.2|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2928||||2928|0|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2928||||2928|1859.79|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2928||||2928|1392.69|2928|614.88
36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2928||||2928|1464|2928|614.88
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|3221||||3221|2240|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3221||||3221|1420.54|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3221||||3221|922.23|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3221||||3221|922.23|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3221||||3221|1379.58|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3221||||3221|1613.72|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3221||||3221|1130.57|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3221||||3221|1385.03|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3221||||3221|1372.15|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3221||||3221|1610.5|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3221||||3221|2093.65|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3221||||3221|2114.91|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3221||||3221|1859.79|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|GEHA [1415]|GEHA [141500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3221||||3221|3133.55|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3221||||3221|1385.03|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3221||||3221|2995.53|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3221||||3221|1932.6|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3221||||3221|1517.54|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3221||||3221|3221|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3221||||3221|890.68|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3221||||3221|1880.13|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3221||||3221|1420.54|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MULTIPLAN [1680]|HMA [168003]|3221||||3221|2089.04|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MULTIPLAN [1680]|IHC HS [168011]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3221||||3221|958.54|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3221||||3221|1517.54|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|Self-pay|Self-pay|3221||||3221|966.3|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3221||||3221|676.41|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3221||||3221|1364.84|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3221||||3221|2033.33|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|TRUSTMARK [2030]|STARMARK [203000]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3221||||3221|1544.47|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|UMR [2035]|UMR OPTIONS [203501]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3221||||3221|848.27|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3221||||3221|2898.9|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3221||||3221|0|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3221||||3221|1859.79|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3221||||3221|1392.69|3221|676.41
36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHING(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3221||||3221|1610.5|3221|676.41
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3823||||3823|2240|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3823||||3823|1420.54|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3823||||3823|922.23|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3823||||3823|922.23|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3823||||3823|1379.58|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3823||||3823|1915.32|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3823||||3823|1341.87|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3823||||3823|1643.89|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3823||||3823|1628.6|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3823||||3823|1911.5|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3823||||3823|2484.95|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3823||||3823|2510.18|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3823||||3823|1859.79|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|GEHA [1415]|GEHA [141500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3823||||3823|3133.55|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3823||||3823|1643.89|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3823||||3823|3555.39|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3823||||3823|2293.8|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3823||||3823|1517.54|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3823||||3823|3272.94|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3823||||3823|890.68|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3823||||3823|1880.13|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3823||||3823|1420.54|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MULTIPLAN [1680]|HMA [168003]|3823||||3823|2089.04|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MULTIPLAN [1680]|IHC HS [168011]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3823||||3823|958.54|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3823||||3823|1517.54|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|Self-pay|Self-pay|3823||||3823|1146.9|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3823||||3823|802.83|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3823||||3823|1364.84|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3823||||3823|2033.33|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|TRUSTMARK [2030]|STARMARK [203000]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3823||||3823|1833.13|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|UMR [2035]|UMR OPTIONS [203501]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3823||||3823|848.27|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3823||||3823|3440.7|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3823||||3823|0|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3823||||3823|1859.79|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3823||||3823|1392.69|3555.39|802.83
36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3823||||3823|1911.5|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|3823||||3823|0|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3823||||3823|1420.54|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3823||||3823|922.23|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3823||||3823|922.23|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3823||||3823|1379.58|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3823||||3823|1915.32|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3823||||3823|1341.87|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3823||||3823|1643.89|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3823||||3823|1628.6|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3823||||3823|1911.5|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3823||||3823|2484.95|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3823||||3823|2510.18|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3823||||3823|1859.79|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|GEHA [1415]|GEHA [141500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3823||||3823|3133.55|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3823||||3823|1643.89|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3823||||3823|3555.39|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3823||||3823|2293.8|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3823||||3823|1517.54|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3823||||3823|3272.94|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3823||||3823|890.68|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3823||||3823|1880.13|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3823||||3823|1420.54|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MULTIPLAN [1680]|HMA [168003]|3823||||3823|2089.04|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MULTIPLAN [1680]|IHC HS [168011]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3823||||3823|958.54|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3823||||3823|1517.54|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|Self-pay|Self-pay|3823||||3823|1146.9|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3823||||3823|802.83|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3823||||3823|1364.84|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3823||||3823|2033.33|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|TRUSTMARK [2030]|STARMARK [203000]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3823||||3823|1833.13|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|UMR [2035]|UMR OPTIONS [203501]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3823||||3823|848.27|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3823||||3823|3440.7|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3823||||3823|0|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3823||||3823|1859.79|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3823||||3823|1392.69|3555.39|802.83
36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRONCHIAL/ENDOBRNCL BIOPSY(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3823||||3823|1911.5|3555.39|802.83
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|AETNA [1015]|AETNA ACO WILCO [101532]|7625||||7625|0|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7625||||7625|2940.99|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7625||||7625|922.23|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7625||||7625|922.23|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7625||||7625|2856.18|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7625||||7625|3820.13|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7625||||7625|2676.38|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7625||||7625|3278.75|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7625||||7625|3248.25|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7625||||7625|3812.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7625||||7625|4956.25|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|CORESOURCE [1315]|CORESOURCE [131500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7625||||7625|5006.58|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7625||||7625|3817.98|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|GEHA [1415]|GEHA [141500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7625||||7625|6487.48|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HEALTHNET [1495]|HEALTHNET [149500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7625||||7625|3278.75|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7625||||7625|7091.25|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7625||||7625|4575|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7625||||7625|3141.8|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7625||||7625|6550.84|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7625||||7625|890.68|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7625||||7625|3892.49|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7625||||7625|2940.99|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MULTIPLAN [1680]|HMA [168003]|7625||||7625|4324.98|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MULTIPLAN [1680]|IHC HS [168011]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7625||||7625|958.54|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7625||||7625|3141.8|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|Self-pay|Self-pay|7625||||7625|2287.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7625||||7625|1601.25|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7625||||7625|2825.66|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7625||||7625|4209.65|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|TRUSTMARK [2030]|STARMARK [203000]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7625||||7625|3656.19|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|UMR [2035]|UMR OPTIONS [203501]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7625||||7625|848.27|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7625||||7625|6862.5|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7625||||7625|0|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7625||||7625|3817.98|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7625||||7625|2883.32|7091.25|848.27
36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7625||||7625|3812.5|7091.25|848.27
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|AETNA [1015]|AETNA ACO WILCO [101532]|3221||||3221|0|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3221||||3221|1420.54|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3221||||3221|922.23|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3221||||3221|922.23|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3221||||3221|1379.58|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3221||||3221|1613.72|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3221||||3221|1130.57|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3221||||3221|1385.03|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3221||||3221|1372.15|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3221||||3221|1610.5|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3221||||3221|2093.65|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|CORESOURCE [1315]|CORESOURCE [131500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3221||||3221|2114.91|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3221||||3221|1859.79|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|GEHA [1415]|GEHA [141500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3221||||3221|3133.55|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HEALTHNET [1495]|HEALTHNET [149500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3221||||3221|1385.03|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3221||||3221|2995.53|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3221||||3221|1932.6|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3221||||3221|1517.54|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3221||||3221|3221|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3221||||3221|890.68|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3221||||3221|1880.13|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3221||||3221|1420.54|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MULTIPLAN [1680]|HMA [168003]|3221||||3221|2089.04|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MULTIPLAN [1680]|IHC HS [168011]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3221||||3221|958.54|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3221||||3221|1517.54|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|Self-pay|Self-pay|3221||||3221|966.3|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3221||||3221|676.41|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3221||||3221|1364.84|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3221||||3221|2033.33|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|TRUSTMARK [2030]|STARMARK [203000]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3221||||3221|1544.47|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|UMR [2035]|UMR OPTIONS [203501]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3221||||3221|848.27|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3221||||3221|2898.9|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3221||||3221|0|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3221||||3221|1859.79|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3221||||3221|1392.69|3221|676.41
36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3221||||3221|1610.5|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3221||||3221|0|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3221||||3221|1420.54|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3221||||3221|922.23|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3221||||3221|922.23|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3221||||3221|1379.58|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3221||||3221|1613.72|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3221||||3221|1130.57|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3221||||3221|1385.03|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3221||||3221|1372.15|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3221||||3221|1610.5|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3221||||3221|2093.65|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3221||||3221|2114.91|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3221||||3221|1859.79|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|GEHA [1415]|GEHA [141500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3221||||3221|3133.55|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3221||||3221|1385.03|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3221||||3221|2995.53|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3221||||3221|1932.6|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3221||||3221|1517.54|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3221||||3221|3221|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3221||||3221|890.68|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3221||||3221|1880.13|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3221||||3221|1420.54|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MULTIPLAN [1680]|HMA [168003]|3221||||3221|2089.04|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MULTIPLAN [1680]|IHC HS [168011]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3221||||3221|958.54|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3221||||3221|1517.54|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|Self-pay|Self-pay|3221||||3221|966.3|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3221||||3221|676.41|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3221||||3221|1364.84|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3221||||3221|2033.33|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|TRUSTMARK [2030]|STARMARK [203000]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3221||||3221|1544.47|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|UMR [2035]|UMR OPTIONS [203501]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3221||||3221|848.27|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3221||||3221|2898.9|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3221||||3221|0|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3221||||3221|1859.79|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3221||||3221|1392.69|3221|676.41
36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3221||||3221|1610.5|3221|676.41
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|2823||||2823|0|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2823||||2823|1414.32|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2823||||2823|990.87|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2823||||2823|1213.89|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2823||||2823|1202.6|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2823||||2823|1411.5|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2823||||2823|1834.95|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|CORESOURCE [1315]|CORESOURCE [131500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2823||||2823|1853.58|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|GEHA [1415]|GEHA [141500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HEALTHNET [1495]|HEALTHNET [149500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2823||||2823|1213.89|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2823||||2823|2625.39|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2823||||2823|1693.8|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2823||||2823|923.84|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MULTIPLAN [1680]|HMA [168003]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MULTIPLAN [1680]|IHC HS [168011]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|Self-pay|Self-pay|2823||||2823|846.9|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2823||||2823|592.83|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|TRUSTMARK [2030]|STARMARK [203000]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2823||||2823|1353.63|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|UMR [2035]|UMR OPTIONS [203501]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2823||||2823|2540.7|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2823||||2823|0|2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2823||||2823||2625.39|592.83
36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2823||||2823|1411.5|2625.39|592.83
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|AETNA [1015]|AETNA ACO WILCO [101532]|7339||||7339|0|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7339||||7339|2940.99|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7339||||7339|2627.87|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7339||||7339|2627.87|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7339||||7339|2856.18|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7339||||7339|3676.84|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7339||||7339|2575.99|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7339||||7339|3155.77|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7339||||7339|3126.41|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7339||||7339|3669.5|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7339||||7339|4770.35|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|CORESOURCE [1315]|CORESOURCE [131500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7339||||7339|4818.79|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7339||||7339|3817.98|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|GEHA [1415]|GEHA [141500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7339||||7339|6487.48|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HEALTHNET [1495]|HEALTHNET [149500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7339||||7339|3155.77|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7339||||7339|6825.27|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7339||||7339|4403.4|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7339||||7339|3141.8|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7339||||7339|6550.84|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7339||||7339|2537.97|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7339||||7339|3892.49|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7339||||7339|2940.99|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MULTIPLAN [1680]|HMA [168003]|7339||||7339|4324.98|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MULTIPLAN [1680]|IHC HS [168011]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7339||||7339|2731.34|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7339||||7339|3141.8|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|Self-pay|Self-pay|7339||||7339|2201.7|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7339||||7339|1541.19|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7339||||7339|2825.66|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7339||||7339|4209.65|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|TRUSTMARK [2030]|STARMARK [203000]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7339||||7339|3519.05|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|UMR [2035]|UMR OPTIONS [203501]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7339||||7339|2417.12|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7339||||7339|6605.1|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7339||||7339|0|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7339||||7339|3817.98|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7339||||7339|2883.32|6825.27|1541.19
36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7339||||7339|3669.5|6825.27|1541.19
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|AETNA [1015]|AETNA ACO WILCO [101532]|8388||||8388|0|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8388||||8388|2940.99|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8388||||8388|2627.87|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8388||||8388|2627.87|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8388||||8388|2856.18|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8388||||8388|4202.39|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8388||||8388|2944.19|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8388||||8388|3606.84|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8388||||8388|3573.29|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8388||||8388|4194|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8388||||8388|5452.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|CORESOURCE [1315]|CORESOURCE [131500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8388||||8388|5507.56|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8388||||8388|3817.98|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|GEHA [1415]|GEHA [141500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8388||||8388|6487.48|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HEALTHNET [1495]|HEALTHNET [149500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8388||||8388|3606.84|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8388||||8388|7800.84|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8388||||8388|5032.8|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8388||||8388|3141.8|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8388||||8388|6550.84|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8388||||8388|2537.97|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8388||||8388|3892.49|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8388||||8388|2940.99|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MULTIPLAN [1680]|HMA [168003]|8388||||8388|4324.98|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MULTIPLAN [1680]|IHC HS [168011]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8388||||8388|2731.34|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8388||||8388|3141.8|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|Self-pay|Self-pay|8388||||8388|2516.4|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8388||||8388|1761.48|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8388||||8388|2825.66|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8388||||8388|4209.65|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|TRUSTMARK [2030]|STARMARK [203000]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8388||||8388|4022.05|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|UMR [2035]|UMR OPTIONS [203501]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8388||||8388|2417.12|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8388||||8388|7549.2|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8388||||8388|0|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8388||||8388|3817.98|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8388||||8388|2883.32|7800.84|1761.48
36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8388||||8388|4194|7800.84|1761.48
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7339||||7339|3676.84|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7339||||7339|2575.99|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7339||||7339|3155.77|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7339||||7339|3126.41|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7339||||7339|3669.5|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7339||||7339|4770.35|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|CORESOURCE [1315]|CORESOURCE [131500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7339||||7339|4818.79|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|GEHA [1415]|GEHA [141500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HEALTHNET [1495]|HEALTHNET [149500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7339||||7339|3155.77|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7339||||7339|6825.27|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7339||||7339|4403.4|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7339||||7339|3669.5|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MULTIPLAN [1680]|HMA [168003]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MULTIPLAN [1680]|IHC HS [168011]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|Self-pay|Self-pay|7339||||7339|2201.7|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7339||||7339|1541.19|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|TRUSTMARK [2030]|STARMARK [203000]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7339||||7339|3519.05|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|UMR [2035]|UMR OPTIONS [203501]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7339||||7339|6605.1|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7339||||7339|0|6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7339||||7339||6825.27|1541.19
36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7339||||7339|3669.5|6825.27|1541.19
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|6650||||6650|0|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6650||||6650|3331.65|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6650||||6650|2334.15|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6650||||6650|2859.5|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6650||||6650|2832.9|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6650||||6650|3325|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6650||||6650|4322.5|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|CORESOURCE [1315]|CORESOURCE [131500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6650||||6650|4366.39|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|GEHA [1415]|GEHA [141500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HEALTHNET [1495]|HEALTHNET [149500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6650||||6650|2859.5|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6650||||6650|6184.5|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6650||||6650|3990|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6650||||6650|6650|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MULTIPLAN [1680]|HMA [168003]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MULTIPLAN [1680]|IHC HS [168011]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|Self-pay|Self-pay|6650||||6650|1995|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6650||||6650|1396.5|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|TRUSTMARK [2030]|STARMARK [203000]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6650||||6650|3188.68|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|UMR [2035]|UMR OPTIONS [203501]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6650||||6650|5985|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6650||||6650|0|6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6650||||6650||6650|1396.5
36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6650||||6650|3325|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|6650||||6650|0|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6650||||6650|3331.65|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6650||||6650|2334.15|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6650||||6650|2859.5|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6650||||6650|2832.9|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6650||||6650|3325|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6650||||6650|4322.5|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|CORESOURCE [1315]|CORESOURCE [131500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6650||||6650|4366.39|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|GEHA [1415]|GEHA [141500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HEALTHNET [1495]|HEALTHNET [149500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6650||||6650|2859.5|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6650||||6650|6184.5|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6650||||6650|3990|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6650||||6650|6650|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MULTIPLAN [1680]|HMA [168003]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MULTIPLAN [1680]|IHC HS [168011]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|Self-pay|Self-pay|6650||||6650|1995|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6650||||6650|1396.5|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|TRUSTMARK [2030]|STARMARK [203000]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6650||||6650|3188.68|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|UMR [2035]|UMR OPTIONS [203501]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6650||||6650|5985|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6650||||6650|0|6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6650||||6650||6650|1396.5
36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6650||||6650|3325|6650|1396.5
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|9712||||9712|2240|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9712||||9712|3022.06|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9712||||9712|2708.71|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9712||||9712|2708.71|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9712||||9712|2934.92|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9712||||9712|4865.71|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9712||||9712|3408.91|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9712||||9712|4176.16|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9712||||9712|4137.31|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9712||||9712|4856|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9712||||9712|6312.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9712||||9712|6376.9|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9712||||9712|4042.14|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|GEHA [1415]|GEHA [141500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9712||||9712|6666.3|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9712||||9712|4176.16|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9712||||9712|9032.16|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9712||||9712|5827.2|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9712||||9712|3228.41|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9712||||9712|7044.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9712||||9712|2616.05|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9712||||9712|3999.78|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9712||||9712|3022.06|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MULTIPLAN [1680]|HMA [168003]|9712||||9712|4444.2|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MULTIPLAN [1680]|IHC HS [168011]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9712||||9712|2815.37|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9712||||9712|3228.41|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|Self-pay|Self-pay|9712||||9712|2913.6|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9712||||9712|2039.52|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9712||||9712|2903.55|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9712||||9712|4325.69|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|TRUSTMARK [2030]|STARMARK [203000]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9712||||9712|4656.9|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|UMR [2035]|UMR OPTIONS [203501]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9712||||9712|2491.48|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9712||||9712|8740.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9712||||9712|0|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9712||||9712|4042.14|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9712||||9712|2962.8|9032.16|2039.52
36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9712||||9712|4856|9032.16|2039.52
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2219||||2219|1111.72|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2219||||2219|778.87|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2219||||2219|954.17|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2219||||2219|945.29|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2219||||2219|1109.5|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2219||||2219|1442.35|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|CORESOURCE [1315]|CORESOURCE [131500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2219||||2219|1457|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|GEHA [1415]|GEHA [141500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HEALTHNET [1495]|HEALTHNET [149500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2219||||2219|954.17|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2219||||2219|2063.67|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2219||||2219|1331.4|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2219||||2219|2219|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MULTIPLAN [1680]|HMA [168003]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MULTIPLAN [1680]|IHC HS [168011]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|Self-pay|Self-pay|2219||||2219|665.7|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2219||||2219|465.99|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|TRUSTMARK [2030]|STARMARK [203000]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2219||||2219|1064.01|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|UMR [2035]|UMR OPTIONS [203501]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2219||||2219|1997.1|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2219||||2219|0|2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2219||||2219||2219|465.99
36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE OPEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2219||||2219|1109.5|2219|465.99
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|4532||||4532|1933|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4532||||4532|514.16|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4532||||4532|514.26|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4532||||4532|514.26|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4532||||4532|499.34|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4532||||4532|2270.53|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4532||||4532|1590.73|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4532||||4532|1948.76|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4532||||4532|1930.63|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4532||||4532|2266|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4532||||4532|2945.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4532||||4532|2975.71|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4532||||4532|819.66|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|GEHA [1415]|GEHA [141500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4532||||4532|1134.19|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4532||||4532|1948.76|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4532||||4532|4214.76|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4532||||4532|2719.2|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4532||||4532|498.4|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4532||||4532|549.27|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4532||||4532|1481.98|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4532||||4532|496.66|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4532||||4532|680.51|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4532||||4532|514.16|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MULTIPLAN [1680]|HMA [168003]|4532||||4532|756.12|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4532||||4532|534.51|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4532||||4532|549.27|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|Self-pay|Self-pay|4532||||4532|1359.6|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4532||||4532|951.72|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4532||||4532|494|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4532||||4532|735.96|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4532||||4532|2173.09|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4532||||4532|473.01|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4532||||4532|4078.8|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4532||||4532|0|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4532||||4532|819.66|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4532||||4532|504.08|4214.76|473.01
36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4532||||4532|2266|4214.76|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2478||||2478|0|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2478||||2478|1334.87|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2478||||2478|514.26|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2478||||2478|514.26|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2478||||2478|1296.38|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2478||||2478|1241.48|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2478||||2478|869.78|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2478||||2478|1065.54|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2478||||2478|1055.63|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2478||||2478|1239|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2478||||2478|1610.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2478||||2478|1627.05|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2478||||2478|2120.47|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|GEHA [1415]|GEHA [141500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2478||||2478|2478|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2478||||2478|1065.54|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2478||||2478|2304.54|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2478||||2478|1486.8|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2478||||2478|1426.02|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2478||||2478|2478|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2478||||2478|496.66|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2478||||2478|1766.74|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2478||||2478|1334.87|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MULTIPLAN [1680]|HMA [168003]|2478||||2478|1963.04|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MULTIPLAN [1680]|IHC HS [168011]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2478||||2478|534.51|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2478||||2478|1426.02|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|Self-pay|Self-pay|2478||||2478|743.4|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2478||||2478|520.38|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2478||||2478|1282.52|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2478||||2478|1910.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|TRUSTMARK [2030]|STARMARK [203000]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2478||||2478|1188.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|UMR [2035]|UMR OPTIONS [203501]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2478||||2478|473.01|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2478||||2478|2230.2|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2478||||2478|0|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2478||||2478|2120.47|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2478||||2478|1308.7|2478|473.01
36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2478||||2478|1239|2478|473.01
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1064||||1064|0|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1064||||1064|533.06|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1064||||1064|373.46|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1064||||1064|457.52|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1064||||1064|453.26|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1064||||1064|532|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1064||||1064|691.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|CORESOURCE [1315]|CORESOURCE [131500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1064||||1064|698.62|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|GEHA [1415]|GEHA [141500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HEALTHNET [1495]|HEALTHNET [149500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1064||||1064|457.52|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1064||||1064|989.52|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1064||||1064|638.4|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1064||||1064|1064|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MULTIPLAN [1680]|HMA [168003]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MULTIPLAN [1680]|IHC HS [168011]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|Self-pay|Self-pay|1064||||1064|319.2|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1064||||1064|223.44|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|TRUSTMARK [2030]|STARMARK [203000]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1064||||1064|510.19|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|UMR [2035]|UMR OPTIONS [203501]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1064||||1064|957.6|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1064||||1064|0|1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1064||||1064||1064|223.44
36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1064||||1064|532|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1064||||1064|0|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1064||||1064|533.06|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1064||||1064|373.46|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1064||||1064|457.52|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1064||||1064|453.26|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1064||||1064|532|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1064||||1064|691.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1064||||1064|698.62|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|GEHA [1415]|GEHA [141500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1064||||1064|457.52|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1064||||1064|989.52|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1064||||1064|638.4|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1064||||1064|1064|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MULTIPLAN [1680]|HMA [168003]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MULTIPLAN [1680]|IHC HS [168011]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|Self-pay|Self-pay|1064||||1064|319.2|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1064||||1064|223.44|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|TRUSTMARK [2030]|STARMARK [203000]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1064||||1064|510.19|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|UMR [2035]|UMR OPTIONS [203501]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1064||||1064|957.6|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1064||||1064|0|1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1064||||1064||1064|223.44
36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1064||||1064|532|1064|223.44
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|AETNA [1015]|AETNA ACO WILCO [101532]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1591||||1591|797.09|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1591||||1591|558.44|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1591||||1591|684.13|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1591||||1591|677.77|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1591||||1591|795.5|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1591||||1591|1034.15|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|CORESOURCE [1315]|CORESOURCE [131500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1591||||1591|1044.65|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1591||||1591|837.56|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|GEHA [1415]|GEHA [141500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HEALTHNET [1495]|HEALTHNET [149500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1591||||1591|684.13|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1591||||1591|1479.63|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1591||||1591|954.6|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1591||||1591|795.5|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MULTIPLAN [1680]|HMA [168003]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MULTIPLAN [1680]|IHC HS [168011]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|Self-pay|Self-pay|1591||||1591|477.3|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1591||||1591|334.11|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|TRUSTMARK [2030]|STARMARK [203000]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1591||||1591|762.88|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|UMR [2035]|UMR OPTIONS [203501]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1591||||1591|1431.9|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1591||||1591|0|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1591||||1591|837.56|1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1591||||1591||1479.63|334.11
36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1591||||1591|795.5|1479.63|334.11
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2194||||2194|1099.19|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2194||||2194|770.09|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2194||||2194|943.42|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2194||||2194|934.64|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2194||||2194|1097|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2194||||2194|1426.1|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|CORESOURCE [1315]|CORESOURCE [131500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2194||||2194|1440.58|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2194||||2194|1294.92|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|GEHA [1415]|GEHA [141500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HEALTHNET [1495]|HEALTHNET [149500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2194||||2194|943.42|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2194||||2194|2040.42|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2194||||2194|1316.4|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2194||||2194|1097|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MULTIPLAN [1680]|HMA [168003]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MULTIPLAN [1680]|IHC HS [168011]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|Self-pay|Self-pay|2194||||2194|658.2|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2194||||2194|460.74|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|TRUSTMARK [2030]|STARMARK [203000]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2194||||2194|1052.02|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|UMR [2035]|UMR OPTIONS [203501]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2194||||2194|1974.6|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2194||||2194|0|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2194||||2194|1294.92|2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2194||||2194||2040.42|460.74
36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2194||||2194|1097|2040.42|460.74
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|974||||974|487.97|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|974||||974|341.87|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|974||||974|418.82|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|974||||974|414.92|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|974||||974|487|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|974||||974|633.1|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|CORESOURCE [1315]|CORESOURCE [131500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|974||||974|639.53|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|974||||974|2163.62|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|GEHA [1415]|GEHA [141500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HEALTHNET [1495]|HEALTHNET [149500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|974||||974|418.82|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|974||||974|905.82|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|974||||974|584.4|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|974||||974|487|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MULTIPLAN [1680]|HMA [168003]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MULTIPLAN [1680]|IHC HS [168011]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|Self-pay|Self-pay|974||||974|292.2|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|974||||974|204.54|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|TRUSTMARK [2030]|STARMARK [203000]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|974||||974|467.03|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|UMR [2035]|UMR OPTIONS [203501]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|974||||974|876.6|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|974||||974|0|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|974||||974|2163.62|2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|974||||974||2163.62|204.54
36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|974||||974|487|2163.62|204.54
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2301||||2301|1152.8|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2301||||2301|807.65|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2301||||2301|989.43|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2301||||2301|980.23|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2301||||2301|1150.5|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2301||||2301|1495.65|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|CORESOURCE [1315]|CORESOURCE [131500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2301||||2301|1510.84|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2301||||2301|2206.8|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|GEHA [1415]|GEHA [141500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HEALTHNET [1495]|HEALTHNET [149500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2301||||2301|989.43|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2301||||2301|2139.93|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2301||||2301|1380.6|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2301||||2301|1150.5|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MULTIPLAN [1680]|HMA [168003]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MULTIPLAN [1680]|IHC HS [168011]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|Self-pay|Self-pay|2301||||2301|690.3|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2301||||2301|483.21|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|TRUSTMARK [2030]|STARMARK [203000]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2301||||2301|1103.33|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|UMR [2035]|UMR OPTIONS [203501]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2301||||2301|2070.9|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2301||||2301|0|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2301||||2301|2206.8|2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2301||||2301||2206.8|483.21
36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2301||||2301|1150.5|2206.8|483.21
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3267||||3267|1636.77|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3267||||3267|1146.72|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3267||||3267|1404.81|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3267||||3267|1391.74|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3267||||3267|1633.5|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3267||||3267|2123.55|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|CORESOURCE [1315]|CORESOURCE [131500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3267||||3267|2145.11|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3267||||3267|1468.48|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|GEHA [1415]|GEHA [141500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HEALTHNET [1495]|HEALTHNET [149500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3267||||3267|1404.81|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3267||||3267|3038.31|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3267||||3267|1960.2|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3267||||3267|1633.5|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MULTIPLAN [1680]|HMA [168003]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MULTIPLAN [1680]|IHC HS [168011]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|Self-pay|Self-pay|3267||||3267|980.1|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3267||||3267|686.07|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|TRUSTMARK [2030]|STARMARK [203000]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3267||||3267|1566.53|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|UMR [2035]|UMR OPTIONS [203501]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3267||||3267|2940.3|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3267||||3267|0|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3267||||3267|1468.48|3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3267||||3267||3038.31|686.07
36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3267||||3267|1633.5|3038.31|686.07
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|AETNA [1015]|AETNA ACO WILCO [101532]|6574||||6574|2240|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6574||||6574|2716.62|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6574||||6574|2768.1|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6574||||6574|2768.1|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6574||||6574|2638.28|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6574||||6574|3293.57|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6574||||6574|2307.47|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6574||||6574|2826.82|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6574||||6574|2800.52|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6574||||6574|3287|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6574||||6574|4273.1|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|CORESOURCE [1315]|CORESOURCE [131500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6574||||6574|4316.49|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6574||||6574|3602.66|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|GEHA [1415]|GEHA [141500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6574||||6574|5992.54|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HEALTHNET [1495]|HEALTHNET [149500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6574||||6574|2826.82|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6574||||6574|6113.82|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6574||||6574|3944.4|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6574||||6574|2902.11|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6574||||6574|6313.87|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6574||||6574|2673.54|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6574||||6574|3595.52|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6574||||6574|2716.62|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MULTIPLAN [1680]|HMA [168003]|6574||||6574|3995.02|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MULTIPLAN [1680]|IHC HS [168011]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6574||||6574|2877.09|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6574||||6574|2902.11|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|Self-pay|Self-pay|6574||||6574|1972.2|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6574||||6574|1380.54|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6574||||6574|2610.08|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6574||||6574|3888.49|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|TRUSTMARK [2030]|STARMARK [203000]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6574||||6574|3152.23|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|UMR [2035]|UMR OPTIONS [203501]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6574||||6574|2546.16|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6574||||6574|5916.6|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6574||||6574|0|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6574||||6574|3602.66|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6574||||6574|2663.35|6313.87|1380.54
36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6574||||6574|3287|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|6574||||6574|2240|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6574||||6574|2716.62|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6574||||6574|2768.1|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6574||||6574|2768.1|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6574||||6574|2638.28|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6574||||6574|3293.57|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6574||||6574|2307.47|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6574||||6574|2826.82|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6574||||6574|2800.52|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6574||||6574|3287|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6574||||6574|4273.1|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6574||||6574|4316.49|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6574||||6574|3602.66|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|GEHA [1415]|GEHA [141500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6574||||6574|5992.54|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6574||||6574|2826.82|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6574||||6574|6113.82|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6574||||6574|3944.4|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6574||||6574|2902.11|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6574||||6574|6313.87|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6574||||6574|2673.54|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6574||||6574|3595.52|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6574||||6574|2716.62|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MULTIPLAN [1680]|HMA [168003]|6574||||6574|3995.02|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MULTIPLAN [1680]|IHC HS [168011]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6574||||6574|2877.09|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6574||||6574|2902.11|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|Self-pay|Self-pay|6574||||6574|1972.2|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6574||||6574|1380.54|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6574||||6574|2610.08|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6574||||6574|3888.49|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|TRUSTMARK [2030]|STARMARK [203000]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6574||||6574|3152.23|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|UMR [2035]|UMR OPTIONS [203501]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6574||||6574|2546.16|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6574||||6574|5916.6|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6574||||6574|0|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6574||||6574|3602.66|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6574||||6574|2663.35|6313.87|1380.54
36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6574||||6574|3287|6313.87|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6574||||6574|2768.1|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6574||||6574|2768.1|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6574||||6574|3293.57|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6574||||6574|2307.47|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6574||||6574|2826.82|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6574||||6574|2800.52|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6574||||6574|3287|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6574||||6574|4273.1|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6574||||6574|4316.49|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|GEHA [1415]|GEHA [141500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6574||||6574|2826.82|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6574||||6574|6113.82|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6574||||6574|3944.4|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6574||||6574|6574|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6574||||6574|2673.54|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MULTIPLAN [1680]|HMA [168003]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MULTIPLAN [1680]|IHC HS [168011]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6574||||6574|2877.09|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|Self-pay|Self-pay|6574||||6574|1972.2|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6574||||6574|1380.54|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|TRUSTMARK [2030]|STARMARK [203000]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6574||||6574|3152.23|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|UMR [2035]|UMR OPTIONS [203501]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6574||||6574|2546.16|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6574||||6574|5916.6|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6574||||6574|0|6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6574||||6574||6574|1380.54
36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6574||||6574|3287|6574|1380.54
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|AETNA [1015]|AETNA ACO WILCO [101532]|10751||||10751|3566|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10751||||10751|4528.58|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10751||||10751|4527.06|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10751||||10751|4527.06|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10751||||10751|4398|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10751||||10751|5386.25|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10751||||10751|3773.6|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10751||||10751|4622.93|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10751||||10751|4579.93|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10751||||10751|5375.5|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10751||||10751|6988.15|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|CORESOURCE [1315]|CORESOURCE [131500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|10751||||10751|7059.11|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10751||||10751|5975.05|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|GEHA [1415]|GEHA [141500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10751||||10751|9989.52|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HEALTHNET [1495]|HEALTHNET [149500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10751||||10751|4622.93|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|10751||||10751|9998.43|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10751||||10751|6450.6|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10751||||10751|4837.8|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10751||||10751|10460.93|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10751||||10751|4372.41|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10751||||10751|5993.71|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10751||||10751|4528.58|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MULTIPLAN [1680]|HMA [168003]|10751||||10751|6659.68|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MULTIPLAN [1680]|IHC HS [168011]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|10751||||10751|4705.31|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10751||||10751|4837.8|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|Self-pay|Self-pay|10751||||10751|3225.3|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10751||||10751|2257.71|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10751||||10751|4350.99|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10751||||10751|6482.09|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|TRUSTMARK [2030]|STARMARK [203000]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10751||||10751|5155.1|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|UMR [2035]|UMR OPTIONS [203501]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10751||||10751|4164.09|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10751||||10751|9675.9|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10751||||10751|0|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10751||||10751|5975.05|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10751||||10751|4439.79|10460.93|2257.71
36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10751||||10751|5375.5|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10751||||10751|4527.06|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10751||||10751|4527.06|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10751||||10751|5386.25|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10751||||10751|3773.6|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10751||||10751|4622.93|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10751||||10751|4579.93|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10751||||10751|5375.5|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10751||||10751|6988.15|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|10751||||10751|7059.11|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|GEHA [1415]|GEHA [141500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10751||||10751|4622.93|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|10751||||10751|9998.43|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10751||||10751|6450.6|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10751||||10751|10460.93|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10751||||10751|4372.41|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MULTIPLAN [1680]|HMA [168003]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MULTIPLAN [1680]|IHC HS [168011]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|10751||||10751|4705.31|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|Self-pay|Self-pay|10751||||10751|3225.3|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10751||||10751|2257.71|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|TRUSTMARK [2030]|STARMARK [203000]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10751||||10751|5155.1|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|UMR [2035]|UMR OPTIONS [203501]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10751||||10751|4164.09|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10751||||10751|9675.9|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10751||||10751|0|10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10751||||10751||10460.93|2257.71
36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10751||||10751|5375.5|10460.93|2257.71
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|AETNA [1015]|AETNA ACO WILCO [101532]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|235||||235|117.74|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235||||235|82.49|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235||||235|101.05|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|235||||235|100.11|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|235||||235|117.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235||||235|152.75|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|CORESOURCE [1315]|CORESOURCE [131500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|CORVEL CORP [2235]|CORVEL CORP [223500]|235||||235|154.3|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|GEHA [1415]|GEHA [141500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HEALTHNET [1495]|HEALTHNET [149500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235||||235|101.05|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HEALTHSMART [1505]|HEALTHSMART [150501]|235||||235|218.55|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235||||235|141|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235||||235|117.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MULTIPLAN [1680]|HMA [168003]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MULTIPLAN [1680]|IHC HS [168011]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|Self-pay|Self-pay|235||||235|70.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235||||235|49.35|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|TRUSTMARK [2030]|STARMARK [203000]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235||||235|112.68|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|UMR [2035]|UMR OPTIONS [203501]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235||||235|211.5|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|235||||235|0|218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|235||||235||218.55|49.35
36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|235||||235|117.5|218.55|49.35
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2937||||2937|1471.44|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2937||||2937|1030.89|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2937||||2937|1262.91|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2937||||2937|1251.16|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2937||||2937|1468.5|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2937||||2937|1909.05|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|CORESOURCE [1315]|CORESOURCE [131500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2937||||2937|1928.43|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2937||||2937|3371.32|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|GEHA [1415]|GEHA [141500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HEALTHNET [1495]|HEALTHNET [149500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2937||||2937|1262.91|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2937||||2937|2731.41|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2937||||2937|1762.2|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2937||||2937|1468.5|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MULTIPLAN [1680]|HMA [168003]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MULTIPLAN [1680]|IHC HS [168011]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|Self-pay|Self-pay|2937||||2937|881.1|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2937||||2937|616.77|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|TRUSTMARK [2030]|STARMARK [203000]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2937||||2937|1408.29|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|UMR [2035]|UMR OPTIONS [203501]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2937||||2937|2643.3|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2937||||2937|0|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2937||||2937|3371.32|3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2937||||2937||3371.32|616.77
36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2937||||2937|1468.5|3371.32|616.77
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3040||||3040|1523.04|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3040||||3040|1067.04|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3040||||3040|1307.2|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3040||||3040|1295.04|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3040||||3040|1520|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3040||||3040|1976|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|CORESOURCE [1315]|CORESOURCE [131500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3040||||3040|1996.06|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3040||||3040|2302.82|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|GEHA [1415]|GEHA [141500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HEALTHNET [1495]|HEALTHNET [149500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3040||||3040|1307.2|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3040||||3040|2827.2|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3040||||3040|1824|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3040||||3040|1520|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MULTIPLAN [1680]|HMA [168003]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MULTIPLAN [1680]|IHC HS [168011]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|Self-pay|Self-pay|3040||||3040|912|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3040||||3040|638.4|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|TRUSTMARK [2030]|STARMARK [203000]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3040||||3040|1457.68|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|UMR [2035]|UMR OPTIONS [203501]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3040||||3040|2736|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3040||||3040|0|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3040||||3040|2302.82|2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3040||||3040||2827.2|638.4
36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3040||||3040|1520|2827.2|638.4
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3219||||3219|1612.72|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3219||||3219|1129.87|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3219||||3219|1384.17|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3219||||3219|1371.29|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3219||||3219|1609.5|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3219||||3219|2092.35|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|CORESOURCE [1315]|CORESOURCE [131500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3219||||3219|2113.6|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3219||||3219|3836.82|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|GEHA [1415]|GEHA [141500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HEALTHNET [1495]|HEALTHNET [149500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3219||||3219|1384.17|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3219||||3219|2993.67|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3219||||3219|1931.4|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3219||||3219|1609.5|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MULTIPLAN [1680]|HMA [168003]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MULTIPLAN [1680]|IHC HS [168011]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|Self-pay|Self-pay|3219||||3219|965.7|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3219||||3219|675.99|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|TRUSTMARK [2030]|STARMARK [203000]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3219||||3219|1543.51|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|UMR [2035]|UMR OPTIONS [203501]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3219||||3219|2897.1|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3219||||3219|0|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3219||||3219|3836.82|3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3219||||3219||3836.82|675.99
36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3219||||3219|1609.5|3836.82|675.99
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|AETNA [1015]|AETNA ACO WILCO [101532]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|307||||307|153.81|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|307||||307|107.76|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|307||||307|132.01|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|307||||307|130.78|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|307||||307|153.5|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|307||||307|199.55|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|CORESOURCE [1315]|CORESOURCE [131500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|307||||307|201.58|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|307||||307|421.8|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|GEHA [1415]|GEHA [141500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HEALTHNET [1495]|HEALTHNET [149500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|307||||307|132.01|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|307||||307|285.51|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|307||||307|184.2|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|307||||307|153.5|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MULTIPLAN [1680]|HMA [168003]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MULTIPLAN [1680]|IHC HS [168011]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|Self-pay|Self-pay|307||||307|92.1|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|307||||307|64.47|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|TRUSTMARK [2030]|STARMARK [203000]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|307||||307|147.21|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|UMR [2035]|UMR OPTIONS [203501]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|307||||307|276.3|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|307||||307|0|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|307||||307|421.8|421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|307||||307||421.8|64.47
36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|307||||307|153.5|421.8|64.47
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|AETNA [1015]|AETNA ACO WILCO [101532]|4514||||4514|2240|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4514||||4514|2716.62|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4514||||4514|2650.21|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4514||||4514|2650.21|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4514||||4514|2638.28|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4514||||4514|2261.51|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4514||||4514|1584.41|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4514||||4514|1941.02|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4514||||4514|1922.96|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4514||||4514|2257|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4514||||4514|2934.1|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|CORESOURCE [1315]|CORESOURCE [131500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4514||||4514|2963.89|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4514||||4514|3602.66|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|GEHA [1415]|GEHA [141500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4514||||4514|4514|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HEALTHNET [1495]|HEALTHNET [149500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4514||||4514|1941.02|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4514||||4514|4198.02|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4514||||4514|2708.4|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4514||||4514|2902.11|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4514||||4514|4514|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4514||||4514|2559.68|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4514||||4514|3595.52|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4514||||4514|2716.62|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MULTIPLAN [1680]|HMA [168003]|4514||||4514|3995.02|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MULTIPLAN [1680]|IHC HS [168011]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4514||||4514|2754.56|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4514||||4514|2902.11|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|Self-pay|Self-pay|4514||||4514|1354.2|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4514||||4514|947.94|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4514||||4514|2610.08|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4514||||4514|3888.49|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|TRUSTMARK [2030]|STARMARK [203000]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4514||||4514|2164.46|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|UMR [2035]|UMR OPTIONS [203501]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4514||||4514|2437.73|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4514||||4514|4062.6|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4514||||4514|0|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4514||||4514|3602.66|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4514||||4514|2663.35|4514|947.94
36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4514||||4514|2257|4514|947.94
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|4498||||4498|2240|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4498||||4498|2716.62|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4498||||4498|2650.21|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4498||||4498|2650.21|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4498||||4498|2638.28|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4498||||4498|2253.5|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4498||||4498|1578.8|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4498||||4498|1934.14|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4498||||4498|1916.15|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4498||||4498|2249|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4498||||4498|2923.7|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4498||||4498|2953.39|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4498||||4498|3602.66|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|GEHA [1415]|GEHA [141500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4498||||4498|4498|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4498||||4498|1934.14|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4498||||4498|4183.14|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4498||||4498|2698.8|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4498||||4498|2902.11|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4498||||4498|4498|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4498||||4498|2559.68|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4498||||4498|3595.52|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4498||||4498|2716.62|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MULTIPLAN [1680]|HMA [168003]|4498||||4498|3995.02|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4498||||4498|2754.56|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4498||||4498|2902.11|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|Self-pay|Self-pay|4498||||4498|1349.4|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4498||||4498|944.58|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4498||||4498|2610.08|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4498||||4498|3888.49|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4498||||4498|2156.79|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|UMR [2035]|UMR OPTIONS [203501]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4498||||4498|2437.73|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4498||||4498|4048.2|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4498||||4498|0|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4498||||4498|3602.66|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4498||||4498|2663.35|4498|944.58
36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4498||||4498|2249|4498|944.58
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|AETNA [1015]|AETNA ACO WILCO [101532]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4813||||4813|2650.21|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4813||||4813|2650.21|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4813||||4813|2411.31|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4813||||4813|1689.36|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4813||||4813|2069.59|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4813||||4813|2050.34|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4813||||4813|2406.5|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4813||||4813|3128.45|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|CORESOURCE [1315]|CORESOURCE [131500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4813||||4813|3160.22|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|GEHA [1415]|GEHA [141500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HEALTHNET [1495]|HEALTHNET [149500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4813||||4813|2069.59|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4813||||4813|4476.09|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4813||||4813|2887.8|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4813||||4813|4813|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4813||||4813|2559.68|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MULTIPLAN [1680]|HMA [168003]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MULTIPLAN [1680]|IHC HS [168011]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4813||||4813|2754.56|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|Self-pay|Self-pay|4813||||4813|1443.9|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4813||||4813|1010.73|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|TRUSTMARK [2030]|STARMARK [203000]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4813||||4813|2307.83|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|UMR [2035]|UMR OPTIONS [203501]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4813||||4813|2437.73|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4813||||4813|4331.7|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4813||||4813|0|4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4813||||4813||4813|1010.73
36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4813||||4813|2406.5|4813|1010.73
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|AETNA [1015]|AETNA ACO WILCO [101532]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|367||||367|183.87|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|367||||367|128.82|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|367||||367|157.81|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|367||||367|156.34|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|367||||367|183.5|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|367||||367|238.55|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|CORESOURCE [1315]|CORESOURCE [131500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|GEHA [1415]|GEHA [141500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HEALTHNET [1495]|HEALTHNET [149500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|367||||367|157.81|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|367||||367|341.31|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|367||||367|220.2|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|367||||367|183.5|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MULTIPLAN [1680]|HMA [168003]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MULTIPLAN [1680]|IHC HS [168011]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|Self-pay|Self-pay|367||||367|110.1|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|367||||367|77.07|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|TRUSTMARK [2030]|STARMARK [203000]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|367||||367|175.98|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|UMR [2035]|UMR OPTIONS [203501]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|367||||367|330.3|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|367||||367|0|341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|367||||367||341.31|77.07
36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR AGE>=3 REQRNG MD/QHP SKILL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|367||||367|183.5|341.31|77.07
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|AETNA [1015]|AETNA ACO WILCO [101532]|64||||64|0|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64||||64|3.06|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64||||64|3.25|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64||||64|3.25|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64||||64|32.06|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64||||64|22.46|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64||||64|27.26|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64||||64|32|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64||||64|41.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|CORESOURCE [1315]|CORESOURCE [131500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64||||64|0|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64||||64|23.68|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|GEHA [1415]|GEHA [141500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64||||64|6.75|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HEALTHNET [1495]|HEALTHNET [149500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64||||64|59.52|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64||||64|38.4|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64||||64|3.3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64||||64|32|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64||||64|3.14|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64||||64|4.05|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64||||64|3.06|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MULTIPLAN [1680]|HMA [168003]|64||||64|4.5|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MULTIPLAN [1680]|IHC HS [168011]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64||||64|3.38|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64||||64|3.3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|Self-pay|Self-pay|64||||64|19.2|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64||||64|13.44|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64||||64|2.94|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64||||64|4.38|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|TRUSTMARK [2030]|STARMARK [203000]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64||||64|30.69|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|UMR [2035]|UMR OPTIONS [203501]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64||||64|2.99|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64||||64|57.6|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64||||64|1.8|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64||||64|23.68|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64||||64|3|59.52|1.8
36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64||||64|32|59.52|1.8
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|AETNA [1015]|AETNA ACO WILCO [101532]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128||||128|64.13|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128||||128|44.93|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128||||128|55.04|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128||||128|54.53|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128||||128|64|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128||||128|83.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|CORESOURCE [1315]|CORESOURCE [131500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|GEHA [1415]|GEHA [141500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HEALTHNET [1495]|HEALTHNET [149500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128||||128|55.04|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128||||128|119.04|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128||||128|76.8|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128||||128|64|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MULTIPLAN [1680]|HMA [168003]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MULTIPLAN [1680]|IHC HS [168011]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|Self-pay|Self-pay|128||||128|38.4|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128||||128|26.88|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|TRUSTMARK [2030]|STARMARK [203000]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128||||128|61.38|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|UMR [2035]|UMR OPTIONS [203501]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128||||128|115.2|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128||||128|1.73|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128||||128|0|119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128||||128||119.04|1.73
36036416|EAP|0300 - LABORATORY-GENERAL|HC CAPILLARY BLOOD DRAW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128||||128|64|119.04|1.73
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4772||||4772|0|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4772||||4772|1061.99|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4772||||4772|1061.99|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4772||||4772|2390.77|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4772||||4772|1674.97|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4772||||4772|2051.96|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4772||||4772|2032.87|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4772||||4772|2386|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4772||||4772|3101.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|CORESOURCE [1315]|CORESOURCE [131500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4772||||4772|3133.3|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|GEHA [1415]|GEHA [141500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HEALTHNET [1495]|HEALTHNET [149500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4772||||4772|2051.96|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4772||||4772|4437.96|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4772||||4772|2863.2|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4772||||4772|2980.63|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4772||||4772|1025.72|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MULTIPLAN [1680]|HMA [168003]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MULTIPLAN [1680]|IHC HS [168011]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4772||||4772|1103.81|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|Self-pay|Self-pay|4772||||4772|1431.6|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4772||||4772|1002.12|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|TRUSTMARK [2030]|STARMARK [203000]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4772||||4772|2288.17|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|UMR [2035]|UMR OPTIONS [203501]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4772||||4772|976.85|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4772||||4772|4294.8|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4772||||4772|0|4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4772||||4772||4437.96|976.85
36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4772||||4772|2386|4437.96|976.85
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|AETNA [1015]|AETNA ACO WILCO [101532]|6470||||6470|1933|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6470||||6470|2685.97|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6470||||6470|992.95|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6470||||6470|992.95|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6470||||6470|2638.28|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6470||||6470|3241.47|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6470||||6470|2270.97|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6470||||6470|2782.1|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6470||||6470|2756.22|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6470||||6470|3235|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6470||||6470|4205.5|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|CORESOURCE [1315]|CORESOURCE [131500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6470||||6470|4248.2|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6470||||6470|2120.47|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|GEHA [1415]|GEHA [141500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6470||||6470|5924.93|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HEALTHNET [1495]|HEALTHNET [149500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6470||||6470|2782.1|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6470||||6470|6017.1|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6470||||6470|3882|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6470||||6470|2663.35|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6470||||6470|2902.11|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6470||||6470|2614.04|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6470||||6470|958.98|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6470||||6470|3554.96|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6470||||6470|2685.97|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MULTIPLAN [1680]|HMA [168003]|6470||||6470|3949.95|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MULTIPLAN [1680]|IHC HS [168011]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6470||||6470|1032.05|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6470||||6470|2902.11|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|Self-pay|Self-pay|6470||||6470|1941|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6470||||6470|1358.7|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6470||||6470|2580.64|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6470||||6470|3844.62|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|TRUSTMARK [2030]|STARMARK [203000]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6470||||6470|3102.37|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|UMR [2035]|UMR OPTIONS [203501]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6470||||6470|913.32|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6470||||6470|5823|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6470||||6470|0|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6470||||6470|2120.47|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6470||||6470|2633.3|6017.1|913.32
36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6470||||6470|3235|6017.1|913.32
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|AETNA [1015]|AETNA ACO WILCO [101532]|9579||||9579|2240|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9579||||9579|2716.62|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9579||||9579|2252.9|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9579||||9579|2252.9|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9579||||9579|2638.28|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9579||||9579|4799.08|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9579||||9579|3362.23|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9579||||9579|4118.97|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9579||||9579|4080.65|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9579||||9579|4789.5|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9579||||9579|6226.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|CORESOURCE [1315]|CORESOURCE [131500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9579||||9579|6289.57|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9579||||9579|3602.66|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|GEHA [1415]|GEHA [141500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9579||||9579|5992.54|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HEALTHNET [1495]|HEALTHNET [149500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9579||||9579|4118.97|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9579||||9579|8908.47|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9579||||9579|5747.4|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9579||||9579|2902.11|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9579||||9579|6313.87|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9579||||9579|2175.82|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9579||||9579|3595.52|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9579||||9579|2716.62|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MULTIPLAN [1680]|HMA [168003]|9579||||9579|3995.02|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MULTIPLAN [1680]|IHC HS [168011]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9579||||9579|2341.61|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9579||||9579|2902.11|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|Self-pay|Self-pay|9579||||9579|2873.7|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9579||||9579|2011.59|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9579||||9579|2610.08|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9579||||9579|3888.49|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|TRUSTMARK [2030]|STARMARK [203000]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9579||||9579|4593.13|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|UMR [2035]|UMR OPTIONS [203501]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9579||||9579|2072.21|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9579||||9579|8621.1|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9579||||9579|0|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9579||||9579|3602.66|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9579||||9579|2663.35|8908.47|2011.59
36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9579||||9579|4789.5|8908.47|2011.59
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|AETNA [1015]|AETNA ACO WILCO [101532]|9598||||9598|3566|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9598||||9598|2716.62|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9598||||9598|2706.88|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9598||||9598|2706.88|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9598||||9598|2638.28|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9598||||9598|4808.6|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9598||||9598|3368.9|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9598||||9598|4127.14|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9598||||9598|4088.75|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9598||||9598|4799|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9598||||9598|6238.7|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|CORESOURCE [1315]|CORESOURCE [131500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9598||||9598|6302.05|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9598||||9598|3602.66|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|GEHA [1415]|GEHA [141500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9598||||9598|5992.54|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HEALTHNET [1495]|HEALTHNET [149500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9598||||9598|4127.14|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9598||||9598|8926.14|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9598||||9598|5758.8|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9598||||9598|2902.11|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9598||||9598|6313.87|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9598||||9598|2614.27|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9598||||9598|3595.52|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9598||||9598|2716.62|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MULTIPLAN [1680]|HMA [168003]|9598||||9598|3995.02|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MULTIPLAN [1680]|IHC HS [168011]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9598||||9598|2813.46|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9598||||9598|2902.11|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|Self-pay|Self-pay|9598||||9598|2879.4|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9598||||9598|2015.58|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9598||||9598|2610.08|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9598||||9598|3888.49|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|TRUSTMARK [2030]|STARMARK [203000]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9598||||9598|4602.24|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|UMR [2035]|UMR OPTIONS [203501]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9598||||9598|2489.79|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9598||||9598|8638.2|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9598||||9598|0|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9598||||9598|3602.66|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9598||||9598|2663.35|8926.14|2015.58
36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9598||||9598|4799|8926.14|2015.58
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|AETNA [1015]|AETNA ACO WILCO [101532]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10271||||10271|5145.77|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10271||||10271|3605.12|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10271||||10271|4416.53|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10271||||10271|4375.45|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10271||||10271|5135.5|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10271||||10271|6676.15|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|CORESOURCE [1315]|CORESOURCE [131500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|10271||||10271|6743.94|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|GEHA [1415]|GEHA [141500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HEALTHNET [1495]|HEALTHNET [149500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10271||||10271|4416.53|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|10271||||10271|9552.03|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10271||||10271|6162.6|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10271||||10271|6313.87|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MULTIPLAN [1680]|HMA [168003]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MULTIPLAN [1680]|IHC HS [168011]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|Self-pay|Self-pay|10271||||10271|3081.3|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10271||||10271|2156.91|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|TRUSTMARK [2030]|STARMARK [203000]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10271||||10271|4924.94|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|UMR [2035]|UMR OPTIONS [203501]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10271||||10271|9243.9|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10271||||10271|0|9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10271||||10271||9552.03|2156.91
36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10271||||10271|5135.5|9552.03|2156.91
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|AETNA [1015]|AETNA ACO WILCO [101532]|6557||||6557|0|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6557||||6557|1334.87|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6557||||6557|992.95|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6557||||6557|992.95|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6557||||6557|1296.38|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6557||||6557|3285.06|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6557||||6557|2301.51|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6557||||6557|2819.51|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6557||||6557|2793.28|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6557||||6557|3278.5|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6557||||6557|4262.05|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|CORESOURCE [1315]|CORESOURCE [131500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6557||||6557|4305.33|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6557||||6557|819.66|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|GEHA [1415]|GEHA [141500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6557||||6557|2944.57|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HEALTHNET [1495]|HEALTHNET [149500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6557||||6557|2819.51|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6557||||6557|6098.01|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6557||||6557|3934.2|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6557||||6557|1426.02|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6557||||6557|1481.98|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6557||||6557|958.98|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6557||||6557|1766.74|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6557||||6557|1334.87|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MULTIPLAN [1680]|HMA [168003]|6557||||6557|1963.04|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MULTIPLAN [1680]|IHC HS [168011]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6557||||6557|1032.05|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6557||||6557|1426.02|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|Self-pay|Self-pay|6557||||6557|1967.1|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6557||||6557|1376.97|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6557||||6557|1282.52|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6557||||6557|1910.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|TRUSTMARK [2030]|STARMARK [203000]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6557||||6557|3144.08|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|UMR [2035]|UMR OPTIONS [203501]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6557||||6557|913.32|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6557||||6557|5901.3|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6557||||6557|0|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6557||||6557|819.66|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6557||||6557|1308.7|6098.01|819.66
36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT <5YRS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6557||||6557|3278.5|6098.01|819.66
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|AETNA [1015]|AETNA ACO WILCO [101532]|4714||||4714|1933|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4714||||4714|1334.87|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4714||||4714|992.95|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4714||||4714|992.95|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4714||||4714|1296.38|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4714||||4714|2361.71|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4714||||4714|1654.61|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4714||||4714|2027.02|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4714||||4714|2008.16|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4714||||4714|2357|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4714||||4714|3064.1|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|CORESOURCE [1315]|CORESOURCE [131500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4714||||4714|3095.21|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4714||||4714|2120.47|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|GEHA [1415]|GEHA [141500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4714||||4714|2944.57|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HEALTHNET [1495]|HEALTHNET [149500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4714||||4714|2027.02|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4714||||4714|4384.02|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4714||||4714|2828.4|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4714||||4714|1426.02|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4714||||4714|2614.04|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4714||||4714|958.98|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4714||||4714|1766.74|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4714||||4714|1334.87|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MULTIPLAN [1680]|HMA [168003]|4714||||4714|1963.04|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MULTIPLAN [1680]|IHC HS [168011]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4714||||4714|1032.05|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4714||||4714|1426.02|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|Self-pay|Self-pay|4714||||4714|1414.2|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4714||||4714|989.94|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4714||||4714|1282.52|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4714||||4714|1910.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|TRUSTMARK [2030]|STARMARK [203000]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4714||||4714|2260.36|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|UMR [2035]|UMR OPTIONS [203501]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4714||||4714|913.32|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4714||||4714|4242.6|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4714||||4714|0|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4714||||4714|2120.47|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4714||||4714|1308.7|4384.02|913.32
36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4714||||4714|2357|4384.02|913.32
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|AETNA [1015]|AETNA ACO WILCO [101532]|8014||||8014|0|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8014||||8014|4015.01|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8014||||8014|2812.91|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8014||||8014|3446.02|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8014||||8014|3413.96|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8014||||8014|4007|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8014||||8014|5209.1|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|CORESOURCE [1315]|CORESOURCE [131500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8014||||8014|5261.99|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|GEHA [1415]|GEHA [141500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HEALTHNET [1495]|HEALTHNET [149500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8014||||8014|3446.02|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8014||||8014|7453.02|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8014||||8014|4808.4|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8014||||8014|6313.87|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MULTIPLAN [1680]|HMA [168003]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MULTIPLAN [1680]|IHC HS [168011]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|Self-pay|Self-pay|8014||||8014|2404.2|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8014||||8014|1682.94|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|TRUSTMARK [2030]|STARMARK [203000]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8014||||8014|3842.71|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|UMR [2035]|UMR OPTIONS [203501]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8014||||8014|7212.6|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8014||||8014|0|7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8014||||8014||7453.02|1682.94
36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE CATH CENTRAL VAD SUBQ PORT/PMP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8014||||8014|4007|7453.02|1682.94
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|AETNA [1015]|AETNA ACO WILCO [101532]|5821||||5821|0|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5821||||5821|2916.32|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5821||||5821|2043.17|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5821||||5821|2503.03|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5821||||5821|2479.75|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5821||||5821|2910.5|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5821||||5821|3783.65|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|CORESOURCE [1315]|CORESOURCE [131500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5821||||5821|3822.07|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|GEHA [1415]|GEHA [141500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HEALTHNET [1495]|HEALTHNET [149500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5821||||5821|2503.03|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5821||||5821|5413.53|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5821||||5821|3492.6|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5821||||5821|2614.04|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MULTIPLAN [1680]|HMA [168003]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MULTIPLAN [1680]|IHC HS [168011]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|Self-pay|Self-pay|5821||||5821|1746.3|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5821||||5821|1222.41|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|TRUSTMARK [2030]|STARMARK [203000]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5821||||5821|2791.17|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|UMR [2035]|UMR OPTIONS [203501]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5821||||5821|5238.9|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5821||||5821|0|5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5821||||5821||5413.53|1222.41
36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5821||||5821|2910.5|5413.53|1222.41
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|AETNA [1015]|AETNA ACO WILCO [101532]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8014||||8014|4015.01|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8014||||8014|2812.91|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8014||||8014|3446.02|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8014||||8014|3413.96|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8014||||8014|4007|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8014||||8014|5209.1|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|CORESOURCE [1315]|CORESOURCE [131500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8014||||8014|5261.99|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|GEHA [1415]|GEHA [141500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HEALTHNET [1495]|HEALTHNET [149500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8014||||8014|3446.02|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8014||||8014|7453.02|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8014||||8014|4808.4|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8014||||8014|6313.87|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MULTIPLAN [1680]|HMA [168003]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MULTIPLAN [1680]|IHC HS [168011]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|Self-pay|Self-pay|8014||||8014|2404.2|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8014||||8014|1682.94|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|TRUSTMARK [2030]|STARMARK [203000]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8014||||8014|3842.71|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|UMR [2035]|UMR OPTIONS [203501]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8014||||8014|7212.6|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8014||||8014|0|7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8014||||8014||7453.02|1682.94
36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8014||||8014|4007|7453.02|1682.94
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|AETNA [1015]|AETNA ACO WILCO [101532]|14146||||14146|3566|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14146||||14146|2716.62|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14146||||14146|2706.88|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14146||||14146|2706.88|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14146||||14146|2638.28|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14146||||14146|7087.15|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14146||||14146|4965.25|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14146||||14146|6082.78|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14146||||14146|6026.2|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14146||||14146|7073|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14146||||14146|9194.9|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|CORESOURCE [1315]|CORESOURCE [131500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14146||||14146|9288.26|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14146||||14146|3602.66|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|GEHA [1415]|GEHA [141500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14146||||14146|5992.54|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HEALTHNET [1495]|HEALTHNET [149500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14146||||14146|6082.78|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14146||||14146|13155.78|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14146||||14146|8487.6|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14146||||14146|2902.11|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14146||||14146|6313.87|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14146||||14146|2614.27|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14146||||14146|3595.52|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14146||||14146|2716.62|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MULTIPLAN [1680]|HMA [168003]|14146||||14146|3995.02|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MULTIPLAN [1680]|IHC HS [168011]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14146||||14146|2813.46|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14146||||14146|2902.11|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|Self-pay|Self-pay|14146||||14146|4243.8|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14146||||14146|2970.66|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14146||||14146|2610.08|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14146||||14146|3888.49|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|TRUSTMARK [2030]|STARMARK [203000]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14146||||14146|6783.01|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|UMR [2035]|UMR OPTIONS [203501]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14146||||14146|2489.79|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14146||||14146|12731.4|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14146||||14146|0|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14146||||14146|3602.66|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14146||||14146|2663.35|13155.78|2489.79
36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14146||||14146|7073|13155.78|2489.79
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|AETNA [1015]|AETNA ACO WILCO [101532]|7382||||7382|1933|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7382||||7382|514.16|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7382||||7382|643.63|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7382||||7382|643.63|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7382||||7382|499.34|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7382||||7382|3698.38|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7382||||7382|2591.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7382||||7382|3174.26|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7382||||7382|3144.73|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7382||||7382|3691|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7382||||7382|4798.3|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|CORESOURCE [1315]|CORESOURCE [131500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7382||||7382|4847.02|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7382||||7382|819.66|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|GEHA [1415]|GEHA [141500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7382||||7382|1134.19|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HEALTHNET [1495]|HEALTHNET [149500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7382||||7382|3174.26|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7382||||7382|6865.26|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7382||||7382|4429.2|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7382||||7382|549.27|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7382||||7382|1481.98|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7382||||7382|621.65|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7382||||7382|680.51|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7382||||7382|514.16|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MULTIPLAN [1680]|HMA [168003]|7382||||7382|756.12|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MULTIPLAN [1680]|IHC HS [168011]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7382||||7382|668.97|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7382||||7382|549.27|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|Self-pay|Self-pay|7382||||7382|2214.6|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7382||||7382|1550.22|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7382||||7382|494|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7382||||7382|735.96|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|TRUSTMARK [2030]|STARMARK [203000]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7382||||7382|3539.67|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|UMR [2035]|UMR OPTIONS [203501]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7382||||7382|592.03|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7382||||7382|6643.8|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7382||||7382|0|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7382||||7382|819.66|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7382||||7382|504.08|6865.26|494
36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7382||||7382|3691|6865.26|494
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|AETNA [1015]|AETNA ACO WILCO [101532]|4170||||4170|1933|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4170||||4170|1334.87|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4170||||4170|1112.36|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4170||||4170|1112.36|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4170||||4170|1296.38|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4170||||4170|2089.17|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4170||||4170|1463.67|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4170||||4170|1793.1|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4170||||4170|1776.42|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4170||||4170|2085|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4170||||4170|2710.5|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|CORESOURCE [1315]|CORESOURCE [131500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4170||||4170|2738.02|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4170||||4170|819.66|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|GEHA [1415]|GEHA [141500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4170||||4170|2944.57|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HEALTHNET [1495]|HEALTHNET [149500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4170||||4170|1793.1|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4170||||4170|3878.1|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4170||||4170|2502|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4170||||4170|1426.02|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4170||||4170|1481.98|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4170||||4170|1074.36|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4170||||4170|1766.74|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4170||||4170|1334.87|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MULTIPLAN [1680]|HMA [168003]|4170||||4170|1963.04|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MULTIPLAN [1680]|IHC HS [168011]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4170||||4170|1156.16|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4170||||4170|1426.02|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|Self-pay|Self-pay|4170||||4170|1251|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4170||||4170|875.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4170||||4170|1282.52|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4170||||4170|1910.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|TRUSTMARK [2030]|STARMARK [203000]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4170||||4170|1999.52|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|UMR [2035]|UMR OPTIONS [203501]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4170||||4170|1023.17|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4170||||4170|3753|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4170||||4170|0|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4170||||4170|819.66|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4170||||4170|1308.7|3878.1|819.66
36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4170||||4170|2085|3878.1|819.66
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1223||||1223|0|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1223||||1223|612.72|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1223||||1223|429.27|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1223||||1223|525.89|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1223||||1223|521|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1223||||1223|611.5|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1223||||1223|794.95|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1223||||1223|803.02|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|GEHA [1415]|GEHA [141500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1223||||1223|525.89|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1223||||1223|1137.39|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1223||||1223|733.8|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1223||||1223|689.3|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MULTIPLAN [1680]|HMA [168003]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MULTIPLAN [1680]|IHC HS [168011]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|Self-pay|Self-pay|1223||||1223|366.9|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1223||||1223|256.83|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|TRUSTMARK [2030]|STARMARK [203000]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1223||||1223|586.43|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|UMR [2035]|UMR OPTIONS [203501]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1223||||1223|1100.7|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1223||||1223|0|1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1223||||1223||1137.39|256.83
36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE BY THROMBOLYTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1223||||1223|611.5|1137.39|256.83
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|AETNA [1015]|AETNA ACO WILCO [101532]|3927||||3927|0|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3927||||3927|1334.87|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3927||||3927|992.95|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3927||||3927|992.95|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3927||||3927|1296.38|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3927||||3927|1967.43|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3927||||3927|1378.38|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3927||||3927|1688.61|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3927||||3927|1672.9|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3927||||3927|1963.5|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3927||||3927|2552.55|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|CORESOURCE [1315]|CORESOURCE [131500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3927||||3927|2578.47|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3927||||3927|2120.47|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|GEHA [1415]|GEHA [141500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3927||||3927|2944.57|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HEALTHNET [1495]|HEALTHNET [149500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3927||||3927|1688.61|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3927||||3927|3652.11|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3927||||3927|2356.2|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3927||||3927|1426.02|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3927||||3927|2614.04|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3927||||3927|958.98|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3927||||3927|1766.74|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3927||||3927|1334.87|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MULTIPLAN [1680]|HMA [168003]|3927||||3927|1963.04|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MULTIPLAN [1680]|IHC HS [168011]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3927||||3927|1032.05|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3927||||3927|1426.02|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|Self-pay|Self-pay|3927||||3927|1178.1|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3927||||3927|824.67|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3927||||3927|1282.52|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3927||||3927|1910.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|TRUSTMARK [2030]|STARMARK [203000]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3927||||3927|1883|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|UMR [2035]|UMR OPTIONS [203501]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3927||||3927|913.32|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3927||||3927|3534.3|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3927||||3927|0|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3927||||3927|2120.47|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3927||||3927|1308.7|3652.11|824.67
36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3927||||3927|1963.5|3652.11|824.67
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|AETNA [1015]|AETNA ACO WILCO [101532]|485||||485|0|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|485||||485|193.18|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|485||||485|213.01|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|485||||485|213.01|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|485||||485|187.61|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|485||||485|242.99|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|485||||485|170.24|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|485||||485|208.55|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|485||||485|206.61|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|485||||485|242.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|485||||485|315.25|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|CORESOURCE [1315]|CORESOURCE [131500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|485||||485|318.45|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|485||||485|238.86|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|GEHA [1415]|GEHA [141500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|485||||485|426.14|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HEALTHNET [1495]|HEALTHNET [149500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|485||||485|208.55|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|485||||485|451.05|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|485||||485|291|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|485||||485|206.37|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|485||||485|447.39|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|485||||485|205.72|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|485||||485|255.68|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|485||||485|193.18|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MULTIPLAN [1680]|HMA [168003]|485||||485|284.09|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MULTIPLAN [1680]|IHC HS [168011]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|485||||485|221.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|485||||485|206.37|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|Self-pay|Self-pay|485||||485|145.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|485||||485|101.85|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|485||||485|185.61|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|485||||485|276.52|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|TRUSTMARK [2030]|STARMARK [203000]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|485||||485|232.56|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|UMR [2035]|UMR OPTIONS [203501]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|485||||485|195.93|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|485||||485|436.5|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|485||||485|0|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|485||||485|238.86|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|485||||485|189.4|451.05|101.85
36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|485||||485|242.5|451.05|101.85
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|342||||342|0|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|342||||342|106.28|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|342||||342|23.78|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|342||||342|23.78|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|342||||342|103.21|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|342||||342|171.34|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|342||||342|120.04|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|342||||342|147.06|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|342||||342|145.69|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|342||||342|171|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|342||||342|222.3|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|342||||342|0|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|342||||342|126.54|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|GEHA [1415]|GEHA [141500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|342||||342|234.43|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|342||||342|147.06|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|342||||342|318.06|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|342||||342|205.2|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|342||||342|103.02|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|342||||342|113.53|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|342||||342|254.52|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|342||||342|22.96|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|342||||342|140.66|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|342||||342|106.28|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MULTIPLAN [1680]|HMA [168003]|342||||342|156.29|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MULTIPLAN [1680]|IHC HS [168011]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|342||||342|24.72|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|342||||342|113.53|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|Self-pay|Self-pay|342||||342|102.6|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|342||||342|71.82|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|342||||342|102.11|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|342||||342||318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|TRUSTMARK [2030]|STARMARK [203000]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|342||||342|163.99|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|UMR [2035]|UMR OPTIONS [203501]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|342||||342|21.87|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|342||||342|307.8|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|342||||342|0|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|342||||342|126.54|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|342||||342|104.19|318.06|21.87
36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|342||||342|171|318.06|21.87
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|AETNA [1015]|AETNA ACO WILCO [101532]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1628||||1628|815.63|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1628||||1628|571.43|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1628||||1628|700.04|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1628||||1628|693.53|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1628||||1628|814|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1628||||1628|1058.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|CORESOURCE [1315]|CORESOURCE [131500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1628||||1628|1068.94|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1628||||1628|144.4|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|GEHA [1415]|GEHA [141500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HEALTHNET [1495]|HEALTHNET [149500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1628||||1628|700.04|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1628||||1628|1514.04|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1628||||1628|976.8|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1628||||1628|814|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MULTIPLAN [1680]|HMA [168003]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MULTIPLAN [1680]|IHC HS [168011]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|Self-pay|Self-pay|1628||||1628|488.4|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1628||||1628|341.88|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|TRUSTMARK [2030]|STARMARK [203000]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1628||||1628|780.63|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|UMR [2035]|UMR OPTIONS [203501]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1628||||1628|1465.2|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1628||||1628|0|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1628||||1628|144.4|1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1628||||1628||1514.04|144.4
36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1628||||1628|814|1514.04|144.4
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|AETNA [1015]|AETNA ACO WILCO [101532]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37601||||37601|9533.91|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37601||||37601|9258.99|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37601||||37601|18838.1|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37601||||37601|13197.95|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37601||||37601|16168.43|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37601||||37601|16018.03|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37601||||37601|18800.5|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37601||||37601|24440.65|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|CORESOURCE [1315]|CORESOURCE [131500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37601||||37601|24688.82|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37601||||37601|2348.81|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|GEHA [1415]|GEHA [141500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37601||||37601|21030.68|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HEALTHNET [1495]|HEALTHNET [149500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37601||||37601|16168.43|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37601||||37601|34968.93|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37601||||37601|22560.6|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37601||||37601|10184.89|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37601||||37601|18800.5|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37601||||37601|12618.41|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37601||||37601|9533.91|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MULTIPLAN [1680]|HMA [168003]|37601||||37601|14020.45|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MULTIPLAN [1680]|IHC HS [168011]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37601||||37601|10184.89|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|Self-pay|Self-pay|37601||||37601|11280.3|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37601||||37601|7896.21|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37601||||37601|9160.03|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37601||||37601|13646.57|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|TRUSTMARK [2030]|STARMARK [203000]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37601||||37601|18029.68|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|UMR [2035]|UMR OPTIONS [203501]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37601||||37601|33840.9|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37601||||37601|0|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37601||||37601|2348.81|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37601||||37601|9346.97|34968.93|2348.81
36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37601||||37601|18800.5|34968.93|2348.81
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|14727||||14727|12441|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14727||||14727|9533.91|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14727||||14727|3637.12|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14727||||14727|3637.12|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14727||||14727|9258.99|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14727||||14727|7378.23|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14727||||14727|5169.18|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14727||||14727|6332.61|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14727||||14727|6273.7|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14727||||14727|7363.5|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14727||||14727|9572.55|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|CORESOURCE [1315]|CORESOURCE [131500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14727||||14727|9669.75|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14727||||14727|6440.08|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|GEHA [1415]|GEHA [141500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14727||||14727|14727|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HEALTHNET [1495]|HEALTHNET [149500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14727||||14727|6332.61|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14727||||14727|13696.11|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14727||||14727|8836.2|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14727||||14727|10184.89|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14727||||14727|11182.79|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14727||||14727|3512.7|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14727||||14727|12618.41|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14727||||14727|9533.91|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MULTIPLAN [1680]|HMA [168003]|14727||||14727|14020.45|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MULTIPLAN [1680]|IHC HS [168011]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14727||||14727|3780.33|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14727||||14727|10184.89|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|Self-pay|Self-pay|14727||||14727|4418.1|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14727||||14727|3092.67|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14727||||14727|9160.03|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14727||||14727|13646.57|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|TRUSTMARK [2030]|STARMARK [203000]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14727||||14727|7061.6|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|UMR [2035]|UMR OPTIONS [203501]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14727||||14727|3345.43|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14727||||14727|13254.3|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14727||||14727|0|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14727||||14727|6440.08|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14727||||14727|9346.97|14727|3092.67
36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14727||||14727|7363.5|14727|3092.67
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|AETNA [1015]|AETNA ACO WILCO [101532]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15760||||15760|7895.76|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15760||||15760|5531.76|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15760||||15760|6776.8|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15760||||15760|6713.76|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15760||||15760|7880|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15760||||15760|10244|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|CORESOURCE [1315]|CORESOURCE [131500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15760||||15760|10348.02|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|GEHA [1415]|GEHA [141500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HEALTHNET [1495]|HEALTHNET [149500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15760||||15760|6776.8|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15760||||15760|14656.8|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15760||||15760|9456|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15760||||15760|6313.87|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MULTIPLAN [1680]|HMA [168003]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MULTIPLAN [1680]|IHC HS [168011]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|Self-pay|Self-pay|15760||||15760|4728|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15760||||15760|3309.6|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|TRUSTMARK [2030]|STARMARK [203000]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15760||||15760|7556.92|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|UMR [2035]|UMR OPTIONS [203501]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15760||||15760|14184|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15760||||15760|0|14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15760||||15760||14656.8|3309.6
36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15760||||15760|7880|14656.8|3309.6
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|8686||||8686|3566|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8686||||8686|4528.58|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8686||||8686|3928.8|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8686||||8686|3928.8|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8686||||8686|4398|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8686||||8686|4351.69|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8686||||8686|3048.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8686||||8686|3734.98|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8686||||8686|3700.24|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8686||||8686|4343|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8686||||8686|5645.9|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8686||||8686|5703.23|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8686||||8686|5975.05|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|GEHA [1415]|GEHA [141500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8686||||8686|8686|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8686||||8686|3734.98|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8686||||8686|8077.98|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8686||||8686|5211.6|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8686||||8686|4837.8|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8686||||8686|8686|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8686||||8686|3794.39|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8686||||8686|5993.71|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8686||||8686|4528.58|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MULTIPLAN [1680]|HMA [168003]|8686||||8686|6659.68|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MULTIPLAN [1680]|IHC HS [168011]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8686||||8686|4083.5|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8686||||8686|4837.8|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|Self-pay|Self-pay|8686||||8686|2605.8|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8686||||8686|1824.06|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8686||||8686|4350.99|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8686||||8686|6482.09|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|TRUSTMARK [2030]|STARMARK [203000]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8686||||8686|4164.94|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|UMR [2035]|UMR OPTIONS [203501]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8686||||8686|3613.71|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8686||||8686|7817.4|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8686||||8686|0|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8686||||8686|5975.05|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8686||||8686|4439.79|8686|1824.06
36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8686||||8686|4343|8686|1824.06
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4915||||4915|3566|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4915||||4915|2716.62|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4915||||4915|2949.09|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4915||||4915|2949.09|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4915||||4915|2638.28|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4915||||4915|2462.42|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4915||||4915|1725.17|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4915||||4915|2113.45|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4915||||4915|2093.79|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4915||||4915|2457.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4915||||4915|3194.75|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4915||||4915|3227.19|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4915||||4915|3602.66|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|GEHA [1415]|GEHA [141500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4915||||4915|4915|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4915||||4915|2113.45|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4915||||4915|4570.95|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4915||||4915|2949|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4915||||4915|2902.11|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4915||||4915|4915|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4915||||4915|2848.19|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4915||||4915|3595.52|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4915||||4915|2716.62|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MULTIPLAN [1680]|HMA [168003]|4915||||4915|3995.02|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MULTIPLAN [1680]|IHC HS [168011]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4915||||4915|3065.21|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4915||||4915|2902.11|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|Self-pay|Self-pay|4915||||4915|1474.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4915||||4915|1032.15|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4915||||4915|2610.08|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4915||||4915|3888.49|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|TRUSTMARK [2030]|STARMARK [203000]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4915||||4915|2356.74|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|UMR [2035]|UMR OPTIONS [203501]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4915||||4915|2712.57|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4915||||4915|4423.5|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4915||||4915|0|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4915||||4915|3602.66|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4915||||4915|2663.35|4915|1032.15
36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4915||||4915|2457.5|4915|1032.15
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|AETNA [1015]|AETNA ACO WILCO [101532]|8023||||8023|3566|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8023||||8023|2716.62|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8023||||8023|2778.28|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8023||||8023|2778.28|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8023||||8023|2638.28|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8023||||8023|4019.52|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8023||||8023|2816.07|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8023||||8023|3449.89|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8023||||8023|3417.8|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8023||||8023|4011.5|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8023||||8023|5214.95|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|CORESOURCE [1315]|CORESOURCE [131500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8023||||8023|5267.9|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8023||||8023|3602.66|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|GEHA [1415]|GEHA [141500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8023||||8023|5992.54|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HEALTHNET [1495]|HEALTHNET [149500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8023||||8023|3449.89|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8023||||8023|7461.39|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8023||||8023|4813.8|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8023||||8023|2902.11|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8023||||8023|6313.87|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8023||||8023|2683.24|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8023||||8023|3595.52|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8023||||8023|2716.62|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MULTIPLAN [1680]|HMA [168003]|8023||||8023|3995.02|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MULTIPLAN [1680]|IHC HS [168011]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8023||||8023|2887.67|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8023||||8023|2902.11|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|Self-pay|Self-pay|8023||||8023|2406.9|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8023||||8023|1684.83|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8023||||8023|2610.08|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8023||||8023|3888.49|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|TRUSTMARK [2030]|STARMARK [203000]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8023||||8023|3847.03|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|UMR [2035]|UMR OPTIONS [203501]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8023||||8023|2555.47|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8023||||8023|7220.7|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8023||||8023|0|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8023||||8023|3602.66|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8023||||8023|2663.35|7461.39|1684.83
36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL INTRAVASC FB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8023||||8023|4011.5|7461.39|1684.83
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|AETNA [1015]|AETNA ACO WILCO [101532]|5968||||5968|0|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5968||||5968|4528.58|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5968||||5968|2706.88|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5968||||5968|2706.88|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5968||||5968|4398|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5968||||5968|2989.97|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5968||||5968|2094.77|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5968||||5968|2566.24|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5968||||5968|2542.37|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5968||||5968|2984|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5968||||5968|3879.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|CORESOURCE [1315]|CORESOURCE [131500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5968||||5968|3918.59|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5968||||5968|5975.05|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|GEHA [1415]|GEHA [141500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5968||||5968|5968|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HEALTHNET [1495]|HEALTHNET [149500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5968||||5968|2566.24|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5968||||5968|5550.24|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5968||||5968|3580.8|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5968||||5968|4837.8|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5968||||5968|5968|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5968||||5968|2614.27|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5968||||5968|5968|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5968||||5968|4528.58|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MULTIPLAN [1680]|HMA [168003]|5968||||5968|5968|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MULTIPLAN [1680]|IHC HS [168011]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5968||||5968|2813.46|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5968||||5968|4837.8|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|Self-pay|Self-pay|5968||||5968|1790.4|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5968||||5968|1253.28|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5968||||5968|4350.99|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5968||||5968|5968|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|TRUSTMARK [2030]|STARMARK [203000]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5968||||5968|2861.66|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|UMR [2035]|UMR OPTIONS [203501]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5968||||5968|2489.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5968||||5968|5371.2|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5968||||5968|0|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5968||||5968|5975.05|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5968||||5968|4439.79|5975.05|1253.28
36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5968||||5968|2984|5975.05|1253.28
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|13022||||13022|1933|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13022||||13022|4528.58|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13022||||13022|980.24|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13022||||13022|980.24|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13022||||13022|4398|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13022||||13022|6524.02|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13022||||13022|4570.72|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13022||||13022|5599.46|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13022||||13022|5547.37|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13022||||13022|6511|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13022||||13022|8464.3|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|CORESOURCE [1315]|CORESOURCE [131500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13022||||13022|8550.25|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13022||||13022|5975.05|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|GEHA [1415]|GEHA [141500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13022||||13022|9989.52|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HEALTHNET [1495]|HEALTHNET [149500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13022||||13022|5599.46|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13022||||13022|12110.46|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13022||||13022|7813.2|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13022||||13022|4837.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13022||||13022|10460.93|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13022||||13022|946.71|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13022||||13022|5993.71|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13022||||13022|4528.58|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MULTIPLAN [1680]|HMA [168003]|13022||||13022|6659.68|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MULTIPLAN [1680]|IHC HS [168011]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13022||||13022|1018.84|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13022||||13022|4837.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|Self-pay|Self-pay|13022||||13022|3906.6|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13022||||13022|2734.62|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13022||||13022|4350.99|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13022||||13022|6482.09|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|TRUSTMARK [2030]|STARMARK [203000]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13022||||13022|6244.05|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|UMR [2035]|UMR OPTIONS [203501]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13022||||13022|901.63|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13022||||13022|11719.8|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13022||||13022|0|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13022||||13022|5975.05|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13022||||13022|4439.79|12110.46|901.63
36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13022||||13022|6511|12110.46|901.63
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2973||||2973|1933|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2973||||2973|2716.62|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2973||||2973|980.24|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2973||||2973|980.24|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2973||||2973|2638.28|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2973||||2973|1489.47|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2973||||2973|1043.52|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2973||||2973|1278.39|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2973||||2973|1266.5|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2973||||2973|1486.5|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2973||||2973|1932.45|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2973||||2973|1952.07|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2973||||2973|3602.66|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|GEHA [1415]|GEHA [141500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2973||||2973|2973|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2973||||2973|1278.39|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2973||||2973|2764.89|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2973||||2973|1783.8|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2973||||2973|2902.11|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2973||||2973|2973|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2973||||2973|946.71|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2973||||2973|2973|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2973||||2973|2716.62|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MULTIPLAN [1680]|HMA [168003]|2973||||2973|2973|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MULTIPLAN [1680]|IHC HS [168011]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2973||||2973|1018.84|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2973||||2973|2902.11|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|Self-pay|Self-pay|2973||||2973|891.9|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2973||||2973|624.33|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2973||||2973|2610.08|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2973||||2973|2973|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|TRUSTMARK [2030]|STARMARK [203000]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2973||||2973|1425.55|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|UMR [2035]|UMR OPTIONS [203501]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2973||||2973|901.63|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2973||||2973|2675.7|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2973||||2973|0|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2973||||2973|3602.66|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2973||||2973|2663.35|3602.66|624.33
36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2973||||2973|1486.5|3602.66|624.33
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6632||||6632|3322.63|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6632||||6632|2327.83|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6632||||6632|2851.76|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6632||||6632|2825.23|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6632||||6632|3316|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6632||||6632|4310.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6632||||6632|4354.57|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|GEHA [1415]|GEHA [141500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6632||||6632|2851.76|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6632||||6632|6167.76|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6632||||6632|3979.2|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6632||||6632|2614.04|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MULTIPLAN [1680]|HMA [168003]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MULTIPLAN [1680]|IHC HS [168011]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|Self-pay|Self-pay|6632||||6632|1989.6|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6632||||6632|1392.72|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|TRUSTMARK [2030]|STARMARK [203000]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6632||||6632|3180.04|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|UMR [2035]|UMR OPTIONS [203501]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6632||||6632|5968.8|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6632||||6632|0|6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6632||||6632||6167.76|1392.72
36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6632||||6632|3316|6167.76|1392.72
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|13544||||13544|3769|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13544||||13544|9533.91|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13544||||13544|4880.63|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13544||||13544|4880.63|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13544||||13544|9258.99|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13544||||13544|6785.54|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13544||||13544|4753.94|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13544||||13544|5823.92|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13544||||13544|5769.74|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13544||||13544|6772|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13544||||13544|8803.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|CORESOURCE [1315]|CORESOURCE [131500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13544||||13544|8892.99|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13544||||13544|12881.02|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|GEHA [1415]|GEHA [141500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13544||||13544|13544|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HEALTHNET [1495]|HEALTHNET [149500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13544||||13544|5823.92|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13544||||13544|12595.92|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13544||||13544|8126.4|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13544||||13544|10184.89|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13544||||13544|13544|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13544||||13544|4713.67|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13544||||13544|12618.41|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13544||||13544|9533.91|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MULTIPLAN [1680]|HMA [168003]|13544||||13544|13544|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MULTIPLAN [1680]|IHC HS [168011]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13544||||13544|5072.8|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13544||||13544|10184.89|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|Self-pay|Self-pay|13544||||13544|4063.2|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13544||||13544|2844.24|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13544||||13544|9160.03|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13544||||13544|13544|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|TRUSTMARK [2030]|STARMARK [203000]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13544||||13544|6494.35|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|UMR [2035]|UMR OPTIONS [203501]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13544||||13544|4489.21|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13544||||13544|12189.6|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13544||||13544|0|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13544||||13544|12881.02|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13544||||13544|9346.97|13544|2844.24
36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13544||||13544|6772|13544|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|AETNA [1015]|AETNA ACO WILCO [101532]|13544||||13544|0|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13544||||13544|4880.63|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13544||||13544|4880.63|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13544||||13544|6785.54|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13544||||13544|4753.94|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13544||||13544|5823.92|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13544||||13544|5769.74|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13544||||13544|6772|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13544||||13544|8803.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|CORESOURCE [1315]|CORESOURCE [131500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13544||||13544|8892.99|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13544||||13544|6495.55|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|GEHA [1415]|GEHA [141500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HEALTHNET [1495]|HEALTHNET [149500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13544||||13544|5823.92|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13544||||13544|12595.92|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13544||||13544|8126.4|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13544||||13544|6772|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13544||||13544|4713.67|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MULTIPLAN [1680]|HMA [168003]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MULTIPLAN [1680]|IHC HS [168011]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13544||||13544|5072.8|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|Self-pay|Self-pay|13544||||13544|4063.2|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13544||||13544|2844.24|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|TRUSTMARK [2030]|STARMARK [203000]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13544||||13544|6494.35|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|UMR [2035]|UMR OPTIONS [203501]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13544||||13544|4489.21|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13544||||13544|12189.6|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13544||||13544|0|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13544||||13544|6495.55|12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13544||||13544||12595.92|2844.24
36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13544||||13544|6772|12595.92|2844.24
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|AETNA [1015]|AETNA ACO WILCO [101532]|25158||||25158|3769|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25158||||25158|9533.91|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25158||||25158|10361.47|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25158||||25158|10361.47|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25158||||25158|9258.99|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25158||||25158|12604.16|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25158||||25158|8830.46|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25158||||25158|10817.94|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25158||||25158|10717.31|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25158||||25158|12579|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25158||||25158|16352.7|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|CORESOURCE [1315]|CORESOURCE [131500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25158||||25158|16518.74|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25158||||25158|12881.02|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|GEHA [1415]|GEHA [141500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25158||||25158|21030.68|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HEALTHNET [1495]|HEALTHNET [149500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25158||||25158|10817.94|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25158||||25158|23396.94|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25158||||25158|15094.8|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25158||||25158|10184.89|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25158||||25158|23111.3|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25158||||25158|10007.01|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25158||||25158|12618.41|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25158||||25158|9533.91|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MULTIPLAN [1680]|HMA [168003]|25158||||25158|14020.45|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MULTIPLAN [1680]|IHC HS [168011]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25158||||25158|10769.45|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25158||||25158|10184.89|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|Self-pay|Self-pay|25158||||25158|7547.4|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25158||||25158|5283.18|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25158||||25158|9160.03|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25158||||25158|13646.57|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|TRUSTMARK [2030]|STARMARK [203000]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25158||||25158|12063.26|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|UMR [2035]|UMR OPTIONS [203501]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25158||||25158|9530.49|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25158||||25158|22642.2|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25158||||25158|0|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25158||||25158|12881.02|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25158||||25158|9346.97|23396.94|3769
36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25158||||25158|12579|23396.94|3769
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|AETNA [1015]|AETNA ACO WILCO [101532]|28402||||28402|3566|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28402||||28402|9533.91|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28402||||28402|11159.48|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28402||||28402|11159.48|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28402||||28402|9258.99|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28402||||28402|14229.4|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28402||||28402|9969.1|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28402||||28402|12212.86|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28402||||28402|12099.25|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28402||||28402|14201|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28402||||28402|18461.3|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|CORESOURCE [1315]|CORESOURCE [131500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28402||||28402|18648.75|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28402||||28402|12881.02|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|GEHA [1415]|GEHA [141500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28402||||28402|21030.68|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HEALTHNET [1495]|HEALTHNET [149500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28402||||28402|12212.86|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28402||||28402|26413.86|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28402||||28402|17041.2|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28402||||28402|10184.89|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28402||||28402|23111.3|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28402||||28402|10777.72|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28402||||28402|12618.41|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28402||||28402|9533.91|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MULTIPLAN [1680]|HMA [168003]|28402||||28402|14020.45|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MULTIPLAN [1680]|IHC HS [168011]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28402||||28402|11598.88|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28402||||28402|10184.89|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|Self-pay|Self-pay|28402||||28402|8520.6|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28402||||28402|5964.42|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28402||||28402|9160.03|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28402||||28402|13646.57|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|TRUSTMARK [2030]|STARMARK [203000]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28402||||28402|13618.76|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|UMR [2035]|UMR OPTIONS [203501]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28402||||28402|10264.5|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28402||||28402|25561.8|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28402||||28402|0|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28402||||28402|12881.02|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28402||||28402|9346.97|26413.86|3566
36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28402||||28402|14201|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|AETNA [1015]|AETNA ACO WILCO [101532]|28402||||28402|3566|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28402||||28402|9533.91|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28402||||28402|11159.48|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28402||||28402|11159.48|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28402||||28402|9258.99|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28402||||28402|14229.4|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28402||||28402|9969.1|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28402||||28402|12212.86|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28402||||28402|12099.25|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28402||||28402|14201|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28402||||28402|18461.3|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|CORESOURCE [1315]|CORESOURCE [131500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28402||||28402|18648.75|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28402||||28402|12881.02|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|GEHA [1415]|GEHA [141500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28402||||28402|21030.68|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HEALTHNET [1495]|HEALTHNET [149500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28402||||28402|12212.86|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28402||||28402|26413.86|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28402||||28402|17041.2|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28402||||28402|10184.89|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28402||||28402|23111.3|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28402||||28402|10777.72|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28402||||28402|12618.41|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28402||||28402|9533.91|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MULTIPLAN [1680]|HMA [168003]|28402||||28402|14020.45|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MULTIPLAN [1680]|IHC HS [168011]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28402||||28402|11598.88|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28402||||28402|10184.89|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|Self-pay|Self-pay|28402||||28402|8520.6|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28402||||28402|5964.42|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28402||||28402|9160.03|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28402||||28402|13646.57|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|TRUSTMARK [2030]|STARMARK [203000]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28402||||28402|13618.76|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|UMR [2035]|UMR OPTIONS [203501]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28402||||28402|10264.5|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28402||||28402|25561.8|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28402||||28402|0|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28402||||28402|12881.02|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28402||||28402|9346.97|26413.86|3566
36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28402||||28402|14201|26413.86|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|32035||||32035|3566|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32035||||32035|9533.91|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32035||||32035|10820.48|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32035||||32035|10820.48|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32035||||32035|9258.99|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32035||||32035|16049.54|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32035||||32035|11244.29|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32035||||32035|13775.05|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32035||||32035|13646.91|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32035||||32035|16017.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32035||||32035|20822.75|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32035||||32035|21034.18|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32035||||32035|12881.02|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|GEHA [1415]|GEHA [141500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32035||||32035|21030.68|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32035||||32035|13775.05|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32035||||32035|29792.55|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32035||||32035|19221|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32035||||32035|10184.89|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32035||||32035|23111.3|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32035||||32035|10450.32|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32035||||32035|12618.41|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32035||||32035|9533.91|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MULTIPLAN [1680]|HMA [168003]|32035||||32035|14020.45|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MULTIPLAN [1680]|IHC HS [168011]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32035||||32035|11246.54|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32035||||32035|10184.89|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|Self-pay|Self-pay|32035||||32035|9610.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32035||||32035|6727.35|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32035||||32035|9160.03|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32035||||32035|13646.57|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|TRUSTMARK [2030]|STARMARK [203000]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32035||||32035|15360.78|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|UMR [2035]|UMR OPTIONS [203501]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32035||||32035|9952.69|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32035||||32035|28831.5|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32035||||32035|0|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32035||||32035|12881.02|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32035||||32035|9346.97|29792.55|3566
36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32035||||32035|16017.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|AETNA [1015]|AETNA ACO WILCO [101532]|32035||||32035|3566|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32035||||32035|9533.91|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32035||||32035|10820.48|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32035||||32035|10820.48|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32035||||32035|9258.99|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32035||||32035|16049.54|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32035||||32035|11244.29|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32035||||32035|13775.05|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32035||||32035|13646.91|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32035||||32035|16017.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32035||||32035|20822.75|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|CORESOURCE [1315]|CORESOURCE [131500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32035||||32035|21034.18|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32035||||32035|12881.02|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|GEHA [1415]|GEHA [141500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32035||||32035|21030.68|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HEALTHNET [1495]|HEALTHNET [149500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32035||||32035|13775.05|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32035||||32035|29792.55|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32035||||32035|19221|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32035||||32035|10184.89|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32035||||32035|23111.3|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32035||||32035|10450.32|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32035||||32035|12618.41|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32035||||32035|9533.91|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MULTIPLAN [1680]|HMA [168003]|32035||||32035|14020.45|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MULTIPLAN [1680]|IHC HS [168011]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32035||||32035|11246.54|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32035||||32035|10184.89|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|Self-pay|Self-pay|32035||||32035|9610.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32035||||32035|6727.35|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32035||||32035|9160.03|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32035||||32035|13646.57|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|TRUSTMARK [2030]|STARMARK [203000]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32035||||32035|15360.78|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|UMR [2035]|UMR OPTIONS [203501]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32035||||32035|9952.69|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32035||||32035|28831.5|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32035||||32035|0|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32035||||32035|12881.02|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32035||||32035|9346.97|29792.55|3566
36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32035||||32035|16017.5|29792.55|3566
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|32035||||32035|0|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32035||||32035|9533.91|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32035||||32035|10820.48|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32035||||32035|10820.48|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32035||||32035|9258.99|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32035||||32035|16049.54|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32035||||32035|11244.29|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32035||||32035|13775.05|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32035||||32035|13646.91|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32035||||32035|16017.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32035||||32035|20822.75|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|CORESOURCE [1315]|CORESOURCE [131500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32035||||32035|21034.18|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32035||||32035|12881.02|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|GEHA [1415]|GEHA [141500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32035||||32035|21030.68|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HEALTHNET [1495]|HEALTHNET [149500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32035||||32035|13775.05|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32035||||32035|29792.55|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32035||||32035|19221|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32035||||32035|10184.89|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32035||||32035|23111.3|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32035||||32035|10450.32|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32035||||32035|12618.41|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32035||||32035|9533.91|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MULTIPLAN [1680]|HMA [168003]|32035||||32035|14020.45|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MULTIPLAN [1680]|IHC HS [168011]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32035||||32035|11246.54|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32035||||32035|10184.89|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|Self-pay|Self-pay|32035||||32035|9610.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32035||||32035|6727.35|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32035||||32035|9160.03|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32035||||32035|13646.57|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|TRUSTMARK [2030]|STARMARK [203000]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32035||||32035|15360.78|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|UMR [2035]|UMR OPTIONS [203501]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32035||||32035|9952.69|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32035||||32035|28831.5|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32035||||32035|0|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32035||||32035|12881.02|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32035||||32035|9346.97|29792.55|6727.35
36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32035||||32035|16017.5|29792.55|6727.35
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|AETNA [1015]|AETNA ACO WILCO [101532]|32035||||32035|3566|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32035||||32035|9533.91|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32035||||32035|10820.48|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32035||||32035|10820.48|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32035||||32035|9258.99|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32035||||32035|16049.54|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32035||||32035|11244.29|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32035||||32035|13775.05|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32035||||32035|13646.91|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32035||||32035|16017.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32035||||32035|20822.75|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|CORESOURCE [1315]|CORESOURCE [131500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32035||||32035|21034.18|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32035||||32035|12881.02|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|GEHA [1415]|GEHA [141500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32035||||32035|21030.68|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HEALTHNET [1495]|HEALTHNET [149500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32035||||32035|13775.05|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32035||||32035|29792.55|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32035||||32035|19221|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32035||||32035|10184.89|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32035||||32035|23111.3|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32035||||32035|10450.32|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32035||||32035|12618.41|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32035||||32035|9533.91|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MULTIPLAN [1680]|HMA [168003]|32035||||32035|14020.45|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MULTIPLAN [1680]|IHC HS [168011]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32035||||32035|11246.54|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32035||||32035|10184.89|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|Self-pay|Self-pay|32035||||32035|9610.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32035||||32035|6727.35|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32035||||32035|9160.03|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32035||||32035|13646.57|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|TRUSTMARK [2030]|STARMARK [203000]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32035||||32035|15360.78|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|UMR [2035]|UMR OPTIONS [203501]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32035||||32035|9952.69|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32035||||32035|28831.5|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32035||||32035|0|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32035||||32035|12881.02|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32035||||32035|9346.97|29792.55|3566
36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32035||||32035|16017.5|29792.55|3566
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|AETNA [1015]|AETNA ACO WILCO [101532]|39604||||39604|5505|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39604||||39604|4705.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39604||||39604|6363.03|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39604||||39604|6363.03|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39604||||39604|4569.91|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39604||||39604|19841.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39604||||39604|13901|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39604||||39604|17029.72|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39604||||39604|16871.3|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39604||||39604|19802|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39604||||39604|25742.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|CORESOURCE [1315]|CORESOURCE [131500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39604||||39604|26003.99|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39604||||39604|6440.08|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|GEHA [1415]|GEHA [141500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39604||||39604|10380|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HEALTHNET [1495]|HEALTHNET [149500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39604||||39604|17029.72|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39604||||39604|36831.72|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39604||||39604|23762.4|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39604||||39604|5026.9|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39604||||39604|11182.79|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39604||||39604|6145.35|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39604||||39604|6228|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39604||||39604|4705.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MULTIPLAN [1680]|HMA [168003]|39604||||39604|6920|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MULTIPLAN [1680]|IHC HS [168011]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39604||||39604|6613.57|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39604||||39604|5026.9|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|Self-pay|Self-pay|39604||||39604|11881.2|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39604||||39604|8316.84|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39604||||39604|4521.07|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39604||||39604|6735.46|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|TRUSTMARK [2030]|STARMARK [203000]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39604||||39604|18990.12|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|UMR [2035]|UMR OPTIONS [203501]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39604||||39604|5852.72|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39604||||39604|35643.6|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39604||||39604|0|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39604||||39604|6440.08|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39604||||39604|4613.33|36831.72|4521.07
36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39604||||39604|19802|36831.72|4521.07
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|AETNA [1015]|AETNA ACO WILCO [101532]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15279||||15279|7654.78|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15279||||15279|5362.93|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15279||||15279|6569.97|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15279||||15279|6508.85|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15279||||15279|7639.5|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15279||||15279|9931.35|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|CORESOURCE [1315]|CORESOURCE [131500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15279||||15279|10032.19|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15279||||15279|2179.15|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|GEHA [1415]|GEHA [141500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HEALTHNET [1495]|HEALTHNET [149500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15279||||15279|6569.97|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15279||||15279|14209.47|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15279||||15279|9167.4|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15279||||15279|7639.5|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MULTIPLAN [1680]|HMA [168003]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MULTIPLAN [1680]|IHC HS [168011]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|Self-pay|Self-pay|15279||||15279|4583.7|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15279||||15279|3208.59|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|TRUSTMARK [2030]|STARMARK [203000]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15279||||15279|7326.28|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|UMR [2035]|UMR OPTIONS [203501]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15279||||15279|13751.1|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15279||||15279|0|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15279||||15279|2179.15|14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15279||||15279||14209.47|2179.15
36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15279||||15279|7639.5|14209.47|2179.15
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|18634||||18634|5505|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18634||||18634|4705.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18634||||18634|6363.03|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18634||||18634|6363.03|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18634||||18634|4569.91|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18634||||18634|9335.63|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18634||||18634|6540.53|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18634||||18634|8012.62|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18634||||18634|7938.08|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18634||||18634|9317|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18634||||18634|12112.1|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|CORESOURCE [1315]|CORESOURCE [131500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18634||||18634|12235.08|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18634||||18634|6440.08|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|GEHA [1415]|GEHA [141500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18634||||18634|10380|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HEALTHNET [1495]|HEALTHNET [149500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18634||||18634|8012.62|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18634||||18634|17329.62|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18634||||18634|11180.4|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18634||||18634|5026.9|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18634||||18634|11182.79|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18634||||18634|6145.35|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18634||||18634|6228|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18634||||18634|4705.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MULTIPLAN [1680]|HMA [168003]|18634||||18634|6920|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MULTIPLAN [1680]|IHC HS [168011]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18634||||18634|6613.57|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18634||||18634|5026.9|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|Self-pay|Self-pay|18634||||18634|5590.2|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18634||||18634|3913.14|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18634||||18634|4521.07|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18634||||18634|6735.46|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|TRUSTMARK [2030]|STARMARK [203000]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18634||||18634|8935|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|UMR [2035]|UMR OPTIONS [203501]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18634||||18634|5852.72|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18634||||18634|16770.6|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18634||||18634|0|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18634||||18634|6440.08|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18634||||18634|4613.33|17329.62|3913.14
36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18634||||18634|9317|17329.62|3913.14
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18634||||18634|9335.63|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18634||||18634|6540.53|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18634||||18634|8012.62|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18634||||18634|7938.08|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18634||||18634|9317|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18634||||18634|12112.1|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|CORESOURCE [1315]|CORESOURCE [131500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18634||||18634|12235.08|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18634||||18634|1613.94|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|GEHA [1415]|GEHA [141500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HEALTHNET [1495]|HEALTHNET [149500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18634||||18634|8012.62|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18634||||18634|17329.62|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18634||||18634|11180.4|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18634||||18634|9317|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MULTIPLAN [1680]|HMA [168003]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MULTIPLAN [1680]|IHC HS [168011]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|Self-pay|Self-pay|18634||||18634|5590.2|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18634||||18634|3913.14|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|TRUSTMARK [2030]|STARMARK [203000]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18634||||18634|8935|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|UMR [2035]|UMR OPTIONS [203501]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18634||||18634|16770.6|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18634||||18634|0|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18634||||18634|1613.94|17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18634||||18634||17329.62|1613.94
36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18634||||18634|9317|17329.62|1613.94
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|AETNA [1015]|AETNA ACO WILCO [101532]|6509||||6509|0|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6509||||6509|1335.69|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6509||||6509|275.66|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6509||||6509|275.66|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6509||||6509|1297.17|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6509||||6509|3261.01|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6509||||6509|2284.66|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6509||||6509|2798.87|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6509||||6509|2772.83|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6509||||6509|3254.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6509||||6509|4230.85|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|CORESOURCE [1315]|CORESOURCE [131500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6509||||6509|4273.81|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6509||||6509|1784.38|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|GEHA [1415]|GEHA [141500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6509||||6509|2946.37|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HEALTHNET [1495]|HEALTHNET [149500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6509||||6509|2798.87|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6509||||6509|6053.37|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6509||||6509|3905.4|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6509||||6509|1294.72|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6509||||6509|1426.89|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6509||||6509|3287.78|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6509||||6509|266.22|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6509||||6509|1767.82|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6509||||6509|1320.62|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MULTIPLAN [1680]|HMA [168003]|6509||||6509|1964.25|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MULTIPLAN [1680]|IHC HS [168011]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6509||||6509|286.51|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6509||||6509|1426.89|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|Self-pay|Self-pay|6509||||6509|1952.7|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6509||||6509|1366.89|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6509||||6509|1268.83|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6509||||6509|1911.87|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|TRUSTMARK [2030]|STARMARK [203000]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6509||||6509|3121.07|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|UMR [2035]|UMR OPTIONS [203501]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6509||||6509|253.55|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6509||||6509|5858.1|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6509||||6509|0|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6509||||6509|1784.38|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6509||||6509|1309.5|6053.37|253.55
36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) BONE MARROW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6509||||6509|3254.5|6053.37|253.55
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|7252||||7252|0|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7252||||7252|1335.69|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7252||||7252|694.91|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7252||||7252|694.91|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7252||||7252|1297.17|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7252||||7252|3633.25|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7252||||7252|2545.45|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7252||||7252|3118.36|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7252||||7252|3089.35|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7252||||7252|3626|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7252||||7252|4713.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7252||||7252|4761.66|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7252||||7252|1784.38|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|GEHA [1415]|GEHA [141500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7252||||7252|2946.37|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7252||||7252|3118.36|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7252||||7252|6744.36|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7252||||7252|4351.2|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7252||||7252|1426.89|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7252||||7252|3287.78|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7252||||7252|671.13|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7252||||7252|1767.82|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7252||||7252|1335.69|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MULTIPLAN [1680]|HMA [168003]|7252||||7252|1964.25|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MULTIPLAN [1680]|IHC HS [168011]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7252||||7252|722.27|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7252||||7252|1426.89|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|Self-pay|Self-pay|7252||||7252|2175.6|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7252||||7252|1522.92|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7252||||7252|1283.31|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7252||||7252|1911.87|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|TRUSTMARK [2030]|STARMARK [203000]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7252||||7252|3477.33|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|UMR [2035]|UMR OPTIONS [203501]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7252||||7252|639.18|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7252||||7252|6526.8|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7252||||7252|0|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7252||||7252|1784.38|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7252||||7252|1309.5|6744.36|639.18
36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7252||||7252|3626|6744.36|639.18
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|107.81|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|107.81|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|GEHA [1415]|GEHA [141500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MULTIPLAN [1680]|HMA [168003]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|Self-pay|Self-pay|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0|107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0||107.81|107.81
36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0|107.81|107.81
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2198||||2198|0|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2198||||2198|768.56|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2198||||2198|566.84|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2198||||2198|566.84|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2198||||2198|746.4|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2198||||2198|1101.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2198||||2198|771.5|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2198||||2198|945.14|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2198||||2198|936.35|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2198||||2198|1099|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2198||||2198|1428.7|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2198||||2198|1443.21|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2198||||2198|1021.7|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|GEHA [1415]|GEHA [141500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2198||||2198|1695.36|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2198||||2198|945.14|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2198||||2198|2044.14|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2198||||2198|1318.8|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2198||||2198|821.04|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2198||||2198|1820.3|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2198||||2198|547.44|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2198||||2198|1017.21|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2198||||2198|768.56|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MULTIPLAN [1680]|HMA [168003]|2198||||2198|1130.24|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2198||||2198|589.16|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2198||||2198|821.04|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|Self-pay|Self-pay|2198||||2198|659.4|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2198||||2198|461.58|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2198||||2198|738.42|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2198||||2198|1100.1|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2198||||2198|1053.94|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|UMR [2035]|UMR OPTIONS [203501]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2198||||2198|521.38|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2198||||2198|1978.2|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2198||||2198|0|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2198||||2198|1021.7|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2198||||2198|753.49|2044.14|461.58
36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2198||||2198|1099|2044.14|461.58
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|AETNA [1015]|AETNA ACO WILCO [101532]|2981||||2981|0|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2981||||2981|1335.69|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2981||||2981|859.62|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2981||||2981|859.62|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2981||||2981|1297.17|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2981||||2981|1493.48|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2981||||2981|1046.33|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2981||||2981|1281.83|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2981||||2981|1269.91|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2981||||2981|1490.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2981||||2981|1937.65|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|CORESOURCE [1315]|CORESOURCE [131500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2981||||2981|1957.32|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2981||||2981|1784.38|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|GEHA [1415]|GEHA [141500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2981||||2981|2946.37|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HEALTHNET [1495]|HEALTHNET [149500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2981||||2981|1281.83|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2981||||2981|2772.33|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2981||||2981|1788.6|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2981||||2981|1294.72|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2981||||2981|1426.89|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2981||||2981|2981|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2981||||2981|830.21|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2981||||2981|1767.82|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2981||||2981|1335.69|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MULTIPLAN [1680]|HMA [168003]|2981||||2981|1964.25|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MULTIPLAN [1680]|IHC HS [168011]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2981||||2981|893.47|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2981||||2981|1426.89|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|Self-pay|Self-pay|2981||||2981|894.3|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2981||||2981|626.01|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2981||||2981|1268.83|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2981||||2981|1911.87|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|TRUSTMARK [2030]|STARMARK [203000]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2981||||2981|1429.39|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|UMR [2035]|UMR OPTIONS [203501]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2981||||2981|790.68|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2981||||2981|2682.9|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2981||||2981|0|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2981||||2981|1784.38|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2981||||2981|1309.5|2981|626.01
36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2981||||2981|1490.5|2981|626.01
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|15610||||15610|0|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15610||||15610|4803.94|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15610||||15610|4567.42|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15610||||15610|4567.42|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15610||||15610|4665.42|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|15610||||15610|7820.61|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15610||||15610|5479.11|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15610||||15610|6712.3|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|15610||||15610|6649.86|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|15610||||15610|7805|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15610||||15610|10146.5|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|CORESOURCE [1315]|CORESOURCE [131500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|15610||||15610|10249.53|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|15610||||15610|6283.82|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|GEHA [1415]|GEHA [141500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|15610||||15610|10596.93|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HEALTHNET [1495]|HEALTHNET [149500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15610||||15610|6712.3|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|15610||||15610|14517.3|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15610||||15610|9366|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15610||||15610|5131.96|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15610||||15610|10985.17|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15610||||15610|4411.16|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15610||||15610|6358.16|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15610||||15610|4803.94|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MULTIPLAN [1680]|HMA [168003]|15610||||15610|7064.62|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MULTIPLAN [1680]|IHC HS [168011]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|15610||||15610|4747.26|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15610||||15610|5131.96|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|Self-pay|Self-pay|15610||||15610|4683|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15610||||15610|3278.1|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|15610||||15610|4615.55|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15610||||15610|6876.23|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|TRUSTMARK [2030]|STARMARK [203000]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15610||||15610|7485|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|UMR [2035]|UMR OPTIONS [203501]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15610||||15610|4201.11|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15610||||15610|14049|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|15610||||15610|0|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|15610||||15610|6283.82|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|15610||||15610|4709.75|14517.3|3278.1
36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|15610||||15610|7805|14517.3|3278.1
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|AETNA [1015]|AETNA ACO WILCO [101532]|5229||||5229|0|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5229||||5229|3022.06|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5229||||5229|2733.86|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5229||||5229|2733.86|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5229||||5229|2934.92|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5229||||5229|2619.73|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5229||||5229|1835.38|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5229||||5229|2248.47|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5229||||5229|2227.55|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5229||||5229|2614.5|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5229||||5229|3398.85|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|CORESOURCE [1315]|CORESOURCE [131500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5229||||5229|3433.36|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5229||||5229|4042.14|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|GEHA [1415]|GEHA [141500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5229||||5229|5229|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HEALTHNET [1495]|HEALTHNET [149500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5229||||5229|2248.47|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5229||||5229|4862.97|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5229||||5229|3137.4|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5229||||5229|3228.41|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5229||||5229|5229|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5229||||5229|2640.34|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5229||||5229|3999.78|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5229||||5229|3022.06|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MULTIPLAN [1680]|HMA [168003]|5229||||5229|4444.2|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MULTIPLAN [1680]|IHC HS [168011]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5229||||5229|2841.51|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5229||||5229|3228.41|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|Self-pay|Self-pay|5229||||5229|1568.7|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5229||||5229|1098.09|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5229||||5229|2903.55|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5229||||5229|4325.69|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|TRUSTMARK [2030]|STARMARK [203000]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5229||||5229|2507.31|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|UMR [2035]|UMR OPTIONS [203501]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5229||||5229|2514.61|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5229||||5229|4706.1|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5229||||5229|0|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5229||||5229|4042.14|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5229||||5229|2962.8|5229|1098.09
36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5229||||5229|2614.5|5229|1098.09
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|AETNA [1015]|AETNA ACO WILCO [101532]|8889||||8889|0|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8889||||8889|3022.06|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8889||||8889|464|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8889||||8889|464|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8889||||8889|2934.92|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8889||||8889|4453.39|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8889||||8889|3120.04|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8889||||8889|3822.27|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8889||||8889|3786.71|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8889||||8889|4444.5|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8889||||8889|5777.85|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|CORESOURCE [1315]|CORESOURCE [131500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8889||||8889|5836.52|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8889||||8889|4042.14|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|GEHA [1415]|GEHA [141500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8889||||8889|6666.3|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HEALTHNET [1495]|HEALTHNET [149500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8889||||8889|3822.27|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8889||||8889|8266.77|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8889||||8889|5333.4|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8889||||8889|3228.41|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8889||||8889|7044.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8889||||8889|448.15|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8889||||8889|3999.78|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8889||||8889|3022.06|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MULTIPLAN [1680]|HMA [168003]|8889||||8889|4444.2|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MULTIPLAN [1680]|IHC HS [168011]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8889||||8889|482.27|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8889||||8889|3228.41|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|Self-pay|Self-pay|8889||||8889|2666.7|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8889||||8889|1866.69|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8889||||8889|2903.55|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8889||||8889|4325.69|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|TRUSTMARK [2030]|STARMARK [203000]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8889||||8889|4262.28|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|UMR [2035]|UMR OPTIONS [203501]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8889||||8889|426.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8889||||8889|8000.1|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8889||||8889|0|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8889||||8889|4042.14|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8889||||8889|2962.8|8266.77|426.8
36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8889||||8889|4444.5|8266.77|426.8
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|AETNA [1015]|AETNA ACO WILCO [101532]|5972||||5972|0|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5972||||5972|2872.19|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5972||||5972|2872.19|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5972||||5972|2991.97|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5972||||5972|2096.17|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5972||||5972|2567.96|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5972||||5972|2544.07|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5972||||5972|2986|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5972||||5972|3881.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|CORESOURCE [1315]|CORESOURCE [131500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5972||||5972|3921.22|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|GEHA [1415]|GEHA [141500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HEALTHNET [1495]|HEALTHNET [149500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5972||||5972|2567.96|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5972||||5972|5553.96|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5972||||5972|3583.2|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5972||||5972|5972|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5972||||5972|2774.08|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MULTIPLAN [1680]|HMA [168003]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MULTIPLAN [1680]|IHC HS [168011]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5972||||5972|2985.28|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|Self-pay|Self-pay|5972||||5972|1791.6|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5972||||5972|1254.12|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|TRUSTMARK [2030]|STARMARK [203000]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5972||||5972|2863.57|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|UMR [2035]|UMR OPTIONS [203501]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5972||||5972|2641.91|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5972||||5972|5374.8|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5972||||5972|0|5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5972||||5972||5972|1254.12
36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5972||||5972|2986|5972|1254.12
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|7260||||7260|0|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7260||||7260|3637.26|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7260||||7260|2548.26|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7260||||7260|3121.8|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7260||||7260|3092.76|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7260||||7260|3630|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7260||||7260|4719|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|CORESOURCE [1315]|CORESOURCE [131500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7260||||7260|4766.92|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|GEHA [1415]|GEHA [141500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HEALTHNET [1495]|HEALTHNET [149500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7260||||7260|3121.8|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7260||||7260|6751.8|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7260||||7260|4356|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7260||||7260|7044.8|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MULTIPLAN [1680]|HMA [168003]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MULTIPLAN [1680]|IHC HS [168011]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|Self-pay|Self-pay|7260||||7260|2178|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7260||||7260|1524.6|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|TRUSTMARK [2030]|STARMARK [203000]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7260||||7260|3481.17|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|UMR [2035]|UMR OPTIONS [203501]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7260||||7260|6534|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7260||||7260|0|7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7260||||7260||7044.8|1524.6
36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7260||||7260|3630|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|AETNA [1015]|AETNA ACO WILCO [101532]|7260||||7260|0|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7260||||7260|3022.06|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7260||||7260|2872.19|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7260||||7260|2872.19|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7260||||7260|2934.92|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7260||||7260|3637.26|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7260||||7260|2548.26|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7260||||7260|3121.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7260||||7260|3092.76|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7260||||7260|3630|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7260||||7260|4719|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|CORESOURCE [1315]|CORESOURCE [131500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7260||||7260|4766.92|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7260||||7260|4042.14|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|GEHA [1415]|GEHA [141500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7260||||7260|6666.3|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HEALTHNET [1495]|HEALTHNET [149500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7260||||7260|3121.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7260||||7260|6751.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7260||||7260|4356|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7260||||7260|3228.41|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7260||||7260|7044.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7260||||7260|2773.93|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7260||||7260|3999.78|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7260||||7260|3022.06|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MULTIPLAN [1680]|HMA [168003]|7260||||7260|4444.2|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MULTIPLAN [1680]|IHC HS [168011]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7260||||7260|2985.28|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7260||||7260|3228.41|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|Self-pay|Self-pay|7260||||7260|2178|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7260||||7260|1524.6|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7260||||7260|2903.55|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7260||||7260|4325.69|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|TRUSTMARK [2030]|STARMARK [203000]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7260||||7260|3481.17|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|UMR [2035]|UMR OPTIONS [203501]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7260||||7260|2641.84|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7260||||7260|6534|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7260||||7260|0|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7260||||7260|4042.14|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7260||||7260|2962.8|7044.8|1524.6
36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7260||||7260|3630|7044.8|1524.6
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|AETNA [1015]|AETNA ACO WILCO [101532]|7623||||7623|0|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7623||||7623|3819.12|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7623||||7623|2675.67|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7623||||7623|3277.89|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7623||||7623|3247.4|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7623||||7623|3811.5|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7623||||7623|4954.95|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|CORESOURCE [1315]|CORESOURCE [131500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7623||||7623|5005.26|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|GEHA [1415]|GEHA [141500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HEALTHNET [1495]|HEALTHNET [149500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7623||||7623|3277.89|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7623||||7623|7089.39|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7623||||7623|4573.8|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7623||||7623|7044.8|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MULTIPLAN [1680]|HMA [168003]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MULTIPLAN [1680]|IHC HS [168011]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|Self-pay|Self-pay|7623||||7623|2286.9|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7623||||7623|1600.83|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|TRUSTMARK [2030]|STARMARK [203000]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7623||||7623|3655.23|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|UMR [2035]|UMR OPTIONS [203501]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7623||||7623|6860.7|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7623||||7623|0|7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7623||||7623||7089.39|1600.83
36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7623||||7623|3811.5|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|7623||||7623|0|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7623||||7623|3022.06|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7623||||7623|2872.19|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7623||||7623|2872.19|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7623||||7623|2934.92|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7623||||7623|3819.12|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7623||||7623|2675.67|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7623||||7623|3277.89|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7623||||7623|3247.4|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7623||||7623|3811.5|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7623||||7623|4954.95|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7623||||7623|5005.26|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7623||||7623|4042.14|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|GEHA [1415]|GEHA [141500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7623||||7623|6666.3|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7623||||7623|3277.89|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7623||||7623|7089.39|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7623||||7623|4573.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7623||||7623|3228.41|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7623||||7623|7044.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7623||||7623|2773.93|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7623||||7623|3999.78|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7623||||7623|3022.06|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MULTIPLAN [1680]|HMA [168003]|7623||||7623|4444.2|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MULTIPLAN [1680]|IHC HS [168011]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7623||||7623|2985.28|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7623||||7623|3228.41|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|Self-pay|Self-pay|7623||||7623|2286.9|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7623||||7623|1600.83|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7623||||7623|2903.55|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7623||||7623|4325.69|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|TRUSTMARK [2030]|STARMARK [203000]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7623||||7623|3655.23|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|UMR [2035]|UMR OPTIONS [203501]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7623||||7623|2641.84|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7623||||7623|6860.7|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7623||||7623|0|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7623||||7623|4042.14|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7623||||7623|2962.8|7089.39|1600.83
36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7623||||7623|3811.5|7089.39|1600.83
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|AETNA [1015]|AETNA ACO WILCO [101532]|2322||||2322|0|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2322||||2322|768.56|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2322||||2322|636.98|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2322||||2322|636.98|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2322||||2322|746.4|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2322||||2322|1163.32|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2322||||2322|815.02|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2322||||2322|998.46|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2322||||2322|989.17|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2322||||2322|1161|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2322||||2322|1509.3|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|CORESOURCE [1315]|CORESOURCE [131500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2322||||2322|1524.63|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2322||||2322|1021.7|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|GEHA [1415]|GEHA [141500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2322||||2322|1695.36|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HEALTHNET [1495]|HEALTHNET [149500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2322||||2322|998.46|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2322||||2322|2159.46|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2322||||2322|1393.2|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2322||||2322|821.04|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2322||||2322|1820.3|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2322||||2322|615.22|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2322||||2322|1017.21|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2322||||2322|768.56|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MULTIPLAN [1680]|HMA [168003]|2322||||2322|1130.24|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MULTIPLAN [1680]|IHC HS [168011]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2322||||2322|662.06|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2322||||2322|821.04|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|Self-pay|Self-pay|2322||||2322|696.6|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2322||||2322|487.62|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2322||||2322|738.42|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2322||||2322|1100.1|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|TRUSTMARK [2030]|STARMARK [203000]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2322||||2322|1113.4|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|UMR [2035]|UMR OPTIONS [203501]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2322||||2322|585.91|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2322||||2322|2089.8|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2322||||2322|0|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2322||||2322|1021.7|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2322||||2322|753.49|2159.46|487.62
36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2322||||2322|1161|2159.46|487.62
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|AETNA [1015]|AETNA ACO WILCO [101532]|13735||||13735|0|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13735||||13735|6881.24|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13735||||13735|4820.99|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13735||||13735|5906.05|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13735||||13735|5851.11|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13735||||13735|6867.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13735||||13735|8927.75|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|CORESOURCE [1315]|CORESOURCE [131500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13735||||13735|9018.4|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|GEHA [1415]|GEHA [141500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HEALTHNET [1495]|HEALTHNET [149500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13735||||13735|5906.05|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13735||||13735|12773.55|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13735||||13735|8241|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13735||||13735|10985.17|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MULTIPLAN [1680]|HMA [168003]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MULTIPLAN [1680]|IHC HS [168011]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|Self-pay|Self-pay|13735||||13735|4120.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13735||||13735|2884.35|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|TRUSTMARK [2030]|STARMARK [203000]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13735||||13735|6585.93|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|UMR [2035]|UMR OPTIONS [203501]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13735||||13735|12361.5|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13735||||13735|0|12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13735||||13735||12773.55|2884.35
36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13735||||13735|6867.5|12773.55|2884.35
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|14422||||14422|0|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14422||||14422|7225.42|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14422||||14422|5062.12|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14422||||14422|6201.46|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14422||||14422|6143.77|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14422||||14422|7211|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14422||||14422|9374.3|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|CORESOURCE [1315]|CORESOURCE [131500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14422||||14422|9469.49|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|GEHA [1415]|GEHA [141500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HEALTHNET [1495]|HEALTHNET [149500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14422||||14422|6201.46|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14422||||14422|13412.46|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14422||||14422|8653.2|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14422||||14422|10985.17|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MULTIPLAN [1680]|HMA [168003]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MULTIPLAN [1680]|IHC HS [168011]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|Self-pay|Self-pay|14422||||14422|4326.6|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14422||||14422|3028.62|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|TRUSTMARK [2030]|STARMARK [203000]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14422||||14422|6915.35|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|UMR [2035]|UMR OPTIONS [203501]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14422||||14422|12979.8|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14422||||14422|0|13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14422||||14422||13412.46|3028.62
36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14422||||14422|7211|13412.46|3028.62
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|AETNA [1015]|AETNA ACO WILCO [101532]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|644||||644|322.64|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|644||||644|226.04|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|644||||644|276.92|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|644||||644|274.34|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|644||||644|322|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|644||||644|418.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|CORESOURCE [1315]|CORESOURCE [131500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|644||||644|422.85|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|GEHA [1415]|GEHA [141500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HEALTHNET [1495]|HEALTHNET [149500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|644||||644|276.92|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|644||||644|598.92|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|644||||644|386.4|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|644||||644|322|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MULTIPLAN [1680]|HMA [168003]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MULTIPLAN [1680]|IHC HS [168011]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|Self-pay|Self-pay|644||||644|193.2|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|644||||644|135.24|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|TRUSTMARK [2030]|STARMARK [203000]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|644||||644|308.8|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|UMR [2035]|UMR OPTIONS [203501]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|644||||644|579.6|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|644||||644|0|598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|644||||644||598.92|135.24
36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|644||||644|322|598.92|135.24
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|8065||||8065|0|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8065||||8065|4040.57|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8065||||8065|2830.82|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8065||||8065|3467.95|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8065||||8065|3435.69|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8065||||8065|4032.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8065||||8065|5242.25|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|CORESOURCE [1315]|CORESOURCE [131500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8065||||8065|5295.48|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|GEHA [1415]|GEHA [141500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HEALTHNET [1495]|HEALTHNET [149500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8065||||8065|3467.95|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8065||||8065|7500.45|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8065||||8065|4839|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8065||||8065|7044.8|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MULTIPLAN [1680]|HMA [168003]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MULTIPLAN [1680]|IHC HS [168011]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|Self-pay|Self-pay|8065||||8065|2419.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8065||||8065|1693.65|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|TRUSTMARK [2030]|STARMARK [203000]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8065||||8065|3867.17|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|UMR [2035]|UMR OPTIONS [203501]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8065||||8065|7258.5|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8065||||8065|0|7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8065||||8065||7500.45|1693.65
36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8065||||8065|4032.5|7500.45|1693.65
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|6280||||6280|0|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6280||||6280|1335.69|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6280||||6280|859.62|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6280||||6280|859.62|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6280||||6280|1297.17|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6280||||6280|3146.28|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6280||||6280|2204.28|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6280||||6280|2700.4|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6280||||6280|2675.28|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6280||||6280|3140|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6280||||6280|4082|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|CORESOURCE [1315]|CORESOURCE [131500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6280||||6280|4123.45|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6280||||6280|1784.38|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|GEHA [1415]|GEHA [141500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6280||||6280|2946.37|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HEALTHNET [1495]|HEALTHNET [149500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6280||||6280|2700.4|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6280||||6280|5840.4|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6280||||6280|3768|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6280||||6280|1426.89|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6280||||6280|3287.78|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6280||||6280|830.21|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6280||||6280|1767.82|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6280||||6280|1335.69|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MULTIPLAN [1680]|HMA [168003]|6280||||6280|1964.25|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MULTIPLAN [1680]|IHC HS [168011]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6280||||6280|893.47|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6280||||6280|1426.89|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|Self-pay|Self-pay|6280||||6280|1884|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6280||||6280|1318.8|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6280||||6280|1283.31|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6280||||6280|1911.87|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|TRUSTMARK [2030]|STARMARK [203000]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6280||||6280|3011.26|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|UMR [2035]|UMR OPTIONS [203501]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6280||||6280|790.68|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6280||||6280|5652|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6280||||6280|0|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6280||||6280|1784.38|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6280||||6280|1309.5|5840.4|790.68
36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6280||||6280|3140|5840.4|790.68
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|6497||||6497|0|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6497||||6497|768.56|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6497||||6497|489.37|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6497||||6497|489.37|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6497||||6497|746.4|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6497||||6497|3255|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6497||||6497|2280.45|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6497||||6497|2793.71|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6497||||6497|2767.72|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6497||||6497|3248.5|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6497||||6497|4223.05|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6497||||6497|4265.93|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6497||||6497|1021.7|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|GEHA [1415]|GEHA [141500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6497||||6497|1695.36|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6497||||6497|2793.71|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6497||||6497|6042.21|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6497||||6497|3898.2|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6497||||6497|744.99|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6497||||6497|821.04|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6497||||6497|1820.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6497||||6497|472.62|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6497||||6497|1017.21|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6497||||6497|768.56|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MULTIPLAN [1680]|HMA [168003]|6497||||6497|1130.24|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6497||||6497|508.64|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6497||||6497|821.04|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|Self-pay|Self-pay|6497||||6497|1949.1|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6497||||6497|1364.37|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6497||||6497|730.09|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6497||||6497|1100.1|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6497||||6497|3115.31|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6497||||6497|450.12|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6497||||6497|5847.3|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6497||||6497|0|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6497||||6497|1021.7|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6497||||6497|753.49|6042.21|450.12
36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6497||||6497|3248.5|6042.21|450.12
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3176||||3176|0|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3176||||3176|1335.69|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3176||||3176|859.62|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3176||||3176|859.62|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3176||||3176|1297.17|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3176||||3176|1591.18|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3176||||3176|1114.78|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3176||||3176|1365.68|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3176||||3176|1352.98|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3176||||3176|1588|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3176||||3176|2064.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|CORESOURCE [1315]|CORESOURCE [131500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3176||||3176|2085.36|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3176||||3176|1784.38|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|GEHA [1415]|GEHA [141500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3176||||3176|2946.37|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HEALTHNET [1495]|HEALTHNET [149500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3176||||3176|1365.68|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3176||||3176|2953.68|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3176||||3176|1905.6|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3176||||3176|1426.89|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3176||||3176|3176|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3176||||3176|830.21|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3176||||3176|1767.82|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3176||||3176|1335.69|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MULTIPLAN [1680]|HMA [168003]|3176||||3176|1964.25|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MULTIPLAN [1680]|IHC HS [168011]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3176||||3176|893.47|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3176||||3176|1426.89|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|Self-pay|Self-pay|3176||||3176|952.8|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3176||||3176|666.96|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3176||||3176|1283.31|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3176||||3176|1911.87|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|TRUSTMARK [2030]|STARMARK [203000]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3176||||3176|1522.89|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|UMR [2035]|UMR OPTIONS [203501]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3176||||3176|790.68|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3176||||3176|2858.4|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3176||||3176|0|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3176||||3176|1784.38|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3176||||3176|1309.5|3176|666.96
36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOM/RETROPERITONIAL MASS PERC NDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3176||||3176|1588|3176|666.96
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|4168||||4168|0|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4168||||4168|590.45|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4168||||4168|1242.72|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4168||||4168|1242.72|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4168||||4168|573.42|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4168||||4168|2088.17|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4168||||4168|1462.97|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4168||||4168|1792.24|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4168||||4168|1775.57|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4168||||4168|2084|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4168||||4168|2709.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|CORESOURCE [1315]|CORESOURCE [131500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4168||||4168|2736.71|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4168||||4168|793.01|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|GEHA [1415]|GEHA [141500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4168||||4168|1302.45|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HEALTHNET [1495]|HEALTHNET [149500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4168||||4168|1792.24|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4168||||4168|3876.24|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4168||||4168|2500.8|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4168||||4168|630.76|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4168||||4168|1384.76|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4168||||4168|1200.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4168||||4168|781.47|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4168||||4168|590.45|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MULTIPLAN [1680]|HMA [168003]|4168||||4168|868.3|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MULTIPLAN [1680]|IHC HS [168011]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4168||||4168|1291.65|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4168||||4168|630.76|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|Self-pay|Self-pay|4168||||4168|1250.4|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4168||||4168|875.28|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4168||||4168|567.29|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4168||||4168|845.15|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|TRUSTMARK [2030]|STARMARK [203000]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4168||||4168|1998.56|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|UMR [2035]|UMR OPTIONS [203501]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4168||||4168|1143.05|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4168||||4168|3751.2|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4168||||4168|0|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4168||||4168|793.01|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4168||||4168|578.87|3876.24|567.29
36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4168||||4168|2084|3876.24|567.29
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|AETNA [1015]|AETNA ACO WILCO [101532]|4433||||4433|0|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4433||||4433|1335.69|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4433||||4433|1496.85|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4433||||4433|1496.85|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4433||||4433|1297.17|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4433||||4433|2220.93|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4433||||4433|1555.98|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4433||||4433|1906.19|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4433||||4433|1888.46|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4433||||4433|2216.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4433||||4433|2881.45|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|CORESOURCE [1315]|CORESOURCE [131500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4433||||4433|2910.71|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4433||||4433|1784.38|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|GEHA [1415]|GEHA [141500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4433||||4433|2946.37|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HEALTHNET [1495]|HEALTHNET [149500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4433||||4433|1906.19|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4433||||4433|4122.69|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4433||||4433|2659.8|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4433||||4433|1426.89|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4433||||4433|3287.78|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4433||||4433|1445.64|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4433||||4433|1767.82|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4433||||4433|1335.69|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MULTIPLAN [1680]|HMA [168003]|4433||||4433|1964.25|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MULTIPLAN [1680]|IHC HS [168011]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4433||||4433|1555.79|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4433||||4433|1426.89|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|Self-pay|Self-pay|4433||||4433|1329.9|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4433||||4433|930.93|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4433||||4433|1283.31|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4433||||4433|1911.87|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|TRUSTMARK [2030]|STARMARK [203000]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4433||||4433|2125.62|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|UMR [2035]|UMR OPTIONS [203501]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4433||||4433|1376.8|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4433||||4433|3989.7|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4433||||4433|0|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4433||||4433|1784.38|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4433||||4433|1309.5|4122.69|930.93
36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4433||||4433|2216.5|4122.69|930.93
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|AETNA [1015]|AETNA ACO WILCO [101532]|4432||||4432|0|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4432||||4432|1335.69|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4432||||4432|1496.85|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4432||||4432|1496.85|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4432||||4432|1297.17|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4432||||4432|2220.43|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4432||||4432|1555.63|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4432||||4432|1905.76|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4432||||4432|1888.03|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4432||||4432|2216|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4432||||4432|2880.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|CORESOURCE [1315]|CORESOURCE [131500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4432||||4432|2910.05|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4432||||4432|1784.38|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|GEHA [1415]|GEHA [141500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4432||||4432|2946.37|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HEALTHNET [1495]|HEALTHNET [149500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4432||||4432|1905.76|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4432||||4432|4121.76|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4432||||4432|2659.2|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4432||||4432|1426.89|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4432||||4432|3287.78|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4432||||4432|1445.64|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4432||||4432|1767.82|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4432||||4432|1335.69|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MULTIPLAN [1680]|HMA [168003]|4432||||4432|1964.25|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MULTIPLAN [1680]|IHC HS [168011]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4432||||4432|1555.79|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4432||||4432|1426.89|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|Self-pay|Self-pay|4432||||4432|1329.6|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4432||||4432|930.72|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4432||||4432|1283.31|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4432||||4432|1911.87|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|TRUSTMARK [2030]|STARMARK [203000]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4432||||4432|2125.14|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|UMR [2035]|UMR OPTIONS [203501]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4432||||4432|1376.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4432||||4432|3988.8|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4432||||4432|0|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4432||||4432|1784.38|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4432||||4432|1309.5|4121.76|930.72
36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4432||||4432|2216|4121.76|930.72
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|AETNA [1015]|AETNA ACO WILCO [101532]|4312||||4312|0|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4312||||4312|2160.31|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4312||||4312|1513.51|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4312||||4312|1854.16|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4312||||4312|1836.91|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4312||||4312|2156|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4312||||4312|2802.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|CORESOURCE [1315]|CORESOURCE [131500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4312||||4312|2831.26|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|GEHA [1415]|GEHA [141500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HEALTHNET [1495]|HEALTHNET [149500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4312||||4312|1854.16|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4312||||4312|4010.16|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4312||||4312|2587.2|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4312||||4312|3287.78|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MULTIPLAN [1680]|HMA [168003]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MULTIPLAN [1680]|IHC HS [168011]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|Self-pay|Self-pay|4312||||4312|1293.6|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4312||||4312|905.52|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|TRUSTMARK [2030]|STARMARK [203000]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4312||||4312|2067.6|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|UMR [2035]|UMR OPTIONS [203501]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4312||||4312|3880.8|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4312||||4312|0|4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4312||||4312||4010.16|905.52
36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4312||||4312|2156|4010.16|905.52
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|AETNA [1015]|AETNA ACO WILCO [101532]|8445||||8445|0|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8445||||8445|3022.06|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8445||||8445|2756.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8445||||8445|2756.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8445||||8445|2934.92|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8445||||8445|4230.95|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8445||||8445|2964.2|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8445||||8445|3631.35|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8445||||8445|3597.57|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8445||||8445|4222.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8445||||8445|5489.25|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|CORESOURCE [1315]|CORESOURCE [131500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8445||||8445|5544.99|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8445||||8445|4042.14|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|GEHA [1415]|GEHA [141500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8445||||8445|6666.3|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HEALTHNET [1495]|HEALTHNET [149500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8445||||8445|3631.35|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8445||||8445|7853.85|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8445||||8445|5067|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8445||||8445|3228.41|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8445||||8445|7044.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8445||||8445|2662.49|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8445||||8445|3999.78|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8445||||8445|3022.06|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MULTIPLAN [1680]|HMA [168003]|8445||||8445|4444.2|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MULTIPLAN [1680]|IHC HS [168011]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8445||||8445|2865.35|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8445||||8445|3228.41|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|Self-pay|Self-pay|8445||||8445|2533.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8445||||8445|1773.45|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8445||||8445|2903.55|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8445||||8445|4325.69|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|TRUSTMARK [2030]|STARMARK [203000]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8445||||8445|4049.38|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|UMR [2035]|UMR OPTIONS [203501]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8445||||8445|2535.71|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8445||||8445|7600.5|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8445||||8445|0|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8445||||8445|4042.14|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8445||||8445|2962.8|7853.85|1773.45
36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8445||||8445|4222.5|7853.85|1773.45
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|AETNA [1015]|AETNA ACO WILCO [101532]|8380||||8380|0|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8380||||8380|2078.41|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8380||||8380|2078.41|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8380||||8380|4198.38|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8380||||8380|2941.38|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8380||||8380|3603.4|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8380||||8380|3569.88|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8380||||8380|4190|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8380||||8380|5447|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|CORESOURCE [1315]|CORESOURCE [131500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8380||||8380|5502.31|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|GEHA [1415]|GEHA [141500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HEALTHNET [1495]|HEALTHNET [149500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8380||||8380|3603.4|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8380||||8380|7793.4|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8380||||8380|5028|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8380||||8380|6313.87|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8380||||8380|2007.41|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MULTIPLAN [1680]|HMA [168003]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MULTIPLAN [1680]|IHC HS [168011]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8380||||8380|2160.25|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|Self-pay|Self-pay|8380||||8380|2514|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8380||||8380|1759.8|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|TRUSTMARK [2030]|STARMARK [203000]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8380||||8380|4018.21|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|UMR [2035]|UMR OPTIONS [203501]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8380||||8380|1911.77|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8380||||8380|7542|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8380||||8380|0|7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8380||||8380||7793.4|1759.8
36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8380||||8380|4190|7793.4|1759.8
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|3526||||3526|0|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3526||||3526|1542.65|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3526||||3526|1361.5|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3526||||3526|1361.5|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3526||||3526|1498.17|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3526||||3526|1766.53|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3526||||3526|1237.63|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3526||||3526|1516.18|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3526||||3526|1502.08|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3526||||3526|1763|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3526||||3526|2291.9|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3526||||3526|2315.17|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3526||||3526|2024.62|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|GEHA [1415]|GEHA [141500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3526||||3526|3402.9|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3526||||3526|1516.18|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3526||||3526|3279.18|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3526||||3526|2115.6|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3526||||3526|1647.98|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3526||||3526|3526|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3526||||3526|1314.91|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3526||||3526|2041.74|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3526||||3526|1542.65|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MULTIPLAN [1680]|HMA [168003]|3526||||3526|2268.6|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MULTIPLAN [1680]|IHC HS [168011]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3526||||3526|1415.11|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3526||||3526|1647.98|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|Self-pay|Self-pay|3526||||3526|1057.8|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3526||||3526|740.46|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3526||||3526|1482.15|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3526||||3526|2208.11|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|TRUSTMARK [2030]|STARMARK [203000]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3526||||3526|1690.72|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|UMR [2035]|UMR OPTIONS [203501]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3526||||3526|1252.3|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3526||||3526|3173.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3526||||3526|0|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3526||||3526|2024.62|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3526||||3526|1512.4|3526|740.46
36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3526||||3526|1763|3526|740.46
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|917||||917|459.42|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|917||||917|321.87|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|917||||917|394.31|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|917||||917|390.64|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|917||||917|458.5|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|917||||917|596.05|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|917||||917|602.1|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|917||||917|411.96|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|GEHA [1415]|GEHA [141500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|917||||917|394.31|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|917||||917|852.81|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|917||||917|550.2|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|917||||917|458.5|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MULTIPLAN [1680]|HMA [168003]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MULTIPLAN [1680]|IHC HS [168011]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|Self-pay|Self-pay|917||||917|275.1|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|917||||917|192.57|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|TRUSTMARK [2030]|STARMARK [203000]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|917||||917|439.7|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|UMR [2035]|UMR OPTIONS [203501]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|917||||917|825.3|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|917||||917|0|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|917||||917|411.96|852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|917||||917||852.81|192.57
36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|917||||917|458.5|852.81|192.57
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|AETNA [1015]|AETNA ACO WILCO [101532]|3795||||3795|0|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3795||||3795|1542.65|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3795||||3795|777.77|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3795||||3795|777.77|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3795||||3795|1498.17|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3795||||3795|1901.3|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3795||||3795|1332.05|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3795||||3795|1631.85|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3795||||3795|1616.67|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3795||||3795|1897.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3795||||3795|2466.75|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|CORESOURCE [1315]|CORESOURCE [131500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3795||||3795|2491.8|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3795||||3795|2024.62|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|GEHA [1415]|GEHA [141500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3795||||3795|3402.9|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HEALTHNET [1495]|HEALTHNET [149500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3795||||3795|1631.85|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3795||||3795|3529.35|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3795||||3795|2277|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3795||||3795|1647.98|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3795||||3795|3545.55|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3795||||3795|751.17|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3795||||3795|2041.74|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3795||||3795|1542.65|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MULTIPLAN [1680]|HMA [168003]|3795||||3795|2268.6|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MULTIPLAN [1680]|IHC HS [168011]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3795||||3795|808.39|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3795||||3795|1647.98|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|Self-pay|Self-pay|3795||||3795|1138.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3795||||3795|796.95|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3795||||3795|1482.15|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3795||||3795|2208.11|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|TRUSTMARK [2030]|STARMARK [203000]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3795||||3795|1819.7|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|UMR [2035]|UMR OPTIONS [203501]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3795||||3795|715.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3795||||3795|3415.5|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3795||||3795|0|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3795||||3795|2024.62|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3795||||3795|1512.4|3545.55|715.4
36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3795||||3795|1897.5|3545.55|715.4
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|AETNA [1015]|AETNA ACO WILCO [101532]|2933||||2933|0|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2933||||2933|1542.65|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2933||||2933|777.77|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2933||||2933|777.77|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2933||||2933|1498.17|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2933||||2933|1469.43|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2933||||2933|1029.48|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2933||||2933|1261.19|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2933||||2933|1249.46|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2933||||2933|1466.5|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2933||||2933|1906.45|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|CORESOURCE [1315]|CORESOURCE [131500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2933||||2933|1925.81|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2933||||2933|2024.62|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|GEHA [1415]|GEHA [141500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2933||||2933|2933|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HEALTHNET [1495]|HEALTHNET [149500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2933||||2933|1261.19|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2933||||2933|2727.69|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2933||||2933|1759.8|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2933||||2933|1647.98|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2933||||2933|2933|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2933||||2933|751.17|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2933||||2933|2041.74|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2933||||2933|1542.65|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MULTIPLAN [1680]|HMA [168003]|2933||||2933|2268.6|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MULTIPLAN [1680]|IHC HS [168011]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2933||||2933|808.39|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2933||||2933|1647.98|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|Self-pay|Self-pay|2933||||2933|879.9|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2933||||2933|615.93|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2933||||2933|1482.15|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2933||||2933|2208.11|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|TRUSTMARK [2030]|STARMARK [203000]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2933||||2933|1406.37|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|UMR [2035]|UMR OPTIONS [203501]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2933||||2933|715.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2933||||2933|2639.7|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2933||||2933|0|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2933||||2933|2024.62|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2933||||2933|1512.4|2933|615.93
36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2933||||2933|1466.5|2933|615.93
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2166||||2166|0|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2166||||2166|1542.65|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2166||||2166|777.77|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2166||||2166|777.77|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2166||||2166|1498.17|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2166||||2166|1085.17|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2166||||2166|760.27|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2166||||2166|931.38|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2166||||2166|922.72|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2166||||2166|1083|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2166||||2166|1407.9|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|CORESOURCE [1315]|CORESOURCE [131500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2166||||2166|1422.2|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2166||||2166|2024.62|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|GEHA [1415]|GEHA [141500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2166||||2166|2166|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HEALTHNET [1495]|HEALTHNET [149500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2166||||2166|931.38|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2166||||2166|2014.38|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2166||||2166|1299.6|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2166||||2166|1647.98|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2166||||2166|2166|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2166||||2166|751.17|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2166||||2166|2041.74|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2166||||2166|1542.65|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MULTIPLAN [1680]|HMA [168003]|2166||||2166|2166|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MULTIPLAN [1680]|IHC HS [168011]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2166||||2166|808.39|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2166||||2166|1647.98|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|Self-pay|Self-pay|2166||||2166|649.8|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2166||||2166|454.86|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2166||||2166|1482.15|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2166||||2166|2166|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|TRUSTMARK [2030]|STARMARK [203000]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2166||||2166|1038.6|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|UMR [2035]|UMR OPTIONS [203501]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2166||||2166|715.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2166||||2166|1949.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2166||||2166|0|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2166||||2166|2024.62|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2166||||2166|1512.4|2166|454.86
36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2166||||2166|1083|2166|454.86
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|AETNA [1015]|AETNA ACO WILCO [101532]|2933||||2933|0|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2933||||2933|768.56|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2933||||2933|566.84|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2933||||2933|566.84|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2933||||2933|746.4|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2933||||2933|1469.43|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2933||||2933|1029.48|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2933||||2933|1261.19|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2933||||2933|1249.46|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2933||||2933|1466.5|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2933||||2933|1906.45|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|CORESOURCE [1315]|CORESOURCE [131500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2933||||2933|1925.81|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2933||||2933|1021.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|GEHA [1415]|GEHA [141500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2933||||2933|1695.36|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HEALTHNET [1495]|HEALTHNET [149500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2933||||2933|1261.19|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2933||||2933|2727.69|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2933||||2933|1759.8|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2933||||2933|821.04|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2933||||2933|1820.3|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2933||||2933|547.44|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2933||||2933|1017.21|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2933||||2933|768.56|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MULTIPLAN [1680]|HMA [168003]|2933||||2933|1130.24|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MULTIPLAN [1680]|IHC HS [168011]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2933||||2933|589.16|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2933||||2933|821.04|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|Self-pay|Self-pay|2933||||2933|879.9|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2933||||2933|615.93|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2933||||2933|738.42|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2933||||2933|1100.1|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|TRUSTMARK [2030]|STARMARK [203000]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2933||||2933|1406.37|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|UMR [2035]|UMR OPTIONS [203501]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2933||||2933|521.38|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2933||||2933|2639.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2933||||2933|0|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2933||||2933|1021.7|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2933||||2933|753.49|2727.69|521.38
36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2933||||2933|1466.5|2727.69|521.38
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1440||||1440|0|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1440||||1440|768.56|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1440||||1440|566.84|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1440||||1440|566.84|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1440||||1440|746.4|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1440||||1440|721.44|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1440||||1440|505.44|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1440||||1440|619.2|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1440||||1440|613.44|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1440||||1440|720|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1440||||1440|936|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|CORESOURCE [1315]|CORESOURCE [131500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1440||||1440|945.5|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1440||||1440|1021.7|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|GEHA [1415]|GEHA [141500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1440||||1440|1440|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HEALTHNET [1495]|HEALTHNET [149500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1440||||1440|619.2|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1440||||1440|1339.2|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1440||||1440|864|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1440||||1440|821.04|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1440||||1440|1440|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1440||||1440|547.44|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1440||||1440|1017.21|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1440||||1440|768.56|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MULTIPLAN [1680]|HMA [168003]|1440||||1440|1130.24|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MULTIPLAN [1680]|IHC HS [168011]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1440||||1440|589.16|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1440||||1440|821.04|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|Self-pay|Self-pay|1440||||1440|432|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1440||||1440|302.4|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1440||||1440|738.42|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1440||||1440|1100.1|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|TRUSTMARK [2030]|STARMARK [203000]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1440||||1440|690.48|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|UMR [2035]|UMR OPTIONS [203501]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1440||||1440|521.38|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1440||||1440|1296|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1440||||1440|0|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1440||||1440|1021.7|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1440||||1440|753.49|1440|302.4
36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1440||||1440|720|1440|302.4
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|AETNA [1015]|AETNA ACO WILCO [101532]|1497||||1497|0|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1497||||1497|768.56|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1497||||1497|566.84|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1497||||1497|566.84|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1497||||1497|746.4|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1497||||1497|750|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1497||||1497|525.45|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1497||||1497|643.71|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1497||||1497|637.72|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1497||||1497|748.5|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1497||||1497|973.05|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|CORESOURCE [1315]|CORESOURCE [131500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1497||||1497|982.93|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1497||||1497|1021.7|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|GEHA [1415]|GEHA [141500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1497||||1497|1497|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HEALTHNET [1495]|HEALTHNET [149500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1497||||1497|643.71|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1497||||1497|1392.21|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1497||||1497|898.2|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1497||||1497|821.04|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1497||||1497|1497|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1497||||1497|547.44|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1497||||1497|1017.21|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1497||||1497|768.56|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MULTIPLAN [1680]|HMA [168003]|1497||||1497|1130.24|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MULTIPLAN [1680]|IHC HS [168011]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1497||||1497|589.16|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1497||||1497|821.04|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|Self-pay|Self-pay|1497||||1497|449.1|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1497||||1497|314.37|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1497||||1497|738.42|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1497||||1497|1100.1|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|TRUSTMARK [2030]|STARMARK [203000]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1497||||1497|717.81|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|UMR [2035]|UMR OPTIONS [203501]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1497||||1497|521.38|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1497||||1497|1347.3|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1497||||1497|0|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1497||||1497|1021.7|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1497||||1497|753.49|1497|314.37
36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1497||||1497|748.5|1497|314.37
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1268||||1268|0|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1268||||1268|635.27|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1268||||1268|445.07|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1268||||1268|545.24|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1268||||1268|540.17|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1268||||1268|634|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1268||||1268|824.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1268||||1268|832.57|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|GEHA [1415]|GEHA [141500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1268||||1268|545.24|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1268||||1268|1179.24|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1268||||1268|760.8|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1268||||1268|1268|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MULTIPLAN [1680]|HMA [168003]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|Self-pay|Self-pay|1268||||1268|380.4|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1268||||1268|266.28|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1268||||1268|608.01|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|UMR [2035]|UMR OPTIONS [203501]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1268||||1268|1141.2|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1268||||1268|0|1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1268||||1268||1268|266.28
36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1268||||1268|634|1268|266.28
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|AETNA [1015]|AETNA ACO WILCO [101532]|924||||924|0|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|924||||924|218.46|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|924||||924|199.11|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|924||||924|199.11|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|924||||924|212.16|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|924||||924|462.92|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|924||||924|324.32|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|924||||924|397.32|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|924||||924|393.62|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|924||||924|462|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|924||||924|600.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|CORESOURCE [1315]|CORESOURCE [131500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|924||||924|606.7|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|924||||924|302.95|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|GEHA [1415]|GEHA [141500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|924||||924|481.9|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HEALTHNET [1495]|HEALTHNET [149500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|924||||924|397.32|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|924||||924|859.32|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|924||||924|554.4|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|924||||924|233.38|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|924||||924|551.1|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|924||||924|192.32|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|924||||924|289.14|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|924||||924|218.46|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MULTIPLAN [1680]|HMA [168003]|924||||924|321.27|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MULTIPLAN [1680]|IHC HS [168011]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|924||||924|206.95|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|924||||924|233.38|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|Self-pay|Self-pay|924||||924|277.2|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|924||||924|194.04|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|924||||924|209.89|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|924||||924|312.7|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|TRUSTMARK [2030]|STARMARK [203000]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|924||||924|443.06|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|UMR [2035]|UMR OPTIONS [203501]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|924||||924|183.15|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|924||||924|831.6|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|924||||924|0|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|924||||924|302.95|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|924||||924|214.18|859.32|183.15
36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|924||||924|462|859.32|183.15
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5568||||5568|0|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5568||||5568|1335.69|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5568||||5568|859.62|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5568||||5568|859.62|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5568||||5568|1297.17|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5568||||5568|2789.57|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5568||||5568|1954.37|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5568||||5568|2394.24|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5568||||5568|2371.97|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5568||||5568|2784|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5568||||5568|3619.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|CORESOURCE [1315]|CORESOURCE [131500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5568||||5568|3655.95|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5568||||5568|1784.38|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|GEHA [1415]|GEHA [141500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5568||||5568|2946.37|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HEALTHNET [1495]|HEALTHNET [149500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5568||||5568|2394.24|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5568||||5568|5178.24|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5568||||5568|3340.8|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5568||||5568|1426.89|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5568||||5568|3287.78|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5568||||5568|830.21|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5568||||5568|1767.82|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5568||||5568|1335.69|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MULTIPLAN [1680]|HMA [168003]|5568||||5568|1964.25|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MULTIPLAN [1680]|IHC HS [168011]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5568||||5568|893.47|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5568||||5568|1426.89|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|Self-pay|Self-pay|5568||||5568|1670.4|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5568||||5568|1169.28|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5568||||5568|1283.31|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5568||||5568|1911.87|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|TRUSTMARK [2030]|STARMARK [203000]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5568||||5568|2669.86|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|UMR [2035]|UMR OPTIONS [203501]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5568||||5568|790.68|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5568||||5568|5011.2|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5568||||5568|0|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5568||||5568|1784.38|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5568||||5568|1309.5|5178.24|790.68
36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5568||||5568|2784|5178.24|790.68
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|4762||||4762|0|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4762||||4762|1702.11|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4762||||4762|1361.5|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4762||||4762|1361.5|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4762||||4762|1653.03|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4762||||4762|2385.76|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4762||||4762|1671.46|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4762||||4762|2047.66|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4762||||4762|2028.61|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4762||||4762|2381|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4762||||4762|3095.3|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4762||||4762|3126.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4762||||4762|2303.02|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|GEHA [1415]|GEHA [141500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4762||||4762|3754.65|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4762||||4762|2047.66|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4762||||4762|4428.66|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4762||||4762|2857.2|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4762||||4762|1818.33|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4762||||4762|4158.42|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4762||||4762|1314.91|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4762||||4762|2252.79|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4762||||4762|1702.11|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MULTIPLAN [1680]|HMA [168003]|4762||||4762|2503.1|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MULTIPLAN [1680]|IHC HS [168011]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4762||||4762|1415.11|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4762||||4762|1818.33|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|Self-pay|Self-pay|4762||||4762|1428.6|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4762||||4762|1000.02|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4762||||4762|1635.36|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4762||||4762|2436.35|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|TRUSTMARK [2030]|STARMARK [203000]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4762||||4762|2283.38|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|UMR [2035]|UMR OPTIONS [203501]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4762||||4762|1252.3|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4762||||4762|4285.8|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4762||||4762|0|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4762||||4762|2303.02|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4762||||4762|1668.73|4428.66|1000.02
36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4762||||4762|2381|4428.66|1000.02
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|AETNA [1015]|AETNA ACO WILCO [101532]|2616||||2616|0|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2616||||2616|634.43|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2616||||2616|634.43|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2616||||2616|1310.62|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2616||||2616|918.22|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2616||||2616|1124.88|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2616||||2616|1114.42|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2616||||2616|1308|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2616||||2616|1700.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|CORESOURCE [1315]|CORESOURCE [131500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2616||||2616|1717.67|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|GEHA [1415]|GEHA [141500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HEALTHNET [1495]|HEALTHNET [149500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2616||||2616|1124.88|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2616||||2616|2432.88|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2616||||2616|1569.6|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2616||||2616|1343.91|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2616||||2616|612.76|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MULTIPLAN [1680]|HMA [168003]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MULTIPLAN [1680]|IHC HS [168011]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2616||||2616|659.41|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|Self-pay|Self-pay|2616||||2616|784.8|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2616||||2616|549.36|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|TRUSTMARK [2030]|STARMARK [203000]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2616||||2616|1254.37|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|UMR [2035]|UMR OPTIONS [203501]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2616||||2616|583.56|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2616||||2616|2354.4|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2616||||2616|0|2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2616||||2616||2432.88|549.36
36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2616||||2616|1308|2432.88|549.36
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3413||||3413|0|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3413||||3413|583.78|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3413||||3413|859.62|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3413||||3413|859.62|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3413||||3413|573.42|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3413||||3413|1709.91|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3413||||3413|1197.96|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3413||||3413|1467.59|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3413||||3413|1453.94|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3413||||3413|1706.5|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3413||||3413|2218.45|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|CORESOURCE [1315]|CORESOURCE [131500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3413||||3413|2240.98|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3413||||3413|793.01|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|GEHA [1415]|GEHA [141500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3413||||3413|1287.76|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HEALTHNET [1495]|HEALTHNET [149500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3413||||3413|1467.59|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3413||||3413|3174.09|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3413||||3413|2047.8|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3413||||3413|630.76|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3413||||3413|1384.76|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3413||||3413|830.21|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3413||||3413|772.66|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3413||||3413|583.78|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MULTIPLAN [1680]|HMA [168003]|3413||||3413|858.51|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MULTIPLAN [1680]|IHC HS [168011]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3413||||3413|893.47|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3413||||3413|630.76|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|Self-pay|Self-pay|3413||||3413|1023.9|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3413||||3413|716.73|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3413||||3413|560.89|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3413||||3413|835.61|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|TRUSTMARK [2030]|STARMARK [203000]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3413||||3413|1636.53|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|UMR [2035]|UMR OPTIONS [203501]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3413||||3413|790.68|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3413||||3413|3071.7|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3413||||3413|0|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3413||||3413|793.01|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3413||||3413|572.34|3174.09|560.89
36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3413||||3413|1706.5|3174.09|560.89
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|AETNA [1015]|AETNA ACO WILCO [101532]|4330||||4330|0|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4330||||4330|545.64|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4330||||4330|691.93|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4330||||4330|691.93|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4330||||4330|529.9|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4330||||4330|2169.33|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4330||||4330|1519.83|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4330||||4330|1861.9|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4330||||4330|1844.58|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4330||||4330|2165|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4330||||4330|2814.5|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|CORESOURCE [1315]|CORESOURCE [131500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4330||||4330|2843.08|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4330||||4330|723.49|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|GEHA [1415]|GEHA [141500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4330||||4330|1203.61|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HEALTHNET [1495]|HEALTHNET [149500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4330||||4330|1861.9|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4330||||4330|4026.9|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4330||||4330|2598|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4330||||4330|582.89|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4330||||4330|1343.91|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4330||||4330|668.3|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4330||||4330|722.17|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4330||||4330|545.64|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MULTIPLAN [1680]|HMA [168003]|4330||||4330|802.41|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MULTIPLAN [1680]|IHC HS [168011]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4330||||4330|719.17|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4330||||4330|582.89|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|Self-pay|Self-pay|4330||||4330|1299|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4330||||4330|909.3|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4330||||4330|524.24|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4330||||4330|781.01|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|TRUSTMARK [2030]|STARMARK [203000]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4330||||4330|2076.24|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|UMR [2035]|UMR OPTIONS [203501]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4330||||4330|636.46|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4330||||4330|3897|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4330||||4330|0|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4330||||4330|723.49|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4330||||4330|534.94|4026.9|524.24
36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4330||||4330|2165|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|AETNA [1015]|AETNA ACO WILCO [101532]|4330||||4330|0|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4330||||4330|545.64|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4330||||4330|691.93|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4330||||4330|691.93|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4330||||4330|529.9|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4330||||4330|2169.33|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4330||||4330|1519.83|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4330||||4330|1861.9|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4330||||4330|1844.58|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4330||||4330|2165|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4330||||4330|2814.5|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|CORESOURCE [1315]|CORESOURCE [131500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4330||||4330|2843.08|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4330||||4330|723.49|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|GEHA [1415]|GEHA [141500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4330||||4330|1203.61|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HEALTHNET [1495]|HEALTHNET [149500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4330||||4330|1861.9|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4330||||4330|4026.9|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4330||||4330|2598|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4330||||4330|582.89|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4330||||4330|1343.91|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4330||||4330|668.3|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4330||||4330|722.17|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4330||||4330|545.64|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MULTIPLAN [1680]|HMA [168003]|4330||||4330|802.41|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MULTIPLAN [1680]|IHC HS [168011]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4330||||4330|719.17|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4330||||4330|582.89|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|Self-pay|Self-pay|4330||||4330|1299|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4330||||4330|909.3|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4330||||4330|524.24|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4330||||4330|781.01|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|TRUSTMARK [2030]|STARMARK [203000]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4330||||4330|2076.24|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|UMR [2035]|UMR OPTIONS [203501]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4330||||4330|636.46|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4330||||4330|3897|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4330||||4330|0|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4330||||4330|723.49|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4330||||4330|534.94|4026.9|524.24
36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4330||||4330|2165|4026.9|524.24
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|AETNA [1015]|AETNA ACO WILCO [101532]|8758||||8758|0|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8758||||8758|1702.11|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8758||||8758|1987.37|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8758||||8758|1987.37|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8758||||8758|1653.03|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8758||||8758|4387.76|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8758||||8758|3074.06|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8758||||8758|3765.94|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8758||||8758|3730.91|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8758||||8758|4379|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8758||||8758|5692.7|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|CORESOURCE [1315]|CORESOURCE [131500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8758||||8758|5750.5|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8758||||8758|2303.02|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|GEHA [1415]|GEHA [141500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8758||||8758|3754.65|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HEALTHNET [1495]|HEALTHNET [149500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8758||||8758|3765.94|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8758||||8758|8144.94|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8758||||8758|5254.8|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8758||||8758|1818.33|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8758||||8758|4158.42|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8758||||8758|1919.38|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8758||||8758|2252.79|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8758||||8758|1702.11|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MULTIPLAN [1680]|HMA [168003]|8758||||8758|2503.1|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MULTIPLAN [1680]|IHC HS [168011]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8758||||8758|2065.62|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8758||||8758|1818.33|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|Self-pay|Self-pay|8758||||8758|2627.4|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8758||||8758|1839.18|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8758||||8758|1635.36|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8758||||8758|2436.35|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|TRUSTMARK [2030]|STARMARK [203000]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8758||||8758|4199.46|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|UMR [2035]|UMR OPTIONS [203501]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8758||||8758|1827.99|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8758||||8758|7882.2|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8758||||8758|0|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8758||||8758|2303.02|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8758||||8758|1668.73|8144.94|1635.36
36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8758||||8758|4379|8144.94|1635.36
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|AETNA [1015]|AETNA ACO WILCO [101532]|8758||||8758|0|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8758||||8758|2920.41|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8758||||8758|1987.37|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8758||||8758|1987.37|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8758||||8758|2836.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8758||||8758|4387.76|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8758||||8758|3074.06|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8758||||8758|3765.94|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8758||||8758|3730.91|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8758||||8758|4379|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8758||||8758|5692.7|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|CORESOURCE [1315]|CORESOURCE [131500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8758||||8758|5750.5|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8758||||8758|3924.1|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|GEHA [1415]|GEHA [141500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8758||||8758|6442.08|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HEALTHNET [1495]|HEALTHNET [149500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8758||||8758|3765.94|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8758||||8758|8144.94|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8758||||8758|5254.8|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8758||||8758|3119.82|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8758||||8758|4158.42|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8758||||8758|1919.38|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8758||||8758|3865.25|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8758||||8758|2920.41|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MULTIPLAN [1680]|HMA [168003]|8758||||8758|4294.72|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MULTIPLAN [1680]|IHC HS [168011]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8758||||8758|2065.62|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8758||||8758|3119.82|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|Self-pay|Self-pay|8758||||8758|2627.4|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8758||||8758|1839.18|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8758||||8758|2805.89|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8758||||8758|4180.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|TRUSTMARK [2030]|STARMARK [203000]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8758||||8758|4199.46|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|UMR [2035]|UMR OPTIONS [203501]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8758||||8758|1827.99|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8758||||8758|7882.2|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8758||||8758|0|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8758||||8758|3924.1|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8758||||8758|2863.15|8144.94|1827.99
36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8758||||8758|4379|8144.94|1827.99
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|6831||||6831|0|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6831||||6831|1702.11|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6831||||6831|691.93|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6831||||6831|691.93|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6831||||6831|1653.03|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6831||||6831|3422.33|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6831||||6831|2397.68|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6831||||6831|2937.33|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6831||||6831|2910.01|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6831||||6831|3415.5|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6831||||6831|4440.15|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6831||||6831|4485.23|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6831||||6831|2303.02|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|GEHA [1415]|GEHA [141500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6831||||6831|3754.65|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6831||||6831|2937.33|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6831||||6831|6352.83|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6831||||6831|4098.6|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6831||||6831|1818.33|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6831||||6831|4158.42|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6831||||6831|668.26|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6831||||6831|2252.79|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6831||||6831|1702.11|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MULTIPLAN [1680]|HMA [168003]|6831||||6831|2503.1|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MULTIPLAN [1680]|IHC HS [168011]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6831||||6831|719.17|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6831||||6831|1818.33|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|Self-pay|Self-pay|6831||||6831|2049.3|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6831||||6831|1434.51|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6831||||6831|1635.36|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6831||||6831|2436.35|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|TRUSTMARK [2030]|STARMARK [203000]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6831||||6831|3275.46|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|UMR [2035]|UMR OPTIONS [203501]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6831||||6831|636.44|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6831||||6831|6147.9|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6831||||6831|0|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6831||||6831|2303.02|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6831||||6831|1668.73|6352.83|636.44
36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6831||||6831|3415.5|6352.83|636.44
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|AETNA [1015]|AETNA ACO WILCO [101532]|13049||||13049|0|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13049||||13049|6537.55|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13049||||13049|4580.2|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13049||||13049|5611.07|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13049||||13049|5558.87|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13049||||13049|6524.5|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13049||||13049|8481.85|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|CORESOURCE [1315]|CORESOURCE [131500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13049||||13049|8567.97|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|GEHA [1415]|GEHA [141500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HEALTHNET [1495]|HEALTHNET [149500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13049||||13049|5611.07|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13049||||13049|12135.57|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13049||||13049|7829.4|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13049||||13049|4158.42|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13049||||13049|0|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MULTIPLAN [1680]|HMA [168003]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MULTIPLAN [1680]|IHC HS [168011]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|Self-pay|Self-pay|13049||||13049|3914.7|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13049||||13049|2740.29|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|TRUSTMARK [2030]|STARMARK [203000]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13049||||13049|6257|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|UMR [2035]|UMR OPTIONS [203501]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13049||||13049|0|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13049||||13049|11744.1|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13049||||13049|0|12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13049||||13049||12135.57|2740.29
36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13049||||13049|6524.5|12135.57|2740.29
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|AETNA [1015]|AETNA ACO WILCO [101532]|14353||||14353|0|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14353||||14353|7190.85|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14353||||14353|5037.9|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14353||||14353|6171.79|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14353||||14353|6114.38|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14353||||14353|7176.5|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14353||||14353|9329.45|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|CORESOURCE [1315]|CORESOURCE [131500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14353||||14353|9424.18|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|GEHA [1415]|GEHA [141500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HEALTHNET [1495]|HEALTHNET [149500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14353||||14353|6171.79|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14353||||14353|13348.29|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14353||||14353|8611.8|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14353||||14353|6995.9|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14353||||14353|0|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MULTIPLAN [1680]|HMA [168003]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MULTIPLAN [1680]|IHC HS [168011]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|Self-pay|Self-pay|14353||||14353|4305.9|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14353||||14353|3014.13|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|TRUSTMARK [2030]|STARMARK [203000]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14353||||14353|6882.26|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|UMR [2035]|UMR OPTIONS [203501]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14353||||14353|0|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14353||||14353|12917.7|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14353||||14353|0|13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14353||||14353||13348.29|3014.13
36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14353||||14353|7176.5|13348.29|3014.13
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|AETNA [1015]|AETNA ACO WILCO [101532]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|705||||705|353.21|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|705||||705|247.46|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|705||||705|303.15|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|705||||705|300.33|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|705||||705|352.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|705||||705|458.25|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|CORESOURCE [1315]|CORESOURCE [131500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|705||||705|462.9|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|705||||705|312.55|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|GEHA [1415]|GEHA [141500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HEALTHNET [1495]|HEALTHNET [149500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|705||||705|303.15|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|705||||705|655.65|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|705||||705|423|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|705||||705|352.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MULTIPLAN [1680]|HMA [168003]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MULTIPLAN [1680]|IHC HS [168011]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|Self-pay|Self-pay|705||||705|211.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|705||||705|148.05|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|TRUSTMARK [2030]|STARMARK [203000]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|705||||705|338.05|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|UMR [2035]|UMR OPTIONS [203501]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|705||||705|634.5|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|705||||705|0|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|705||||705|312.55|655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|705||||705||655.65|148.05
36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|705||||705|352.5|655.65|148.05
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|AETNA [1015]|AETNA ACO WILCO [101532]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|576||||576|288.58|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|576||||576|202.18|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|576||||576|247.68|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|576||||576|245.38|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|576||||576|288|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|576||||576|374.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|CORESOURCE [1315]|CORESOURCE [131500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|576||||576|378.2|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|576||||576|258.64|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|GEHA [1415]|GEHA [141500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HEALTHNET [1495]|HEALTHNET [149500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|576||||576|247.68|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|576||||576|535.68|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|576||||576|345.6|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|576||||576|288|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MULTIPLAN [1680]|HMA [168003]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MULTIPLAN [1680]|IHC HS [168011]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|Self-pay|Self-pay|576||||576|172.8|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|576||||576|120.96|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|TRUSTMARK [2030]|STARMARK [203000]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|576||||576|276.19|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|UMR [2035]|UMR OPTIONS [203501]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|576||||576|518.4|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|576||||576|0|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|576||||576|258.64|535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|576||||576||535.68|120.96
36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|576||||576|288|535.68|120.96
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|AETNA [1015]|AETNA ACO WILCO [101532]|9886||||9886|0|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9886||||9886|2920.41|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9886||||9886|2959.76|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9886||||9886|2959.76|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9886||||9886|2836.2|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9886||||9886|4952.89|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9886||||9886|3469.99|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9886||||9886|4250.98|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9886||||9886|4211.44|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9886||||9886|4943|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9886||||9886|6425.9|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|CORESOURCE [1315]|CORESOURCE [131500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9886||||9886|6491.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9886||||9886|3924.1|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|GEHA [1415]|GEHA [141500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9886||||9886|6442.08|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HEALTHNET [1495]|HEALTHNET [149500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9886||||9886|4250.98|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9886||||9886|9193.98|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9886||||9886|5931.6|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9886||||9886|3119.82|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9886||||9886|4158.42|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9886||||9886|2858.5|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9886||||9886|3865.25|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9886||||9886|2920.41|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MULTIPLAN [1680]|HMA [168003]|9886||||9886|4294.72|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MULTIPLAN [1680]|IHC HS [168011]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9886||||9886|3076.3|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9886||||9886|3119.82|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|Self-pay|Self-pay|9886||||9886|2965.8|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9886||||9886|2076.06|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9886||||9886|2805.89|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9886||||9886|4180.2|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|TRUSTMARK [2030]|STARMARK [203000]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9886||||9886|4740.34|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|UMR [2035]|UMR OPTIONS [203501]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9886||||9886|2722.39|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9886||||9886|8897.4|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9886||||9886|0|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9886||||9886|3924.1|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9886||||9886|2863.15|9193.98|2076.06
36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9886||||9886|4943|9193.98|2076.06
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|12477||||12477|0|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12477||||12477|1702.11|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12477||||12477|1780.7|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12477||||12477|1780.7|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12477||||12477|1653.03|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12477||||12477|6250.98|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12477||||12477|4379.43|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12477||||12477|5365.11|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12477||||12477|5315.2|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12477||||12477|6238.5|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12477||||12477|8110.05|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|CORESOURCE [1315]|CORESOURCE [131500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|12477||||12477|8192.4|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12477||||12477|2303.02|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|GEHA [1415]|GEHA [141500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12477||||12477|3754.65|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HEALTHNET [1495]|HEALTHNET [149500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12477||||12477|5365.11|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|12477||||12477|11603.61|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12477||||12477|7486.2|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12477||||12477|1818.33|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12477||||12477|4158.42|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12477||||12477|1719.78|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12477||||12477|2252.79|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12477||||12477|1702.11|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MULTIPLAN [1680]|HMA [168003]|12477||||12477|2503.1|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MULTIPLAN [1680]|IHC HS [168011]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|12477||||12477|1850.82|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12477||||12477|1818.33|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|Self-pay|Self-pay|12477||||12477|3743.1|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12477||||12477|2620.17|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12477||||12477|1635.36|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12477||||12477|2436.35|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|TRUSTMARK [2030]|STARMARK [203000]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12477||||12477|5982.72|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|UMR [2035]|UMR OPTIONS [203501]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12477||||12477|1637.89|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12477||||12477|11229.3|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12477||||12477|0|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12477||||12477|2303.02|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12477||||12477|1668.73|11603.61|1635.36
36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12477||||12477|6238.5|11603.61|1635.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|AETNA [1015]|AETNA ACO WILCO [101532]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1416||||1416|709.42|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1416||||1416|497.02|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1416||||1416|608.88|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1416||||1416|603.22|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1416||||1416|708|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1416||||1416|920.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|CORESOURCE [1315]|CORESOURCE [131500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1416||||1416|929.75|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1416||||1416|501.81|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|GEHA [1415]|GEHA [141500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HEALTHNET [1495]|HEALTHNET [149500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1416||||1416|608.88|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1416||||1416|1316.88|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1416||||1416|849.6|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1416||||1416|708|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MULTIPLAN [1680]|HMA [168003]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MULTIPLAN [1680]|IHC HS [168011]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|Self-pay|Self-pay|1416||||1416|424.8|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1416||||1416|297.36|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|TRUSTMARK [2030]|STARMARK [203000]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1416||||1416|678.97|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|UMR [2035]|UMR OPTIONS [203501]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1416||||1416|1274.4|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1416||||1416|0|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1416||||1416|501.81|1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1416||||1416||1316.88|297.36
36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1416||||1416|708|1316.88|297.36
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|AETNA [1015]|AETNA ACO WILCO [101532]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|588||||588|294.59|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|588||||588|206.39|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|588||||588|252.84|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|588||||588|250.49|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|588||||588|294|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|588||||588|382.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|CORESOURCE [1315]|CORESOURCE [131500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|CORVEL CORP [2235]|CORVEL CORP [223500]|588||||588|386.08|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|588||||588|289.25|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|GEHA [1415]|GEHA [141500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HEALTHNET [1495]|HEALTHNET [149500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|588||||588|252.84|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HEALTHSMART [1505]|HEALTHSMART [150501]|588||||588|546.84|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|588||||588|352.8|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|588||||588|294|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MULTIPLAN [1680]|HMA [168003]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MULTIPLAN [1680]|IHC HS [168011]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|Self-pay|Self-pay|588||||588|176.4|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|588||||588|123.48|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|TRUSTMARK [2030]|STARMARK [203000]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|588||||588|281.95|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|UMR [2035]|UMR OPTIONS [203501]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|588||||588|529.2|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|588||||588|0|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|588||||588|289.25|546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|588||||588||546.84|123.48
36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|588||||588|294|546.84|123.48
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1009||||1009|1009|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1009||||1009|106.28|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1009||||1009|173.73|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1009||||1009|173.73|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1009||||1009|103.21|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1009||||1009|505.51|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1009||||1009|354.16|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1009||||1009|433.87|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1009||||1009|429.83|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1009||||1009|504.5|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1009||||1009|655.85|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|CORESOURCE [1315]|CORESOURCE [131500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1009||||1009|662.51|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1009||||1009|141.74|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|GEHA [1415]|GEHA [141500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1009||||1009|234.43|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HEALTHNET [1495]|HEALTHNET [149500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1009||||1009|433.87|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1009||||1009|938.37|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1009||||1009|605.4|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1009||||1009|113.53|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1009||||1009|254.52|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1009||||1009|167.79|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1009||||1009|140.66|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1009||||1009|106.28|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MULTIPLAN [1680]|HMA [168003]|1009||||1009|156.29|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MULTIPLAN [1680]|IHC HS [168011]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1009||||1009|180.57|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1009||||1009|113.53|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|Self-pay|Self-pay|1009||||1009|302.7|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1009||||1009|211.89|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1009||||1009|102.11|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1009||||1009|152.12|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|TRUSTMARK [2030]|STARMARK [203000]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1009||||1009|483.82|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|UMR [2035]|UMR OPTIONS [203501]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1009||||1009|159.8|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1009||||1009|908.1|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1009||||1009|0|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1009||||1009|141.74|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1009||||1009|104.19|1009|102.11
36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1009||||1009|504.5|1009|102.11
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2254||||2254|0|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2254||||2254|252.65|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2254||||2254|179.58|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2254||||2254|179.58|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2254||||2254|245.37|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2254||||2254|1129.25|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2254||||2254|791.15|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2254||||2254|969.22|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2254||||2254|960.2|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2254||||2254|1127|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2254||||2254|1465.1|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|CORESOURCE [1315]|CORESOURCE [131500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2254||||2254|1479.98|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2254||||2254|305.37|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|GEHA [1415]|GEHA [141500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2254||||2254|557.32|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HEALTHNET [1495]|HEALTHNET [149500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2254||||2254|969.22|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2254||||2254|2096.22|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2254||||2254|1352.4|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2254||||2254|269.9|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2254||||2254|553.15|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2254||||2254|173.43|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2254||||2254|334.39|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2254||||2254|252.65|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MULTIPLAN [1680]|HMA [168003]|2254||||2254|371.55|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MULTIPLAN [1680]|IHC HS [168011]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2254||||2254|186.65|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2254||||2254|269.9|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|Self-pay|Self-pay|2254||||2254|676.2|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2254||||2254|473.34|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2254||||2254|242.75|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2254||||2254|361.64|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|TRUSTMARK [2030]|STARMARK [203000]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2254||||2254|1080.79|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|UMR [2035]|UMR OPTIONS [203501]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2254||||2254|165.18|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2254||||2254|2028.6|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2254||||2254|0|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2254||||2254|305.37|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2254||||2254|247.7|2096.22|165.18
36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE SIMPLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2254||||2254|1127|2096.22|165.18
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|AETNA [1015]|AETNA ACO WILCO [101532]|2478||||2478|0|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2478||||2478|545.64|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2478||||2478|566.84|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2478||||2478|566.84|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2478||||2478|529.9|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2478||||2478|1241.48|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2478||||2478|869.78|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2478||||2478|1065.54|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2478||||2478|1055.63|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2478||||2478|1239|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2478||||2478|1610.7|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|CORESOURCE [1315]|CORESOURCE [131500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2478||||2478|1627.05|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2478||||2478|723.49|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|GEHA [1415]|GEHA [141500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2478||||2478|1203.61|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HEALTHNET [1495]|HEALTHNET [149500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2478||||2478|1065.54|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2478||||2478|2304.54|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2478||||2478|1486.8|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2478||||2478|582.89|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2478||||2478|1343.91|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2478||||2478|547.44|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2478||||2478|722.17|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2478||||2478|545.64|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MULTIPLAN [1680]|HMA [168003]|2478||||2478|802.41|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MULTIPLAN [1680]|IHC HS [168011]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2478||||2478|589.16|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2478||||2478|582.89|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|Self-pay|Self-pay|2478||||2478|743.4|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2478||||2478|520.38|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2478||||2478|524.24|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2478||||2478|781.01|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|TRUSTMARK [2030]|STARMARK [203000]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2478||||2478|1188.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|UMR [2035]|UMR OPTIONS [203501]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2478||||2478|521.38|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2478||||2478|2230.2|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2478||||2478|0|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2478||||2478|723.49|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2478||||2478|534.94|2304.54|520.38
36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2478||||2478|1239|2304.54|520.38
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|273||||273|0|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273||||273|52.24|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273||||273|69.06|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273||||273|69.06|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273||||273|51.31|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|273||||273|136.77|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273||||273|95.82|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273||||273|117.39|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|273||||273|116.3|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|273||||273|136.5|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273||||273|177.45|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|CORESOURCE [1315]|CORESOURCE [131500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|273||||273|0|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|273||||273|0|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|GEHA [1415]|GEHA [141500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|273||||273|115.23|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HEALTHNET [1495]|HEALTHNET [149500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273||||273|117.39|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|273||||273|253.89|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273||||273|163.8|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273||||273|56.44|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273||||273|133.61|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273||||273|66.71|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273||||273|69.14|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273||||273|52.24|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MULTIPLAN [1680]|HMA [168003]|273||||273|76.82|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MULTIPLAN [1680]|IHC HS [168011]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|273||||273|71.78|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273||||273|56.44|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|Self-pay|Self-pay|273||||273|81.9|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273||||273|57.33|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|273||||273|50.19|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273||||273|74.77|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|TRUSTMARK [2030]|STARMARK [203000]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273||||273|130.9|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|UMR [2035]|UMR OPTIONS [203501]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273||||273|63.53|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273||||273|245.7|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|273||||273|0|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|273||||273|0|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|273||||273|51.21|253.89|50.19
36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|273||||273|136.5|253.89|50.19
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|5302||||5302|0|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5302||||5302|1702.11|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5302||||5302|1105.47|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5302||||5302|1105.47|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5302||||5302|1653.03|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5302||||5302|2656.3|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5302||||5302|1861|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5302||||5302|2279.86|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5302||||5302|2258.65|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5302||||5302|2651|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5302||||5302|3446.3|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|CORESOURCE [1315]|CORESOURCE [131500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5302||||5302|3481.29|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5302||||5302|2303.02|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|GEHA [1415]|GEHA [141500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5302||||5302|3754.65|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HEALTHNET [1495]|HEALTHNET [149500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5302||||5302|2279.86|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5302||||5302|4930.86|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5302||||5302|3181.2|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5302||||5302|1818.33|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5302||||5302|4158.42|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5302||||5302|1067.65|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5302||||5302|2252.79|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5302||||5302|1702.11|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MULTIPLAN [1680]|HMA [168003]|5302||||5302|2503.1|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MULTIPLAN [1680]|IHC HS [168011]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5302||||5302|1149|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5302||||5302|1818.33|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|Self-pay|Self-pay|5302||||5302|1590.6|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5302||||5302|1113.42|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5302||||5302|1635.36|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5302||||5302|2436.35|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|TRUSTMARK [2030]|STARMARK [203000]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5302||||5302|2542.31|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|UMR [2035]|UMR OPTIONS [203501]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5302||||5302|1016.81|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5302||||5302|4771.8|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5302||||5302|0|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5302||||5302|2303.02|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5302||||5302|1668.73|4930.86|1016.81
36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5302||||5302|2651|4930.86|1016.81
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|AETNA [1015]|AETNA ACO WILCO [101532]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|784||||784|392.78|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784||||784|275.18|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784||||784|337.12|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|784||||784|333.98|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|784||||784|392|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784||||784|509.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|CORESOURCE [1315]|CORESOURCE [131500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|CORVEL CORP [2235]|CORVEL CORP [223500]|784||||784|514.77|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|784||||784|339.64|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|GEHA [1415]|GEHA [141500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HEALTHNET [1495]|HEALTHNET [149500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784||||784|337.12|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HEALTHSMART [1505]|HEALTHSMART [150501]|784||||784|729.12|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784||||784|470.4|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784||||784|392|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MULTIPLAN [1680]|HMA [168003]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MULTIPLAN [1680]|IHC HS [168011]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|Self-pay|Self-pay|784||||784|235.2|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784||||784|164.64|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|TRUSTMARK [2030]|STARMARK [203000]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784||||784|375.93|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|UMR [2035]|UMR OPTIONS [203501]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784||||784|705.6|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|784||||784|0|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|784||||784|339.64|729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|784||||784||729.12|164.64
36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|784||||784|392|729.12|164.64
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1395||||1395|0|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1395||||1395|583.78|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1395||||1395|408.99|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1395||||1395|408.99|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1395||||1395|573.42|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1395||||1395|698.9|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1395||||1395|489.65|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1395||||1395|599.85|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1395||||1395|594.27|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1395||||1395|697.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1395||||1395|906.75|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|CORESOURCE [1315]|CORESOURCE [131500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1395||||1395|915.96|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1395||||1395|793.01|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|GEHA [1415]|GEHA [141500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1395||||1395|1287.76|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HEALTHNET [1495]|HEALTHNET [149500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1395||||1395|599.85|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1395||||1395|1297.35|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1395||||1395|837|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1395||||1395|630.76|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1395||||1395|1384.76|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1395||||1395|394.99|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1395||||1395|772.66|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1395||||1395|583.78|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MULTIPLAN [1680]|HMA [168003]|1395||||1395|858.51|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MULTIPLAN [1680]|IHC HS [168011]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1395||||1395|425.09|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1395||||1395|630.76|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|Self-pay|Self-pay|1395||||1395|418.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1395||||1395|292.95|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1395||||1395|560.89|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1395||||1395|835.61|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|TRUSTMARK [2030]|STARMARK [203000]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1395||||1395|668.9|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|UMR [2035]|UMR OPTIONS [203501]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1395||||1395|376.19|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1395||||1395|1255.5|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1395||||1395|0|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1395||||1395|793.01|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1395||||1395|572.34|1384.76|292.95
36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1395||||1395|697.5|1384.76|292.95
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|AETNA [1015]|AETNA ACO WILCO [101532]|14012||||14012|0|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14012||||14012|4803.94|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14012||||14012|4335.7|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14012||||14012|4335.7|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14012||||14012|4665.42|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14012||||14012|7020.01|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14012||||14012|4918.21|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14012||||14012|6025.16|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14012||||14012|5969.11|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14012||||14012|7006|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14012||||14012|9107.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|CORESOURCE [1315]|CORESOURCE [131500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14012||||14012|9200.28|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14012||||14012|6283.82|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|GEHA [1415]|GEHA [141500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14012||||14012|10596.93|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HEALTHNET [1495]|HEALTHNET [149500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14012||||14012|6025.16|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14012||||14012|13031.16|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14012||||14012|8407.2|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14012||||14012|5131.96|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14012||||14012|10985.17|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14012||||14012|4187.37|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14012||||14012|6358.16|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14012||||14012|4803.94|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MULTIPLAN [1680]|HMA [168003]|14012||||14012|7064.62|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MULTIPLAN [1680]|IHC HS [168011]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14012||||14012|4506.42|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14012||||14012|5131.96|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|Self-pay|Self-pay|14012||||14012|4203.6|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14012||||14012|2942.52|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14012||||14012|4615.55|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14012||||14012|6876.23|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|TRUSTMARK [2030]|STARMARK [203000]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14012||||14012|6718.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|UMR [2035]|UMR OPTIONS [203501]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14012||||14012|3987.98|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14012||||14012|12610.8|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14012||||14012|0|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14012||||14012|6283.82|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14012||||14012|4709.75|13031.16|2942.52
36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14012||||14012|7006|13031.16|2942.52
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|AETNA [1015]|AETNA ACO WILCO [101532]|2126||||2126|0|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2126||||2126|602.42|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2126||||2126|566.84|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2126||||2126|566.84|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2126||||2126|585.05|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2126||||2126|1065.13|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2126||||2126|746.23|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2126||||2126|914.18|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2126||||2126|905.68|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2126||||2126|1063|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2126||||2126|1381.9|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|CORESOURCE [1315]|CORESOURCE [131500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2126||||2126|1395.93|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2126||||2126|812.57|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|GEHA [1415]|GEHA [141500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2126||||2126|1328.88|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HEALTHNET [1495]|HEALTHNET [149500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2126||||2126|914.18|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2126||||2126|1977.18|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2126||||2126|1275.6|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2126||||2126|643.56|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2126||||2126|1431.31|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2126||||2126|547.44|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2126||||2126|797.33|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2126||||2126|602.42|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MULTIPLAN [1680]|HMA [168003]|2126||||2126|885.92|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MULTIPLAN [1680]|IHC HS [168011]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2126||||2126|589.16|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2126||||2126|643.56|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|Self-pay|Self-pay|2126||||2126|637.8|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2126||||2126|446.46|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2126||||2126|578.8|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2126||||2126|862.29|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|TRUSTMARK [2030]|STARMARK [203000]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2126||||2126|1019.42|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|UMR [2035]|UMR OPTIONS [203501]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2126||||2126|521.38|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2126||||2126|1913.4|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2126||||2126|0|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2126||||2126|812.57|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2126||||2126|590.61|1977.18|446.46
36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2126||||2126|1063|1977.18|446.46
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|AETNA [1015]|AETNA ACO WILCO [101532]|32361||||32361|0|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32361||||32361|16212.86|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32361||||32361|11358.71|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32361||||32361|13915.23|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32361||||32361|13785.79|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32361||||32361|16180.5|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32361||||32361|21034.65|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|CORESOURCE [1315]|CORESOURCE [131500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32361||||32361|21248.23|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|GEHA [1415]|GEHA [141500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HEALTHNET [1495]|HEALTHNET [149500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32361||||32361|13915.23|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32361||||32361|30095.73|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32361||||32361|19416.6|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32361||||32361|23111.3|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MULTIPLAN [1680]|HMA [168003]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MULTIPLAN [1680]|IHC HS [168011]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|Self-pay|Self-pay|32361||||32361|9708.3|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32361||||32361|6795.81|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|TRUSTMARK [2030]|STARMARK [203000]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32361||||32361|15517.1|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|UMR [2035]|UMR OPTIONS [203501]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32361||||32361|29124.9|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32361||||32361|0|30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32361||||32361||30095.73|6795.81
36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32361||||32361|16180.5|30095.73|6795.81
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|AETNA [1015]|AETNA ACO WILCO [101532]|1883||||1883|0|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1883||||1883|590.45|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1883||||1883|408.99|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1883||||1883|408.99|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1883||||1883|573.42|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1883||||1883|943.38|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1883||||1883|660.93|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1883||||1883|809.69|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1883||||1883|802.16|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1883||||1883|941.5|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1883||||1883|1223.95|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|CORESOURCE [1315]|CORESOURCE [131500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1883||||1883|1236.38|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1883||||1883|793.01|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|GEHA [1415]|GEHA [141500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1883||||1883|1302.45|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HEALTHNET [1495]|HEALTHNET [149500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1883||||1883|809.69|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1883||||1883|1751.19|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1883||||1883|1129.8|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1883||||1883|630.76|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1883||||1883|1384.76|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1883||||1883|394.99|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1883||||1883|781.47|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1883||||1883|590.45|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MULTIPLAN [1680]|HMA [168003]|1883||||1883|868.3|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MULTIPLAN [1680]|IHC HS [168011]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1883||||1883|425.09|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1883||||1883|630.76|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|Self-pay|Self-pay|1883||||1883|564.9|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1883||||1883|395.43|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1883||||1883|567.29|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1883||||1883|845.15|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|TRUSTMARK [2030]|STARMARK [203000]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1883||||1883|902.9|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|UMR [2035]|UMR OPTIONS [203501]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1883||||1883|376.19|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1883||||1883|1694.7|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1883||||1883|0|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1883||||1883|793.01|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1883||||1883|578.87|1751.19|376.19
36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1883||||1883|941.5|1751.19|376.19
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|3928||||3928|0|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3928||||3928|602.42|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3928||||3928|330.99|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3928||||3928|330.99|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3928||||3928|585.05|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3928||||3928|1967.93|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3928||||3928|1378.73|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3928||||3928|1689.04|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3928||||3928|1673.33|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3928||||3928|1964|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3928||||3928|2553.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3928||||3928|2579.12|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3928||||3928|812.57|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|GEHA [1415]|GEHA [141500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3928||||3928|1328.88|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3928||||3928|1689.04|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3928||||3928|3653.04|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3928||||3928|2356.8|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3928||||3928|643.56|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3928||||3928|1431.31|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3928||||3928|319.66|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3928||||3928|797.33|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3928||||3928|602.42|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MULTIPLAN [1680]|HMA [168003]|3928||||3928|885.92|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MULTIPLAN [1680]|IHC HS [168011]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3928||||3928|344.02|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3928||||3928|643.56|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|Self-pay|Self-pay|3928||||3928|1178.4|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3928||||3928|824.88|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3928||||3928|578.8|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3928||||3928|862.29|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|TRUSTMARK [2030]|STARMARK [203000]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3928||||3928|1883.48|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|UMR [2035]|UMR OPTIONS [203501]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3928||||3928|304.44|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3928||||3928|3535.2|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3928||||3928|0|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3928||||3928|812.57|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3928||||3928|590.61|3653.04|304.44
36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3928||||3928|1964|3653.04|304.44
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1271||||1271|0|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1271||||1271|636.77|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1271||||1271|446.12|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1271||||1271|546.53|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1271||||1271|541.45|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1271||||1271|635.5|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1271||||1271|826.15|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|CORESOURCE [1315]|CORESOURCE [131500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1271||||1271|834.54|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|GEHA [1415]|GEHA [141500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HEALTHNET [1495]|HEALTHNET [149500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1271||||1271|546.53|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1271||||1271|1182.03|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1271||||1271|762.6|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1271||||1271|1271|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MULTIPLAN [1680]|HMA [168003]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MULTIPLAN [1680]|IHC HS [168011]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|Self-pay|Self-pay|1271||||1271|381.3|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1271||||1271|266.91|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|TRUSTMARK [2030]|STARMARK [203000]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1271||||1271|609.44|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|UMR [2035]|UMR OPTIONS [203501]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1271||||1271|1143.9|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1271||||1271|0|1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1271||||1271||1271|266.91
36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1271||||1271|635.5|1271|266.91
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|AETNA [1015]|AETNA ACO WILCO [101532]|6127||||6127|0|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6127||||6127|602.42|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6127||||6127|330.99|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6127||||6127|330.99|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6127||||6127|585.05|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6127||||6127|3069.63|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6127||||6127|2150.58|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6127||||6127|2634.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6127||||6127|2610.1|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6127||||6127|3063.5|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6127||||6127|3982.55|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|CORESOURCE [1315]|CORESOURCE [131500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6127||||6127|4022.99|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6127||||6127|812.57|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|GEHA [1415]|GEHA [141500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6127||||6127|1328.88|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HEALTHNET [1495]|HEALTHNET [149500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6127||||6127|2634.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6127||||6127|5698.11|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6127||||6127|3676.2|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6127||||6127|643.56|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6127||||6127|1431.31|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6127||||6127|319.66|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6127||||6127|797.33|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6127||||6127|602.42|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MULTIPLAN [1680]|HMA [168003]|6127||||6127|885.92|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MULTIPLAN [1680]|IHC HS [168011]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6127||||6127|344.02|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6127||||6127|643.56|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|Self-pay|Self-pay|6127||||6127|1838.1|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6127||||6127|1286.67|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6127||||6127|578.8|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6127||||6127|862.29|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|TRUSTMARK [2030]|STARMARK [203000]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6127||||6127|2937.9|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|UMR [2035]|UMR OPTIONS [203501]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6127||||6127|304.44|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6127||||6127|5514.3|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6127||||6127|0|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6127||||6127|812.57|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6127||||6127|590.61|5698.11|304.44
36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6127||||6127|3063.5|5698.11|304.44
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|AETNA [1015]|AETNA ACO WILCO [101532]|5136||||5136|0|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5136||||5136|602.42|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5136||||5136|668.84|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5136||||5136|668.84|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5136||||5136|585.05|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5136||||5136|2573.14|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5136||||5136|1802.74|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5136||||5136|2208.48|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5136||||5136|2187.94|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5136||||5136|2568|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5136||||5136|3338.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|CORESOURCE [1315]|CORESOURCE [131500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5136||||5136|3372.3|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5136||||5136|812.57|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|GEHA [1415]|GEHA [141500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5136||||5136|1328.88|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HEALTHNET [1495]|HEALTHNET [149500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5136||||5136|2208.48|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5136||||5136|4776.48|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5136||||5136|3081.6|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5136||||5136|643.56|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5136||||5136|1431.31|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5136||||5136|645.97|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5136||||5136|797.33|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5136||||5136|602.42|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MULTIPLAN [1680]|HMA [168003]|5136||||5136|885.92|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MULTIPLAN [1680]|IHC HS [168011]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5136||||5136|695.18|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5136||||5136|643.56|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|Self-pay|Self-pay|5136||||5136|1540.8|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5136||||5136|1078.56|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5136||||5136|578.8|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5136||||5136|862.29|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|TRUSTMARK [2030]|STARMARK [203000]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5136||||5136|2462.71|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|UMR [2035]|UMR OPTIONS [203501]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5136||||5136|615.21|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5136||||5136|4622.4|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5136||||5136|0|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5136||||5136|812.57|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5136||||5136|590.61|4776.48|578.8
36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5136||||5136|2568|4776.48|578.8
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1964||||1964|0|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1964||||1964|596.75|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1964||||1964|668.84|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1964||||1964|668.84|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1964||||1964|983.96|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1964||||1964|689.36|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1964||||1964|844.52|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1964||||1964|836.66|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1964||||1964|982|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1964||||1964|1276.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1964||||1964|1289.56|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1964||||1964|812.57|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|GEHA [1415]|GEHA [141500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1964||||1964|1316.37|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1964||||1964|844.52|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1964||||1964|1826.52|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1964||||1964|1178.4|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1964||||1964|643.56|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1964||||1964|1431.31|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1964||||1964|645.97|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1964||||1964|789.82|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1964||||1964|596.75|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MULTIPLAN [1680]|HMA [168003]|1964||||1964|877.58|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MULTIPLAN [1680]|IHC HS [168011]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1964||||1964|695.18|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1964||||1964|643.56|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|Self-pay|Self-pay|1964||||1964|589.2|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1964||||1964|412.44|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1964||||1964|573.35|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1964||||1964|854.18|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|TRUSTMARK [2030]|STARMARK [203000]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1964||||1964|941.74|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|UMR [2035]|UMR OPTIONS [203501]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1964||||1964|615.21|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1964||||1964|1767.6|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1964||||1964|0|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1964||||1964|812.57|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1964||||1964|585.05|1826.52|412.44
36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1964||||1964|982|1826.52|412.44
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5363||||5363|0|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5363||||5363|602.42|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5363||||5363|668.84|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5363||||5363|668.84|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5363||||5363|585.05|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5363||||5363|2686.86|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5363||||5363|1882.41|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5363||||5363|2306.09|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5363||||5363|2284.64|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5363||||5363|2681.5|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5363||||5363|3485.95|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5363||||5363|3521.35|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5363||||5363|812.57|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|GEHA [1415]|GEHA [141500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5363||||5363|1328.88|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5363||||5363|2306.09|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5363||||5363|4987.59|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5363||||5363|3217.8|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5363||||5363|643.56|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5363||||5363|1431.31|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5363||||5363|645.97|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5363||||5363|797.33|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5363||||5363|602.42|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MULTIPLAN [1680]|HMA [168003]|5363||||5363|885.92|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MULTIPLAN [1680]|IHC HS [168011]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5363||||5363|695.18|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5363||||5363|643.56|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|Self-pay|Self-pay|5363||||5363|1608.9|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5363||||5363|1126.23|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5363||||5363|578.8|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5363||||5363|862.29|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|TRUSTMARK [2030]|STARMARK [203000]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5363||||5363|2571.56|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|UMR [2035]|UMR OPTIONS [203501]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5363||||5363|615.21|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5363||||5363|4826.7|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5363||||5363|0|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5363||||5363|812.57|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5363||||5363|590.61|4987.59|578.8
36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5363||||5363|2681.5|4987.59|578.8
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|AETNA [1015]|AETNA ACO WILCO [101532]|6126||||6126|0|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6126||||6126|596.75|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6126||||6126|668.84|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6126||||6126|668.84|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6126||||6126|3069.13|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6126||||6126|2150.23|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6126||||6126|2634.18|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6126||||6126|2609.68|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6126||||6126|3063|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6126||||6126|3981.9|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|CORESOURCE [1315]|CORESOURCE [131500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6126||||6126|4022.33|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6126||||6126|812.57|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|GEHA [1415]|GEHA [141500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6126||||6126|1316.37|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HEALTHNET [1495]|HEALTHNET [149500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6126||||6126|2634.18|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6126||||6126|5697.18|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6126||||6126|3675.6|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6126||||6126|643.56|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6126||||6126|1431.31|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6126||||6126|645.97|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6126||||6126|789.82|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6126||||6126|596.75|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MULTIPLAN [1680]|HMA [168003]|6126||||6126|877.58|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MULTIPLAN [1680]|IHC HS [168011]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6126||||6126|695.18|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6126||||6126|643.56|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|Self-pay|Self-pay|6126||||6126|1837.8|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6126||||6126|1286.46|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6126||||6126|573.35|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6126||||6126|854.18|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|TRUSTMARK [2030]|STARMARK [203000]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6126||||6126|2937.42|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|UMR [2035]|UMR OPTIONS [203501]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6126||||6126|615.21|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6126||||6126|5513.4|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6126||||6126|0|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6126||||6126|812.57|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6126||||6126|585.05|5697.18|573.35
36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6126||||6126|3063|5697.18|573.35
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5363||||5363|0|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5363||||5363|2686.86|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5363||||5363|1882.41|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5363||||5363|2306.09|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5363||||5363|2284.64|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5363||||5363|2681.5|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5363||||5363|3485.95|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|CORESOURCE [1315]|CORESOURCE [131500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5363||||5363|3521.35|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|GEHA [1415]|GEHA [141500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HEALTHNET [1495]|HEALTHNET [149500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5363||||5363|2306.09|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5363||||5363|4987.59|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5363||||5363|3217.8|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5363||||5363|1828.14|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MULTIPLAN [1680]|HMA [168003]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MULTIPLAN [1680]|IHC HS [168011]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|Self-pay|Self-pay|5363||||5363|1608.9|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5363||||5363|1126.23|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|TRUSTMARK [2030]|STARMARK [203000]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5363||||5363|2571.56|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|UMR [2035]|UMR OPTIONS [203501]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5363||||5363|4826.7|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5363||||5363|0|4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5363||||5363||4987.59|1126.23
36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5363||||5363|2681.5|4987.59|1126.23
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|AETNA [1015]|AETNA ACO WILCO [101532]|51191||||51191|0|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51191||||51191|16168.62|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51191||||51191|17665.88|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51191||||51191|17665.88|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51191||||51191|15702.39|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51191||||51191|25646.69|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51191||||51191|17968.04|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51191||||51191|22012.13|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51191||||51191|21807.37|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51191||||51191|25595.5|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51191||||51191|33274.15|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|CORESOURCE [1315]|CORESOURCE [131500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51191||||51191|33612.01|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51191||||51191|21471.37|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|GEHA [1415]|GEHA [141500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51191||||51191|35666.07|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HEALTHNET [1495]|HEALTHNET [149500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51191||||51191|22012.13|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51191||||51191|47607.63|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51191||||51191|30714.6|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51191||||51191|17272.63|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51191||||51191|38404.89|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51191||||51191|17061.54|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51191||||51191|21399.64|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51191||||51191|16168.62|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MULTIPLAN [1680]|HMA [168003]|51191||||51191|23777.38|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MULTIPLAN [1680]|IHC HS [168011]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51191||||51191|18361.47|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51191||||51191|17272.63|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|Self-pay|Self-pay|51191||||51191|15357.3|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51191||||51191|10750.11|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51191||||51191|15534.56|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51191||||51191|23143.32|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|TRUSTMARK [2030]|STARMARK [203000]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51191||||51191|24546.08|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|UMR [2035]|UMR OPTIONS [203501]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51191||||51191|16249.09|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51191||||51191|46071.9|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51191||||51191|0|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51191||||51191|21471.37|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51191||||51191|15851.59|47607.63|10750.11
36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT/REPLACE INTRATHECAL/EPIDURAL INFUSION P|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51191||||51191|25595.5|47607.63|10750.11
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|AETNA [1015]|AETNA ACO WILCO [101532]|14070||||14070|0|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14070||||14070|3887.07|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14070||||14070|3887.07|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14070||||14070|7049.07|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14070||||14070|4938.57|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14070||||14070|6050.1|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14070||||14070|5993.82|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14070||||14070|7035|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14070||||14070|9145.5|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|CORESOURCE [1315]|CORESOURCE [131500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14070||||14070|9238.36|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|GEHA [1415]|GEHA [141500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HEALTHNET [1495]|HEALTHNET [149500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14070||||14070|6050.1|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14070||||14070|13085.1|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14070||||14070|8442|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14070||||14070|10913.98|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14070||||14070|3754.3|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MULTIPLAN [1680]|HMA [168003]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MULTIPLAN [1680]|IHC HS [168011]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14070||||14070|4040.12|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|Self-pay|Self-pay|14070||||14070|4221|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14070||||14070|2954.7|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|TRUSTMARK [2030]|STARMARK [203000]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14070||||14070|6746.57|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|UMR [2035]|UMR OPTIONS [203501]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14070||||14070|3575.42|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14070||||14070|12663|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14070||||14070|0|13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14070||||14070||13085.1|2954.7
36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14070||||14070|7035|13085.1|2954.7
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|AETNA [1015]|AETNA ACO WILCO [101532]|851||||851|0|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|851||||851|258.66|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|851||||851|225.92|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|851||||851|225.92|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|851||||851|251.2|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|851||||851|426.35|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|851||||851|298.7|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|851||||851|365.93|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|851||||851|362.53|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|851||||851|425.5|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|851||||851|553.15|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|CORESOURCE [1315]|CORESOURCE [131500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|851||||851|558.77|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|851||||851|352.18|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|GEHA [1415]|GEHA [141500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|851||||851|570.57|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HEALTHNET [1495]|HEALTHNET [149500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|851||||851|365.93|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|851||||851|791.43|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|851||||851|510.6|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|851||||851|276.32|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|851||||851|670.24|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|851||||851|218.2|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|851||||851|342.34|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|851||||851|258.66|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MULTIPLAN [1680]|HMA [168003]|851||||851|380.38|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MULTIPLAN [1680]|IHC HS [168011]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|851||||851|234.82|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|851||||851|276.32|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|Self-pay|Self-pay|851||||851|255.3|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|851||||851|178.71|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|851||||851|248.51|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|851||||851|370.24|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|TRUSTMARK [2030]|STARMARK [203000]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|851||||851|408.05|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|UMR [2035]|UMR OPTIONS [203501]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|851||||851|207.81|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|851||||851|765.9|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|851||||851|0|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|851||||851|352.18|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|851||||851|253.59|791.43|178.71
36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|851||||851|425.5|791.43|178.71
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|AETNA [1015]|AETNA ACO WILCO [101532]|937||||937|0|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|937||||937|258.66|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|937||||937|225.92|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|937||||937|225.92|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|937||||937|251.2|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|937||||937|469.44|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|937||||937|328.89|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|937||||937|402.91|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|937||||937|399.16|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|937||||937|468.5|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|937||||937|609.05|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|CORESOURCE [1315]|CORESOURCE [131500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|937||||937|615.23|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|937||||937|352.18|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|GEHA [1415]|GEHA [141500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|937||||937|570.57|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HEALTHNET [1495]|HEALTHNET [149500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|937||||937|402.91|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|937||||937|871.41|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|937||||937|562.2|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|937||||937|276.32|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|937||||937|670.24|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|937||||937|218.2|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|937||||937|342.34|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|937||||937|258.66|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MULTIPLAN [1680]|HMA [168003]|937||||937|380.38|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MULTIPLAN [1680]|IHC HS [168011]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|937||||937|234.82|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|937||||937|276.32|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|Self-pay|Self-pay|937||||937|281.1|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|937||||937|196.77|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|937||||937|248.51|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|937||||937|370.24|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|TRUSTMARK [2030]|STARMARK [203000]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|937||||937|449.29|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|UMR [2035]|UMR OPTIONS [203501]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|937||||937|207.81|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|937||||937|843.3|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|937||||937|0|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|937||||937|352.18|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|937||||937|253.59|871.41|196.77
36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|937||||937|468.5|871.41|196.77
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|20408||||20408|0|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20408||||20408|5793.38|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20408||||20408|5843.3|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20408||||20408|5843.3|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20408||||20408|10224.41|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20408||||20408|7163.21|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20408||||20408|8775.44|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20408||||20408|8693.81|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20408||||20408|10204|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20408||||20408|13265.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|CORESOURCE [1315]|CORESOURCE [131500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|20408||||20408|13399.89|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20408||||20408|8043.27|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|GEHA [1415]|GEHA [141500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20408||||20408|12779.51|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HEALTHNET [1495]|HEALTHNET [149500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20408||||20408|8775.44|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|20408||||20408|18979.44|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20408||||20408|12244.8|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20408||||20408|6247.76|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20408||||20408|14292.5|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20408||||20408|5643.69|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20408||||20408|7667.71|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20408||||20408|5793.38|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MULTIPLAN [1680]|HMA [168003]|20408||||20408|8519.67|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MULTIPLAN [1680]|IHC HS [168011]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|20408||||20408|6073.38|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20408||||20408|6247.76|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|Self-pay|Self-pay|20408||||20408|6122.4|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20408||||20408|4285.68|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20408||||20408|5566.19|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20408||||20408|8292.48|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|TRUSTMARK [2030]|STARMARK [203000]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20408||||20408|9785.64|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|UMR [2035]|UMR OPTIONS [203501]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20408||||20408|5374.8|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20408||||20408|18367.2|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20408||||20408|0|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20408||||20408|8043.27|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20408||||20408|5679.78|18979.44|4285.68
36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20408||||20408|10204|18979.44|4285.68
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|AETNA [1015]|AETNA ACO WILCO [101532]|1016||||1016|0|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1016||||1016|247.93|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1016||||1016|227.28|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1016||||1016|227.28|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1016||||1016|240.78|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1016||||1016|509.02|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1016||||1016|356.62|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1016||||1016|436.88|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1016||||1016|432.82|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1016||||1016|508|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1016||||1016|660.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|CORESOURCE [1315]|CORESOURCE [131500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1016||||1016|667.11|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1016||||1016|340.3|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|GEHA [1415]|GEHA [141500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1016||||1016|546.9|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HEALTHNET [1495]|HEALTHNET [149500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1016||||1016|436.88|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1016||||1016|944.88|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1016||||1016|609.6|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1016||||1016|264.86|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1016||||1016|591.53|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1016||||1016|219.5|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1016||||1016|328.14|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1016||||1016|247.93|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MULTIPLAN [1680]|HMA [168003]|1016||||1016|364.6|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MULTIPLAN [1680]|IHC HS [168011]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1016||||1016|236.23|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1016||||1016|264.86|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|Self-pay|Self-pay|1016||||1016|304.8|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1016||||1016|213.36|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1016||||1016|238.21|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1016||||1016|354.88|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|TRUSTMARK [2030]|STARMARK [203000]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1016||||1016|487.17|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|UMR [2035]|UMR OPTIONS [203501]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1016||||1016|209.05|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1016||||1016|914.4|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1016||||1016|0|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1016||||1016|340.3|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1016||||1016|243.07|944.88|209.05
36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL EA BRANCH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1016||||1016|508|944.88|209.05
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1016||||1016|0|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1016||||1016|245.6|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1016||||1016|330.99|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1016||||1016|330.99|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1016||||1016|509.02|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1016||||1016|356.62|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1016||||1016|436.88|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1016||||1016|432.82|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1016||||1016|508|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1016||||1016|660.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1016||||1016|667.11|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1016||||1016|340.3|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|GEHA [1415]|GEHA [141500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1016||||1016|541.75|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1016||||1016|436.88|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1016||||1016|944.88|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1016||||1016|609.6|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1016||||1016|264.86|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1016||||1016|591.53|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1016||||1016|319.66|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1016||||1016|325.05|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1016||||1016|245.6|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MULTIPLAN [1680]|HMA [168003]|1016||||1016|361.17|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MULTIPLAN [1680]|IHC HS [168011]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1016||||1016|344.02|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1016||||1016|264.86|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|Self-pay|Self-pay|1016||||1016|304.8|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1016||||1016|213.36|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1016||||1016|235.96|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1016||||1016|351.54|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|TRUSTMARK [2030]|STARMARK [203000]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1016||||1016|487.17|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|UMR [2035]|UMR OPTIONS [203501]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1016||||1016|304.44|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1016||||1016|914.4|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1016||||1016|0|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1016||||1016|340.3|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1016||||1016|240.78|944.88|213.36
36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1016||||1016|508|944.88|213.36
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|4203||||4203|0|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4203||||4203|780.77|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4203||||4203|330.99|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4203||||4203|330.99|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4203||||4203|758.25|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4203||||4203|2105.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4203||||4203|1475.25|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4203||||4203|1807.29|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4203||||4203|1790.48|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4203||||4203|2101.5|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4203||||4203|2731.95|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4203||||4203|2759.69|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4203||||4203|1055.67|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|GEHA [1415]|GEHA [141500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4203||||4203|1722.28|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4203||||4203|1807.29|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4203||||4203|3908.79|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4203||||4203|2521.8|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4203||||4203|756.82|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4203||||4203|834.08|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4203||||4203|1828.14|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4203||||4203|319.66|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4203||||4203|1021.71|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4203||||4203|771.96|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MULTIPLAN [1680]|HMA [168003]|4203||||4203|1148.19|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MULTIPLAN [1680]|IHC HS [168011]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4203||||4203|344.02|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4203||||4203|834.08|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|Self-pay|Self-pay|4203||||4203|1260.9|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4203||||4203|882.63|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4203||||4203|750.15|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4203||||4203|1117.57|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|TRUSTMARK [2030]|STARMARK [203000]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4203||||4203|2015.34|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|UMR [2035]|UMR OPTIONS [203501]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4203||||4203|304.44|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4203||||4203|3782.7|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4203||||4203|0|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4203||||4203|1055.67|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4203||||4203|765.46|3908.79|304.44
36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4203||||4203|2101.5|3908.79|304.44
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|4624||||4624|0|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4624||||4624|2316.62|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4624||||4624|1623.02|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4624||||4624|1988.32|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4624||||4624|1969.82|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4624||||4624|2312|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4624||||4624|3005.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4624||||4624|3036.12|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|GEHA [1415]|GEHA [141500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4624||||4624|1988.32|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4624||||4624|4300.32|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4624||||4624|2774.4|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4624||||4624|1828.14|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MULTIPLAN [1680]|HMA [168003]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MULTIPLAN [1680]|IHC HS [168011]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|Self-pay|Self-pay|4624||||4624|1387.2|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4624||||4624|971.04|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|TRUSTMARK [2030]|STARMARK [203000]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4624||||4624|2217.21|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|UMR [2035]|UMR OPTIONS [203501]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4624||||4624|4161.6|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4624||||4624|0|4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4624||||4624||4300.32|971.04
36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4624||||4624|2312|4300.32|971.04
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1685||||1685|0|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1685||||1685|780.77|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1685||||1685|330.99|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1685||||1685|330.99|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1685||||1685|758.25|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1685||||1685|844.19|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1685||||1685|591.44|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1685||||1685|724.55|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1685||||1685|717.81|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1685||||1685|842.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1685||||1685|1095.25|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|CORESOURCE [1315]|CORESOURCE [131500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1685||||1685|1106.37|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1685||||1685|1055.67|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|GEHA [1415]|GEHA [141500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1685||||1685|1685|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HEALTHNET [1495]|HEALTHNET [149500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1685||||1685|724.55|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1685||||1685|1567.05|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1685||||1685|1011|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1685||||1685|756.82|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1685||||1685|834.08|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1685||||1685|1685|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1685||||1685|319.66|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1685||||1685|1033.37|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1685||||1685|771.96|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MULTIPLAN [1680]|HMA [168003]|1685||||1685|1148.19|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MULTIPLAN [1680]|IHC HS [168011]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1685||||1685|344.02|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1685||||1685|834.08|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|Self-pay|Self-pay|1685||||1685|505.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1685||||1685|353.85|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1685||||1685|741.69|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1685||||1685|1117.57|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|TRUSTMARK [2030]|STARMARK [203000]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1685||||1685|807.96|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|UMR [2035]|UMR OPTIONS [203501]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1685||||1685|304.44|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1685||||1685|1516.5|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1685||||1685|0|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1685||||1685|1055.67|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1685||||1685|765.46|1685|304.44
36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1685||||1685|842.5|1685|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|AETNA [1015]|AETNA ACO WILCO [101532]|2591||||2591|0|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2591||||2591|596.75|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2591||||2591|330.99|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2591||||2591|330.99|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2591||||2591|1298.09|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2591||||2591|909.44|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2591||||2591|1114.13|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2591||||2591|1103.77|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2591||||2591|1295.5|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2591||||2591|1684.15|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|CORESOURCE [1315]|CORESOURCE [131500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2591||||2591|1701.25|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2591||||2591|812.57|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|GEHA [1415]|GEHA [141500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2591||||2591|1316.37|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HEALTHNET [1495]|HEALTHNET [149500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2591||||2591|1114.13|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2591||||2591|2409.63|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2591||||2591|1554.6|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2591||||2591|643.56|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2591||||2591|1431.31|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2591||||2591|319.66|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2591||||2591|789.82|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2591||||2591|596.75|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MULTIPLAN [1680]|HMA [168003]|2591||||2591|877.58|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MULTIPLAN [1680]|IHC HS [168011]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2591||||2591|344.02|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2591||||2591|643.56|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|Self-pay|Self-pay|2591||||2591|777.3|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2591||||2591|544.11|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2591||||2591|573.35|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2591||||2591|854.18|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|TRUSTMARK [2030]|STARMARK [203000]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2591||||2591|1242.38|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|UMR [2035]|UMR OPTIONS [203501]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2591||||2591|304.44|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2591||||2591|2331.9|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2591||||2591|0|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2591||||2591|812.57|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2591||||2591|585.05|2409.63|304.44
36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2591||||2591|1295.5|2409.63|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1764||||1764|0|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1764||||1764|596.75|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1764||||1764|330.99|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1764||||1764|330.99|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1764||||1764|883.76|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1764||||1764|619.16|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1764||||1764|758.52|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1764||||1764|751.46|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1764||||1764|882|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1764||||1764|1146.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1764||||1764|1158.24|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1764||||1764|812.57|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|GEHA [1415]|GEHA [141500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1764||||1764|1316.37|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1764||||1764|758.52|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1764||||1764|1640.52|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1764||||1764|1058.4|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1764||||1764|643.56|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1764||||1764|1431.31|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1764||||1764|319.66|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1764||||1764|789.82|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1764||||1764|596.75|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MULTIPLAN [1680]|HMA [168003]|1764||||1764|877.58|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MULTIPLAN [1680]|IHC HS [168011]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1764||||1764|344.02|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1764||||1764|643.56|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|Self-pay|Self-pay|1764||||1764|529.2|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1764||||1764|370.44|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1764||||1764|573.35|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1764||||1764|854.18|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|TRUSTMARK [2030]|STARMARK [203000]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1764||||1764|845.84|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|UMR [2035]|UMR OPTIONS [203501]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1764||||1764|304.44|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1764||||1764|1587.6|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1764||||1764|0|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1764||||1764|812.57|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1764||||1764|585.05|1640.52|304.44
36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1764||||1764|882|1640.52|304.44
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3436||||3436|0|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3436||||3436|773.42|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3436||||3436|640.29|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3436||||3436|640.29|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3436||||3436|1721.44|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3436||||3436|1206.04|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3436||||3436|1477.48|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3436||||3436|1463.74|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3436||||3436|1718|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3436||||3436|2233.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3436||||3436|2256.08|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3436||||3436|1055.67|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|GEHA [1415]|GEHA [141500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3436||||3436|1706.07|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3436||||3436|1477.48|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3436||||3436|3195.48|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3436||||3436|2061.6|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3436||||3436|834.08|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3436||||3436|1828.14|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3436||||3436|618.38|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3436||||3436|1023.64|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3436||||3436|773.42|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MULTIPLAN [1680]|HMA [168003]|3436||||3436|1137.38|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MULTIPLAN [1680]|IHC HS [168011]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3436||||3436|665.5|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3436||||3436|834.08|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|Self-pay|Self-pay|3436||||3436|1030.8|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3436||||3436|721.56|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3436||||3436|743.09|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3436||||3436|1107.05|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|TRUSTMARK [2030]|STARMARK [203000]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3436||||3436|1647.56|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|UMR [2035]|UMR OPTIONS [203501]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3436||||3436|588.94|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3436||||3436|3092.4|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3436||||3436|0|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3436||||3436|1055.67|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3436||||3436|758.25|3195.48|588.94
36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL EA ADDL LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3436||||3436|1718|3195.48|588.94
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|1089||||1089|0|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1089||||1089|596.75|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1089||||1089|330.99|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1089||||1089|330.99|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1089||||1089|545.59|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1089||||1089|382.24|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1089||||1089|468.27|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1089||||1089|463.91|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1089||||1089|544.5|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1089||||1089|707.85|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|CORESOURCE [1315]|CORESOURCE [131500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1089||||1089|715.04|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1089||||1089|812.57|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|GEHA [1415]|GEHA [141500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1089||||1089|1089|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HEALTHNET [1495]|HEALTHNET [149500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1089||||1089|468.27|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1089||||1089|1012.77|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1089||||1089|653.4|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1089||||1089|643.56|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1089||||1089|1089|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1089||||1089|319.66|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1089||||1089|789.82|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1089||||1089|596.75|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MULTIPLAN [1680]|HMA [168003]|1089||||1089|877.58|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MULTIPLAN [1680]|IHC HS [168011]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1089||||1089|344.02|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1089||||1089|643.56|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|Self-pay|Self-pay|1089||||1089|326.7|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1089||||1089|228.69|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1089||||1089|573.35|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1089||||1089|854.18|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|TRUSTMARK [2030]|STARMARK [203000]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1089||||1089|522.18|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|UMR [2035]|UMR OPTIONS [203501]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1089||||1089|304.44|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1089||||1089|980.1|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1089||||1089|0|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1089||||1089|812.57|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1089||||1089|585.05|1089|228.69
36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1089||||1089|544.5|1089|228.69
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4118||||4118|0|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4118||||4118|773.42|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4118||||4118|640.29|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4118||||4118|640.29|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4118||||4118|2063.12|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4118||||4118|1445.42|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4118||||4118|1770.74|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4118||||4118|1754.27|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4118||||4118|2059|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4118||||4118|2676.7|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|CORESOURCE [1315]|CORESOURCE [131500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4118||||4118|2703.88|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4118||||4118|1055.67|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|GEHA [1415]|GEHA [141500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4118||||4118|1706.07|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HEALTHNET [1495]|HEALTHNET [149500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4118||||4118|1770.74|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4118||||4118|3829.74|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4118||||4118|2470.8|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4118||||4118|834.08|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4118||||4118|1828.14|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4118||||4118|618.38|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4118||||4118|1023.64|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4118||||4118|773.42|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MULTIPLAN [1680]|HMA [168003]|4118||||4118|1137.38|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MULTIPLAN [1680]|IHC HS [168011]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4118||||4118|665.5|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4118||||4118|834.08|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|Self-pay|Self-pay|4118||||4118|1235.4|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4118||||4118|864.78|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4118||||4118|743.09|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4118||||4118|1107.05|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|TRUSTMARK [2030]|STARMARK [203000]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4118||||4118|1974.58|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|UMR [2035]|UMR OPTIONS [203501]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4118||||4118|588.94|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4118||||4118|3706.2|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4118||||4118|0|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4118||||4118|1055.67|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4118||||4118|758.25|3829.74|588.94
36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4118||||4118|2059|3829.74|588.94
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|2650||||2650|0|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2650||||2650|596.75|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2650||||2650|640.29|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2650||||2650|640.29|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2650||||2650|1327.65|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2650||||2650|930.15|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2650||||2650|1139.5|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2650||||2650|1128.9|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2650||||2650|1325|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2650||||2650|1722.5|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|CORESOURCE [1315]|CORESOURCE [131500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2650||||2650|1739.99|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2650||||2650|812.57|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|GEHA [1415]|GEHA [141500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2650||||2650|1316.37|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HEALTHNET [1495]|HEALTHNET [149500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2650||||2650|1139.5|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2650||||2650|2464.5|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2650||||2650|1590|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2650||||2650|643.56|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2650||||2650|1431.31|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2650||||2650|618.38|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2650||||2650|789.82|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2650||||2650|596.75|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MULTIPLAN [1680]|HMA [168003]|2650||||2650|877.58|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MULTIPLAN [1680]|IHC HS [168011]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2650||||2650|665.5|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2650||||2650|643.56|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|Self-pay|Self-pay|2650||||2650|795|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2650||||2650|556.5|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2650||||2650|573.35|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2650||||2650|854.18|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|TRUSTMARK [2030]|STARMARK [203000]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2650||||2650|1270.68|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|UMR [2035]|UMR OPTIONS [203501]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2650||||2650|588.94|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2650||||2650|2385|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2650||||2650|0|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2650||||2650|812.57|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2650||||2650|585.05|2464.5|556.5
36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2650||||2650|1325|2464.5|556.5
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2126||||2126|0|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2126||||2126|1065.13|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2126||||2126|746.23|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2126||||2126|914.18|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2126||||2126|905.68|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2126||||2126|1063|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2126||||2126|1381.9|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2126||||2126|1395.93|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|GEHA [1415]|GEHA [141500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2126||||2126|914.18|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2126||||2126|1977.18|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2126||||2126|1275.6|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2126||||2126|1828.14|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MULTIPLAN [1680]|HMA [168003]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MULTIPLAN [1680]|IHC HS [168011]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|Self-pay|Self-pay|2126||||2126|637.8|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2126||||2126|446.46|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|TRUSTMARK [2030]|STARMARK [203000]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2126||||2126|1019.42|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|UMR [2035]|UMR OPTIONS [203501]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2126||||2126|1913.4|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2126||||2126|0|1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2126||||2126||1977.18|446.46
36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2126||||2126|1063|1977.18|446.46
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1685||||1685|0|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1685||||1685|602.42|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1685||||1685|330.99|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1685||||1685|330.99|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1685||||1685|585.05|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1685||||1685|844.19|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1685||||1685|591.44|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1685||||1685|724.55|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1685||||1685|717.81|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1685||||1685|842.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1685||||1685|1095.25|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1685||||1685|585.05|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1685||||1685|1106.37|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1685||||1685|812.57|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|GEHA [1415]|GEHA [141500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1685||||1685|1328.88|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1685||||1685|724.55|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1685||||1685|1567.05|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1685||||1685|1011|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1685||||1685|643.56|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1685||||1685|1431.31|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1685||||1685|319.66|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1685||||1685|797.33|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1685||||1685|595.63|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MULTIPLAN [1680]|HMA [168003]|1685||||1685|885.92|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MULTIPLAN [1680]|IHC HS [168011]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1685||||1685|344.02|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1685||||1685|643.56|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|Self-pay|Self-pay|1685||||1685|505.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1685||||1685|353.85|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1685||||1685|578.8|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1685||||1685|862.29|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|TRUSTMARK [2030]|STARMARK [203000]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1685||||1685|807.96|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|UMR [2035]|UMR OPTIONS [203501]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1685||||1685|304.44|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1685||||1685|1516.5|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1685||||1685|0|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1685||||1685|812.57|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1685||||1685|590.61|1567.05|304.44
36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1685||||1685|842.5|1567.05|304.44
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|6646||||6646|0|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6646||||6646|3329.65|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6646||||6646|2332.75|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6646||||6646|2857.78|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6646||||6646|2831.2|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6646||||6646|3323|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6646||||6646|4319.9|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|CORESOURCE [1315]|CORESOURCE [131500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6646||||6646|4363.76|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|GEHA [1415]|GEHA [141500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HEALTHNET [1495]|HEALTHNET [149500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6646||||6646|2857.78|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6646||||6646|6180.78|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6646||||6646|3987.6|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6646||||6646|1828.14|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MULTIPLAN [1680]|HMA [168003]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MULTIPLAN [1680]|IHC HS [168011]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|Self-pay|Self-pay|6646||||6646|1993.8|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6646||||6646|1395.66|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|TRUSTMARK [2030]|STARMARK [203000]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6646||||6646|3186.76|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|UMR [2035]|UMR OPTIONS [203501]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6646||||6646|5981.4|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6646||||6646|0|6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6646||||6646||6180.78|1395.66
36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6646||||6646|3323|6180.78|1395.66
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1180||||1180|0|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1180||||1180|596.75|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1180||||1180|330.99|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1180||||1180|330.99|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1180||||1180|591.18|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1180||||1180|414.18|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1180||||1180|507.4|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1180||||1180|502.68|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1180||||1180|590|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1180||||1180|767|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1180||||1180|774.79|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1180||||1180|812.57|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|GEHA [1415]|GEHA [141500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1180||||1180|1180|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1180||||1180|507.4|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1180||||1180|1097.4|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1180||||1180|708|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1180||||1180|643.56|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1180||||1180|1180|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1180||||1180|319.66|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1180||||1180|789.82|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1180||||1180|596.75|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MULTIPLAN [1680]|HMA [168003]|1180||||1180|877.58|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MULTIPLAN [1680]|IHC HS [168011]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1180||||1180|344.02|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1180||||1180|643.56|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|Self-pay|Self-pay|1180||||1180|354|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1180||||1180|247.8|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1180||||1180|573.35|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1180||||1180|854.18|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|TRUSTMARK [2030]|STARMARK [203000]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1180||||1180|565.81|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|UMR [2035]|UMR OPTIONS [203501]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1180||||1180|304.44|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1180||||1180|1062|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1180||||1180|0|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1180||||1180|812.57|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1180||||1180|585.05|1180|247.8
36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1180||||1180|590|1180|247.8
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|AETNA [1015]|AETNA ACO WILCO [101532]|1964||||1964|0|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1964||||1964|983.96|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1964||||1964|689.36|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1964||||1964|844.52|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1964||||1964|836.66|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1964||||1964|982|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1964||||1964|1276.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|CORESOURCE [1315]|CORESOURCE [131500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1964||||1964|1289.56|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|GEHA [1415]|GEHA [141500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HEALTHNET [1495]|HEALTHNET [149500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1964||||1964|844.52|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1964||||1964|1826.52|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1964||||1964|1178.4|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1964||||1964|0|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1964||||1964|0|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MULTIPLAN [1680]|HMA [168003]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MULTIPLAN [1680]|IHC HS [168011]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|Self-pay|Self-pay|1964||||1964|589.2|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1964||||1964|412.44|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|TRUSTMARK [2030]|STARMARK [203000]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1964||||1964|941.74|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|UMR [2035]|UMR OPTIONS [203501]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1964||||1964|0|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1964||||1964|1767.6|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1964||||1964|0|1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1964||||1964||1826.52|412.44
36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1964||||1964|982|1826.52|412.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|AETNA [1015]|AETNA ACO WILCO [101532]|2064||||2064|0|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2064||||2064|596.75|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2064||||2064|824.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2064||||2064|824.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2064||||2064|1034.06|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2064||||2064|724.46|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2064||||2064|887.52|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2064||||2064|879.26|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2064||||2064|1032|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2064||||2064|1341.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|CORESOURCE [1315]|CORESOURCE [131500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2064||||2064|1355.22|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2064||||2064|812.57|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|GEHA [1415]|GEHA [141500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2064||||2064|1316.37|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HEALTHNET [1495]|HEALTHNET [149500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2064||||2064|887.52|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2064||||2064|1919.52|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2064||||2064|1238.4|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2064||||2064|643.56|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2064||||2064|0|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2064||||2064|0|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2064||||2064|789.82|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2064||||2064|596.75|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MULTIPLAN [1680]|HMA [168003]|2064||||2064|877.58|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MULTIPLAN [1680]|IHC HS [168011]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2064||||2064|857.07|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2064||||2064|643.56|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|Self-pay|Self-pay|2064||||2064|619.2|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2064||||2064|433.44|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2064||||2064|573.35|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2064||||2064|854.18|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|TRUSTMARK [2030]|STARMARK [203000]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2064||||2064|989.69|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|UMR [2035]|UMR OPTIONS [203501]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2064||||2064|0|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2064||||2064|1857.6|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2064||||2064|0|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2064||||2064|812.57|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2064||||2064|585.05|1919.52|433.44
36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2064||||2064|1032|1919.52|433.44
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3436||||3436|0|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3436||||3436|773.42|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3436||||3436|640.29|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3436||||3436|640.29|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3436||||3436|1721.44|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3436||||3436|1206.04|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3436||||3436|1477.48|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3436||||3436|1463.74|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3436||||3436|1718|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3436||||3436|2233.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|CORESOURCE [1315]|CORESOURCE [131500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3436||||3436|2256.08|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3436||||3436|1055.67|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|GEHA [1415]|GEHA [141500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3436||||3436|1706.07|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HEALTHNET [1495]|HEALTHNET [149500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3436||||3436|1477.48|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3436||||3436|3195.48|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3436||||3436|2061.6|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3436||||3436|834.08|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3436||||3436|1828.14|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3436||||3436|618.38|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3436||||3436|1023.64|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3436||||3436|773.42|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MULTIPLAN [1680]|HMA [168003]|3436||||3436|1137.38|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MULTIPLAN [1680]|IHC HS [168011]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3436||||3436|665.5|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3436||||3436|834.08|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|Self-pay|Self-pay|3436||||3436|1030.8|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3436||||3436|721.56|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3436||||3436|743.09|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3436||||3436|1107.05|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|TRUSTMARK [2030]|STARMARK [203000]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3436||||3436|1647.56|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|UMR [2035]|UMR OPTIONS [203501]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3436||||3436|588.94|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3436||||3436|3092.4|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3436||||3436|0|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3436||||3436|1055.67|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3436||||3436|758.25|3195.48|588.94
36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3436||||3436|1718|3195.48|588.94
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3850||||3850|0|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3850||||3850|330.99|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3850||||3850|330.99|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3850||||3850|1928.85|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3850||||3850|1351.35|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3850||||3850|1655.5|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3850||||3850|1640.1|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3850||||3850|1925|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3850||||3850|2502.5|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|CORESOURCE [1315]|CORESOURCE [131500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3850||||3850|2527.91|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3850||||3850|320.48|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|GEHA [1415]|GEHA [141500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HEALTHNET [1495]|HEALTHNET [149500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3850||||3850|1655.5|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3850||||3850|3580.5|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3850||||3850|2310|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3850||||3850|1925|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3850||||3850|319.66|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MULTIPLAN [1680]|HMA [168003]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MULTIPLAN [1680]|IHC HS [168011]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3850||||3850|344.02|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|Self-pay|Self-pay|3850||||3850|1155|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3850||||3850|808.5|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|TRUSTMARK [2030]|STARMARK [203000]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3850||||3850|1846.08|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|UMR [2035]|UMR OPTIONS [203501]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3850||||3850|304.44|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3850||||3850|3465|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3850||||3850|0|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3850||||3850|320.48|3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3850||||3850||3580.5|304.44
36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3850||||3850|1925|3580.5|304.44
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|AETNA [1015]|AETNA ACO WILCO [101532]|5125||||5125|0|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5125||||5125|773.42|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5125||||5125|640.29|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5125||||5125|640.29|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5125||||5125|2567.63|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5125||||5125|1798.88|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5125||||5125|2203.75|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5125||||5125|2183.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5125||||5125|2562.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5125||||5125|3331.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|CORESOURCE [1315]|CORESOURCE [131500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5125||||5125|3365.08|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5125||||5125|1055.67|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|GEHA [1415]|GEHA [141500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5125||||5125|1706.07|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HEALTHNET [1495]|HEALTHNET [149500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5125||||5125|2203.75|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5125||||5125|4766.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5125||||5125|3075|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5125||||5125|834.08|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5125||||5125|1828.14|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5125||||5125|618.38|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5125||||5125|1023.64|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5125||||5125|773.42|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MULTIPLAN [1680]|HMA [168003]|5125||||5125|1137.38|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MULTIPLAN [1680]|IHC HS [168011]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5125||||5125|665.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5125||||5125|834.08|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|Self-pay|Self-pay|5125||||5125|1537.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5125||||5125|1076.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5125||||5125|743.09|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5125||||5125|1107.05|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|TRUSTMARK [2030]|STARMARK [203000]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5125||||5125|2457.44|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|UMR [2035]|UMR OPTIONS [203501]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5125||||5125|588.94|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5125||||5125|4612.5|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5125||||5125|0|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5125||||5125|1055.67|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5125||||5125|758.25|4766.25|588.94
36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5125||||5125|2562.5|4766.25|588.94
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3850||||3850|0|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3850||||3850|330.99|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3850||||3850|330.99|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3850||||3850|1928.85|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3850||||3850|1351.35|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3850||||3850|1655.5|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3850||||3850|1640.1|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3850||||3850|1925|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3850||||3850|2502.5|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|CORESOURCE [1315]|CORESOURCE [131500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3850||||3850|2527.91|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3850||||3850|283.48|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|GEHA [1415]|GEHA [141500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HEALTHNET [1495]|HEALTHNET [149500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3850||||3850|1655.5|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3850||||3850|3580.5|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3850||||3850|2310|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3850||||3850|1925|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3850||||3850|319.66|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MULTIPLAN [1680]|HMA [168003]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MULTIPLAN [1680]|IHC HS [168011]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3850||||3850|344.02|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|Self-pay|Self-pay|3850||||3850|1155|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3850||||3850|808.5|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|TRUSTMARK [2030]|STARMARK [203000]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3850||||3850|1846.08|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|UMR [2035]|UMR OPTIONS [203501]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3850||||3850|304.44|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3850||||3850|3465|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3850||||3850|0|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3850||||3850|283.48|3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3850||||3850||3580.5|283.48
36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3850||||3850|1925|3580.5|283.48
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4239||||4239|2123.74|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4239||||4239|1487.89|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4239||||4239|1822.77|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4239||||4239|1805.81|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4239||||4239|2119.5|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4239||||4239|2755.35|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4239||||4239|2783.33|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4239||||4239|347.63|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|GEHA [1415]|GEHA [141500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4239||||4239|1822.77|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4239||||4239|3942.27|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4239||||4239|2543.4|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4239||||4239|2119.5|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MULTIPLAN [1680]|HMA [168003]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MULTIPLAN [1680]|IHC HS [168011]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|Self-pay|Self-pay|4239||||4239|1271.7|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4239||||4239|890.19|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|TRUSTMARK [2030]|STARMARK [203000]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4239||||4239|2032.6|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|UMR [2035]|UMR OPTIONS [203501]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4239||||4239|3815.1|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4239||||4239|0|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4239||||4239|347.63|3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4239||||4239||3942.27|347.63
36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4239||||4239|2119.5|3942.27|347.63
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8279||||8279|4147.78|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8279||||8279|2905.93|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8279||||8279|3559.97|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8279||||8279|3526.85|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8279||||8279|4139.5|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8279||||8279|5381.35|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|8279||||8279|5435.99|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8279||||8279|428.25|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|GEHA [1415]|GEHA [141500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8279||||8279|3559.97|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|8279||||8279|7699.47|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8279||||8279|4967.4|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8279||||8279|4139.5|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MULTIPLAN [1680]|HMA [168003]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MULTIPLAN [1680]|IHC HS [168011]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|Self-pay|Self-pay|8279||||8279|2483.7|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8279||||8279|1738.59|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|TRUSTMARK [2030]|STARMARK [203000]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8279||||8279|3969.78|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|UMR [2035]|UMR OPTIONS [203501]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8279||||8279|7451.1|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|8279||||8279|0|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8279||||8279|428.25|7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8279||||8279||7699.47|428.25
36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8279||||8279|4139.5|7699.47|428.25
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|4090||||4090|0|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4090||||4090|773.42|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4090||||4090|640.29|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4090||||4090|640.29|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4090||||4090|2049.09|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4090||||4090|1435.59|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4090||||4090|1758.7|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4090||||4090|1742.34|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4090||||4090|2045|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4090||||4090|2658.5|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4090||||4090|2685.49|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4090||||4090|1055.67|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|GEHA [1415]|GEHA [141500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4090||||4090|1706.07|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4090||||4090|1758.7|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4090||||4090|3803.7|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4090||||4090|2454|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4090||||4090|834.08|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4090||||4090|1828.14|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4090||||4090|618.38|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4090||||4090|1023.64|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4090||||4090|773.42|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MULTIPLAN [1680]|HMA [168003]|4090||||4090|1137.38|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MULTIPLAN [1680]|IHC HS [168011]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4090||||4090|665.5|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4090||||4090|834.08|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|Self-pay|Self-pay|4090||||4090|1227|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4090||||4090|858.9|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4090||||4090|743.09|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4090||||4090|1107.05|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|TRUSTMARK [2030]|STARMARK [203000]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4090||||4090|1961.16|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|UMR [2035]|UMR OPTIONS [203501]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4090||||4090|588.94|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4090||||4090|3681|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4090||||4090|0|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4090||||4090|1055.67|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4090||||4090|758.25|3803.7|588.94
36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4090||||4090|2045|3803.7|588.94
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1717||||1717|0|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1717||||1717|227.28|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1717||||1717|227.28|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1717||||1717|860.22|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1717||||1717|602.67|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1717||||1717|738.31|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1717||||1717|731.44|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1717||||1717|858.5|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1717||||1717|1116.05|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1717||||1717|1127.38|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1717||||1717|261.22|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|GEHA [1415]|GEHA [141500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1717||||1717|738.31|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1717||||1717|1596.81|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1717||||1717|1030.2|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1717||||1717|858.5|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1717||||1717|219.5|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MULTIPLAN [1680]|HMA [168003]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MULTIPLAN [1680]|IHC HS [168011]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1717||||1717|236.23|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|Self-pay|Self-pay|1717||||1717|515.1|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1717||||1717|360.57|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|TRUSTMARK [2030]|STARMARK [203000]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1717||||1717|823.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|UMR [2035]|UMR OPTIONS [203501]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1717||||1717|209.05|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1717||||1717|1545.3|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1717||||1717|0|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1717||||1717|261.22|1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1717||||1717||1596.81|209.05
36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1717||||1717|858.5|1596.81|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1360||||1360|0|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1360||||1360|227.28|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1360||||1360|227.28|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1360||||1360|681.36|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1360||||1360|477.36|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1360||||1360|584.8|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1360||||1360|579.36|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1360||||1360|680|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1360||||1360|884|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1360||||1360|892.98|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1360||||1360|263.2|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|GEHA [1415]|GEHA [141500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1360||||1360|584.8|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1360||||1360|1264.8|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1360||||1360|816|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1360||||1360|680|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1360||||1360|219.5|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MULTIPLAN [1680]|HMA [168003]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MULTIPLAN [1680]|IHC HS [168011]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1360||||1360|236.23|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|Self-pay|Self-pay|1360||||1360|408|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1360||||1360|285.6|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|TRUSTMARK [2030]|STARMARK [203000]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1360||||1360|652.12|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|UMR [2035]|UMR OPTIONS [203501]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1360||||1360|209.05|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1360||||1360|1224|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1360||||1360|0|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1360||||1360|263.2|1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1360||||1360||1264.8|209.05
36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1360||||1360|680|1264.8|209.05
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|4938||||4938|0|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4938||||4938|773.42|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4938||||4938|640.29|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4938||||4938|640.29|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4938||||4938|2473.94|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4938||||4938|1733.24|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4938||||4938|2123.34|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4938||||4938|2103.59|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4938||||4938|2469|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4938||||4938|3209.7|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4938||||4938|3242.29|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4938||||4938|1055.67|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|GEHA [1415]|GEHA [141500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4938||||4938|1706.07|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4938||||4938|2123.34|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4938||||4938|4592.34|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4938||||4938|2962.8|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4938||||4938|834.08|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4938||||4938|1828.14|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4938||||4938|618.38|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4938||||4938|1023.64|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4938||||4938|773.42|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MULTIPLAN [1680]|HMA [168003]|4938||||4938|1137.38|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MULTIPLAN [1680]|IHC HS [168011]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4938||||4938|665.5|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4938||||4938|834.08|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|Self-pay|Self-pay|4938||||4938|1481.4|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4938||||4938|1036.98|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4938||||4938|743.09|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4938||||4938|1107.05|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|TRUSTMARK [2030]|STARMARK [203000]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4938||||4938|2367.77|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|UMR [2035]|UMR OPTIONS [203501]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4938||||4938|588.94|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4938||||4938|4444.2|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4938||||4938|0|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4938||||4938|1055.67|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4938||||4938|758.25|4592.34|588.94
36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4938||||4938|2469|4592.34|588.94
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1717||||1717|0|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1717||||1717|227.28|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1717||||1717|227.28|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1717||||1717|860.22|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1717||||1717|602.67|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1717||||1717|738.31|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1717||||1717|731.44|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1717||||1717|858.5|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1717||||1717|1116.05|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1717||||1717|1127.38|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1717||||1717|241.74|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|GEHA [1415]|GEHA [141500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1717||||1717|738.31|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1717||||1717|1596.81|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1717||||1717|1030.2|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1717||||1717|858.5|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1717||||1717|219.5|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MULTIPLAN [1680]|HMA [168003]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MULTIPLAN [1680]|IHC HS [168011]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1717||||1717|236.23|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|Self-pay|Self-pay|1717||||1717|515.1|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1717||||1717|360.57|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|TRUSTMARK [2030]|STARMARK [203000]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1717||||1717|823.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|UMR [2035]|UMR OPTIONS [203501]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1717||||1717|209.05|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1717||||1717|1545.3|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1717||||1717|0|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1717||||1717|241.74|1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1717||||1717||1596.81|209.05
36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1717||||1717|858.5|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1717||||1717|0|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1717||||1717|227.28|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1717||||1717|227.28|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1717||||1717|860.22|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1717||||1717|602.67|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1717||||1717|738.31|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1717||||1717|731.44|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1717||||1717|858.5|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1717||||1717|1116.05|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|CORESOURCE [1315]|CORESOURCE [131500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1717||||1717|1127.38|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1717||||1717|241.74|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|GEHA [1415]|GEHA [141500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HEALTHNET [1495]|HEALTHNET [149500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1717||||1717|738.31|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1717||||1717|1596.81|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1717||||1717|1030.2|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1717||||1717|858.5|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1717||||1717|219.5|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MULTIPLAN [1680]|HMA [168003]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MULTIPLAN [1680]|IHC HS [168011]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1717||||1717|236.23|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|Self-pay|Self-pay|1717||||1717|515.1|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1717||||1717|360.57|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|TRUSTMARK [2030]|STARMARK [203000]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1717||||1717|823.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|UMR [2035]|UMR OPTIONS [203501]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1717||||1717|209.05|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1717||||1717|1545.3|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1717||||1717|0|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1717||||1717|241.74|1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1717||||1717||1596.81|209.05
36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1717||||1717|858.5|1596.81|209.05
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|AETNA [1015]|AETNA ACO WILCO [101532]|786||||786|0|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|786||||786|245.6|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|786||||786|227.28|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|786||||786|227.28|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|786||||786|393.79|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|786||||786|275.89|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|786||||786|337.98|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|786||||786|334.84|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|786||||786|393|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|786||||786|510.9|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|CORESOURCE [1315]|CORESOURCE [131500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|786||||786|516.09|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|786||||786|340.3|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|GEHA [1415]|GEHA [141500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|786||||786|541.75|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HEALTHNET [1495]|HEALTHNET [149500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|786||||786|337.98|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|786||||786|730.98|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|786||||786|471.6|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|786||||786|264.86|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|786||||786|591.53|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|786||||786|219.5|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|786||||786|325.05|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|786||||786|245.6|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MULTIPLAN [1680]|HMA [168003]|786||||786|361.17|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MULTIPLAN [1680]|IHC HS [168011]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|786||||786|236.23|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|786||||786|264.86|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|Self-pay|Self-pay|786||||786|235.8|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|786||||786|165.06|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|786||||786|235.96|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|786||||786|351.54|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|TRUSTMARK [2030]|STARMARK [203000]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|786||||786|376.89|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|UMR [2035]|UMR OPTIONS [203501]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|786||||786|209.05|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|786||||786|707.4|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|786||||786|0|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|786||||786|340.3|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|786||||786|240.78|730.98|165.06
36064505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES SPHENOPALATINE GANGLION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|786||||786|393|730.98|165.06
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|AETNA [1015]|AETNA ACO WILCO [101532]|3850||||3850|0|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3850||||3850|780.77|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3850||||3850|640.29|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3850||||3850|640.29|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3850||||3850|758.25|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3850||||3850|1928.85|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3850||||3850|1351.35|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3850||||3850|1655.5|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3850||||3850|1640.1|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3850||||3850|1925|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3850||||3850|2502.5|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|CORESOURCE [1315]|CORESOURCE [131500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3850||||3850|2527.91|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3850||||3850|1055.67|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|GEHA [1415]|GEHA [141500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3850||||3850|1722.28|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HEALTHNET [1495]|HEALTHNET [149500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3850||||3850|1655.5|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3850||||3850|3580.5|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3850||||3850|2310|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3850||||3850|834.08|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3850||||3850|1828.14|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3850||||3850|618.38|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3850||||3850|1033.37|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3850||||3850|780.77|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MULTIPLAN [1680]|HMA [168003]|3850||||3850|1148.19|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MULTIPLAN [1680]|IHC HS [168011]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3850||||3850|665.5|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3850||||3850|834.08|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|Self-pay|Self-pay|3850||||3850|1155|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3850||||3850|808.5|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3850||||3850|750.15|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3850||||3850|1117.57|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|TRUSTMARK [2030]|STARMARK [203000]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3850||||3850|1846.08|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|UMR [2035]|UMR OPTIONS [203501]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3850||||3850|588.94|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3850||||3850|3465|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3850||||3850|0|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3850||||3850|1055.67|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3850||||3850|765.46|3580.5|588.94
36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3850||||3850|1925|3580.5|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|AETNA [1015]|AETNA ACO WILCO [101532]|3638||||3638|0|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3638||||3638|780.77|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3638||||3638|640.29|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3638||||3638|640.29|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3638||||3638|758.25|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3638||||3638|1822.64|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3638||||3638|1276.94|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3638||||3638|1564.34|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3638||||3638|1549.79|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3638||||3638|1819|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3638||||3638|2364.7|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|CORESOURCE [1315]|CORESOURCE [131500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3638||||3638|2388.71|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3638||||3638|1055.67|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|GEHA [1415]|GEHA [141500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3638||||3638|1722.28|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HEALTHNET [1495]|HEALTHNET [149500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3638||||3638|1564.34|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3638||||3638|3383.34|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3638||||3638|2182.8|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3638||||3638|834.08|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3638||||3638|1828.14|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3638||||3638|618.38|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3638||||3638|1033.37|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3638||||3638|780.77|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MULTIPLAN [1680]|HMA [168003]|3638||||3638|1148.19|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MULTIPLAN [1680]|IHC HS [168011]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3638||||3638|665.5|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3638||||3638|834.08|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|Self-pay|Self-pay|3638||||3638|1091.4|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3638||||3638|763.98|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3638||||3638|750.15|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3638||||3638|1117.57|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|TRUSTMARK [2030]|STARMARK [203000]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3638||||3638|1744.42|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|UMR [2035]|UMR OPTIONS [203501]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3638||||3638|588.94|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3638||||3638|3274.2|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3638||||3638|0|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3638||||3638|1055.67|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3638||||3638|765.46|3383.34|588.94
36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3638||||3638|1819|3383.34|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|3436||||3436|0|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3436||||3436|773.42|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3436||||3436|640.29|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3436||||3436|640.29|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3436||||3436|1721.44|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3436||||3436|1206.04|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3436||||3436|1477.48|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3436||||3436|1463.74|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3436||||3436|1718|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3436||||3436|2233.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|CORESOURCE [1315]|CORESOURCE [131500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3436||||3436|2256.08|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3436||||3436|1055.67|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|GEHA [1415]|GEHA [141500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3436||||3436|1706.07|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HEALTHNET [1495]|HEALTHNET [149500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3436||||3436|1477.48|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3436||||3436|3195.48|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3436||||3436|2061.6|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3436||||3436|834.08|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3436||||3436|1828.14|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3436||||3436|618.38|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3436||||3436|1023.64|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3436||||3436|773.42|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MULTIPLAN [1680]|HMA [168003]|3436||||3436|1137.38|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MULTIPLAN [1680]|IHC HS [168011]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3436||||3436|665.5|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3436||||3436|834.08|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|Self-pay|Self-pay|3436||||3436|1030.8|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3436||||3436|721.56|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3436||||3436|743.09|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3436||||3436|1107.05|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|TRUSTMARK [2030]|STARMARK [203000]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3436||||3436|1647.56|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|UMR [2035]|UMR OPTIONS [203501]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3436||||3436|588.94|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3436||||3436|3092.4|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3436||||3436|0|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3436||||3436|1055.67|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3436||||3436|758.25|3195.48|588.94
36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3436||||3436|1718|3195.48|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|AETNA [1015]|AETNA ACO WILCO [101532]|5314||||5314|0|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5314||||5314|780.77|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5314||||5314|640.29|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5314||||5314|640.29|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5314||||5314|758.25|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5314||||5314|2662.31|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5314||||5314|1865.21|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5314||||5314|2285.02|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5314||||5314|2263.76|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5314||||5314|2657|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5314||||5314|3454.1|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|CORESOURCE [1315]|CORESOURCE [131500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5314||||5314|3489.17|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5314||||5314|1055.67|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|GEHA [1415]|GEHA [141500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5314||||5314|1722.28|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HEALTHNET [1495]|HEALTHNET [149500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5314||||5314|2285.02|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5314||||5314|4942.02|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5314||||5314|3188.4|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5314||||5314|834.08|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5314||||5314|1828.14|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5314||||5314|618.38|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5314||||5314|1033.37|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5314||||5314|780.77|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MULTIPLAN [1680]|HMA [168003]|5314||||5314|1148.19|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MULTIPLAN [1680]|IHC HS [168011]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5314||||5314|665.5|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5314||||5314|834.08|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|Self-pay|Self-pay|5314||||5314|1594.2|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5314||||5314|1115.94|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5314||||5314|750.15|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5314||||5314|1117.57|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|TRUSTMARK [2030]|STARMARK [203000]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5314||||5314|2548.06|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|UMR [2035]|UMR OPTIONS [203501]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5314||||5314|588.94|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5314||||5314|4782.6|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5314||||5314|0|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5314||||5314|1055.67|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5314||||5314|765.46|4942.02|588.94
36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5314||||5314|2657|4942.02|588.94
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|781||||781|0|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|781||||781|245.6|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|781||||781|227.72|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|781||||781|227.72|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|781||||781|391.28|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|781||||781|274.13|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|781||||781|335.83|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|781||||781|332.71|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|781||||781|390.5|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|781||||781|507.65|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|781||||781|512.8|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|781||||781|340.3|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|GEHA [1415]|GEHA [141500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|781||||781|541.75|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|781||||781|335.83|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|781||||781|726.33|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|781||||781|468.6|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|781||||781|264.86|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|781||||781|591.53|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|781||||781|219.92|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|781||||781|325.05|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|781||||781|245.6|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MULTIPLAN [1680]|HMA [168003]|781||||781|361.17|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|781||||781|236.69|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|781||||781|264.86|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|Self-pay|Self-pay|781||||781|234.3|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|781||||781|164.01|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|781||||781|235.96|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|781||||781|351.54|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|781||||781|374.49|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|UMR [2035]|UMR OPTIONS [203501]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|781||||781|209.45|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|781||||781|702.9|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|781||||781|0|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|781||||781|340.3|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|781||||781|240.78|726.33|164.01
36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|781||||781|390.5|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|AETNA [1015]|AETNA ACO WILCO [101532]|781||||781|0|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|781||||781|245.6|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|781||||781|247.44|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|781||||781|247.44|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|781||||781|391.28|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|781||||781|274.13|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|781||||781|335.83|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|781||||781|332.71|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|781||||781|390.5|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|781||||781|507.65|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|CORESOURCE [1315]|CORESOURCE [131500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|781||||781|512.8|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|781||||781|340.3|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|GEHA [1415]|GEHA [141500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|781||||781|541.75|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HEALTHNET [1495]|HEALTHNET [149500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|781||||781|335.83|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|781||||781|726.33|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|781||||781|468.6|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|781||||781|264.86|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|781||||781|591.53|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|781||||781|238.96|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|781||||781|325.05|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|781||||781|245.6|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MULTIPLAN [1680]|HMA [168003]|781||||781|361.17|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MULTIPLAN [1680]|IHC HS [168011]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|781||||781|257.18|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|781||||781|264.86|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|Self-pay|Self-pay|781||||781|234.3|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|781||||781|164.01|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|781||||781|235.96|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|781||||781|351.54|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|TRUSTMARK [2030]|STARMARK [203000]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|781||||781|374.49|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|UMR [2035]|UMR OPTIONS [203501]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|781||||781|227.59|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|781||||781|702.9|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|781||||781|0|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|781||||781|340.3|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|781||||781|240.78|726.33|164.01
36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|781||||781|390.5|726.33|164.01
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|AETNA [1015]|AETNA ACO WILCO [101532]|5401||||5401|0|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5401||||5401|1649.79|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5401||||5401|2268.28|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5401||||5401|2268.28|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5401||||5401|2705.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5401||||5401|1895.75|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5401||||5401|2322.43|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5401||||5401|2300.83|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5401||||5401|2700.5|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5401||||5401|3510.65|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|CORESOURCE [1315]|CORESOURCE [131500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5401||||5401|3546.3|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5401||||5401|2235.16|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|GEHA [1415]|GEHA [141500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5401||||5401|3639.24|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HEALTHNET [1495]|HEALTHNET [149500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5401||||5401|2322.43|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5401||||5401|5022.93|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5401||||5401|3240.6|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5401||||5401|1779.18|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5401||||5401|0|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5401||||5401|0|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5401||||5401|2183.54|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5401||||5401|1649.79|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MULTIPLAN [1680]|HMA [168003]|5401||||5401|2426.16|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MULTIPLAN [1680]|IHC HS [168011]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5401||||5401|2357.59|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5401||||5401|1779.18|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|Self-pay|Self-pay|5401||||5401|1620.3|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5401||||5401|1134.21|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5401||||5401|1585.09|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5401||||5401|2361.46|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|TRUSTMARK [2030]|STARMARK [203000]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5401||||5401|2589.78|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|UMR [2035]|UMR OPTIONS [203501]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5401||||5401|0|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5401||||5401|4860.9|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5401||||5401|0|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5401||||5401|2235.16|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5401||||5401|1617.44|5022.93|1134.21
36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC  DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5401||||5401|2700.5|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|AETNA [1015]|AETNA ACO WILCO [101532]|5401||||5401|0|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5401||||5401|1665.46|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5401||||5401|2268.28|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5401||||5401|2268.28|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5401||||5401|1617.44|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5401||||5401|2705.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5401||||5401|1895.75|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5401||||5401|2322.43|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5401||||5401|2300.83|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5401||||5401|2700.5|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5401||||5401|3510.65|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|CORESOURCE [1315]|CORESOURCE [131500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5401||||5401|3546.3|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5401||||5401|2235.16|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|GEHA [1415]|GEHA [141500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5401||||5401|3673.82|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HEALTHNET [1495]|HEALTHNET [149500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5401||||5401|2322.43|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5401||||5401|5022.93|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5401||||5401|3240.6|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5401||||5401|1779.18|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5401||||5401|0|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5401||||5401|0|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5401||||5401|2204.29|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5401||||5401|1665.46|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MULTIPLAN [1680]|HMA [168003]|5401||||5401|2449.21|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MULTIPLAN [1680]|IHC HS [168011]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5401||||5401|2357.59|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5401||||5401|1779.18|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|Self-pay|Self-pay|5401||||5401|1620.3|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5401||||5401|1134.21|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5401||||5401|1600.15|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5401||||5401|2383.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|TRUSTMARK [2030]|STARMARK [203000]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5401||||5401|2589.78|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|UMR [2035]|UMR OPTIONS [203501]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5401||||5401|0|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5401||||5401|4860.9|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5401||||5401|0|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5401||||5401|2235.16|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5401||||5401|1632.81|5022.93|1134.21
36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5401||||5401|2700.5|5022.93|1134.21
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|AETNA [1015]|AETNA ACO WILCO [101532]|5341||||5341|0|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5341||||5341|1649.79|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5341||||5341|664.08|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5341||||5341|664.08|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5341||||5341|2675.84|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5341||||5341|1874.69|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5341||||5341|2296.63|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5341||||5341|2275.27|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5341||||5341|2670.5|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5341||||5341|3471.65|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|CORESOURCE [1315]|CORESOURCE [131500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5341||||5341|3506.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5341||||5341|2235.16|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|GEHA [1415]|GEHA [141500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5341||||5341|3639.24|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HEALTHNET [1495]|HEALTHNET [149500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5341||||5341|2296.63|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5341||||5341|4967.13|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5341||||5341|3204.6|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5341||||5341|1779.18|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5341||||5341|3899.62|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5341||||5341|641.36|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5341||||5341|2183.54|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5341||||5341|1649.79|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MULTIPLAN [1680]|HMA [168003]|5341||||5341|2426.16|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MULTIPLAN [1680]|IHC HS [168011]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5341||||5341|690.23|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5341||||5341|1779.18|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|Self-pay|Self-pay|5341||||5341|1602.3|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5341||||5341|1121.61|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5341||||5341|1585.09|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5341||||5341|2361.46|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|TRUSTMARK [2030]|STARMARK [203000]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5341||||5341|2561.01|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|UMR [2035]|UMR OPTIONS [203501]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5341||||5341|610.82|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5341||||5341|4806.9|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5341||||5341|0|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5341||||5341|2235.16|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5341||||5341|1617.44|4967.13|610.82
36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5341||||5341|2670.5|4967.13|610.82
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|AETNA [1015]|AETNA ACO WILCO [101532]|2350||||2350|0|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2350||||2350|232.09|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2350||||2350|232.09|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2350||||2350|1177.35|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2350||||2350|824.85|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2350||||2350|1010.5|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2350||||2350|1001.1|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2350||||2350|1175|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2350||||2350|1527.5|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|CORESOURCE [1315]|CORESOURCE [131500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2350||||2350|1543.01|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2350||||2350|551.4|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|GEHA [1415]|GEHA [141500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HEALTHNET [1495]|HEALTHNET [149500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2350||||2350|1010.5|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2350||||2350|2185.5|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2350||||2350|1410|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2350||||2350|1175|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2350||||2350|224.15|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MULTIPLAN [1680]|HMA [168003]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MULTIPLAN [1680]|IHC HS [168011]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2350||||2350|241.23|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|Self-pay|Self-pay|2350||||2350|705|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2350||||2350|493.5|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|TRUSTMARK [2030]|STARMARK [203000]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2350||||2350|1126.83|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|UMR [2035]|UMR OPTIONS [203501]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2350||||2350|213.48|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2350||||2350|2115|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2350||||2350|0|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2350||||2350|551.4|2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2350||||2350||2185.5|213.48
36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2350||||2350|1175|2185.5|213.48
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|AETNA [1015]|AETNA ACO WILCO [101532]|5349||||5349|0|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5349||||5349|1649.79|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5349||||5349|1146.03|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5349||||5349|1146.03|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5349||||5349|2679.85|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5349||||5349|1877.5|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5349||||5349|2300.07|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5349||||5349|2278.67|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5349||||5349|2674.5|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5349||||5349|3476.85|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|CORESOURCE [1315]|CORESOURCE [131500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5349||||5349|3512.15|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5349||||5349|2235.16|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|GEHA [1415]|GEHA [141500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5349||||5349|3639.24|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HEALTHNET [1495]|HEALTHNET [149500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5349||||5349|2300.07|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5349||||5349|4974.57|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5349||||5349|3209.4|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5349||||5349|1779.18|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5349||||5349|3899.62|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5349||||5349|1106.82|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5349||||5349|2183.54|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5349||||5349|1649.79|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MULTIPLAN [1680]|HMA [168003]|5349||||5349|2426.16|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MULTIPLAN [1680]|IHC HS [168011]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5349||||5349|1191.15|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5349||||5349|1779.18|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|Self-pay|Self-pay|5349||||5349|1604.7|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5349||||5349|1123.29|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5349||||5349|1585.09|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5349||||5349|2361.46|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|TRUSTMARK [2030]|STARMARK [203000]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5349||||5349|2564.85|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|UMR [2035]|UMR OPTIONS [203501]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5349||||5349|1054.12|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5349||||5349|4814.1|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5349||||5349|0|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5349||||5349|2235.16|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5349||||5349|1617.44|4974.57|1054.12
36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5349||||5349|2674.5|4974.57|1054.12
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|AETNA [1015]|AETNA ACO WILCO [101532]|5456||||5456|0|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5456||||5456|664.08|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5456||||5456|664.08|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5456||||5456|2733.46|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5456||||5456|1915.06|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5456||||5456|2346.08|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5456||||5456|2324.26|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5456||||5456|2728|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5456||||5456|3546.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|CORESOURCE [1315]|CORESOURCE [131500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5456||||5456|3582.41|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5456||||5456|501.94|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|GEHA [1415]|GEHA [141500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HEALTHNET [1495]|HEALTHNET [149500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5456||||5456|2346.08|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5456||||5456|5074.08|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5456||||5456|3273.6|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5456||||5456|2728|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5456||||5456|641.36|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MULTIPLAN [1680]|HMA [168003]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MULTIPLAN [1680]|IHC HS [168011]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5456||||5456|690.23|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|Self-pay|Self-pay|5456||||5456|1636.8|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5456||||5456|1145.76|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|TRUSTMARK [2030]|STARMARK [203000]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5456||||5456|2616.15|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|UMR [2035]|UMR OPTIONS [203501]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5456||||5456|610.82|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5456||||5456|4910.4|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5456||||5456|0|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5456||||5456|501.94|5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5456||||5456||5074.08|501.94
36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5456||||5456|2728|5074.08|501.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|AETNA [1015]|AETNA ACO WILCO [101532]|3039||||3039|0|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3039||||3039|780.77|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3039||||3039|640.29|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3039||||3039|640.29|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3039||||3039|758.25|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3039||||3039|1522.54|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3039||||3039|1066.69|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3039||||3039|1306.77|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3039||||3039|1294.61|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3039||||3039|1519.5|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3039||||3039|1975.35|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|CORESOURCE [1315]|CORESOURCE [131500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3039||||3039|1995.41|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3039||||3039|1055.67|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|GEHA [1415]|GEHA [141500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3039||||3039|1722.28|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HEALTHNET [1495]|HEALTHNET [149500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3039||||3039|1306.77|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3039||||3039|2826.27|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3039||||3039|1823.4|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3039||||3039|834.08|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3039||||3039|1828.14|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3039||||3039|618.38|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3039||||3039|1033.37|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3039||||3039|780.77|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MULTIPLAN [1680]|HMA [168003]|3039||||3039|1148.19|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MULTIPLAN [1680]|IHC HS [168011]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3039||||3039|665.5|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3039||||3039|834.08|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|Self-pay|Self-pay|3039||||3039|911.7|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3039||||3039|638.19|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3039||||3039|750.15|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3039||||3039|1117.57|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|TRUSTMARK [2030]|STARMARK [203000]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3039||||3039|1457.2|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|UMR [2035]|UMR OPTIONS [203501]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3039||||3039|588.94|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3039||||3039|2735.1|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3039||||3039|0|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3039||||3039|1055.67|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3039||||3039|765.46|2826.27|588.94
36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3039||||3039|1519.5|2826.27|588.94
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1772||||1772|0|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1772||||1772|596.75|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1772||||1772|433.16|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1772||||1772|433.16|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1772||||1772|887.77|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1772||||1772|621.97|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1772||||1772|761.96|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1772||||1772|754.87|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1772||||1772|886|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1772||||1772|1151.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|CORESOURCE [1315]|CORESOURCE [131500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1772||||1772|1163.5|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1772||||1772|812.57|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|GEHA [1415]|GEHA [141500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1772||||1772|1316.37|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HEALTHNET [1495]|HEALTHNET [149500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1772||||1772|761.96|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1772||||1772|1647.96|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1772||||1772|1063.2|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1772||||1772|643.56|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1772||||1772|1431.31|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1772||||1772|418.34|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1772||||1772|789.82|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1772||||1772|596.75|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MULTIPLAN [1680]|HMA [168003]|1772||||1772|877.58|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MULTIPLAN [1680]|IHC HS [168011]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1772||||1772|450.22|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1772||||1772|643.56|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|Self-pay|Self-pay|1772||||1772|531.6|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1772||||1772|372.12|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1772||||1772|573.35|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1772||||1772|854.18|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|TRUSTMARK [2030]|STARMARK [203000]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1772||||1772|849.67|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|UMR [2035]|UMR OPTIONS [203501]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1772||||1772|398.42|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1772||||1772|1594.8|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1772||||1772|0|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1772||||1772|812.57|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1772||||1772|585.05|1647.96|372.12
36064642|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1772||||1772|886|1647.96|372.12
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1772||||1772|887.77|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1772||||1772|621.97|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1772||||1772|761.96|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1772||||1772|754.87|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1772||||1772|886|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1772||||1772|1151.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|CORESOURCE [1315]|CORESOURCE [131500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1772||||1772|1163.5|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1772||||1772|251.2|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|GEHA [1415]|GEHA [141500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HEALTHNET [1495]|HEALTHNET [149500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1772||||1772|761.96|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1772||||1772|1647.96|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1772||||1772|1063.2|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1772||||1772|886|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MULTIPLAN [1680]|HMA [168003]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MULTIPLAN [1680]|IHC HS [168011]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|Self-pay|Self-pay|1772||||1772|531.6|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1772||||1772|372.12|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|TRUSTMARK [2030]|STARMARK [203000]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1772||||1772|849.67|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|UMR [2035]|UMR OPTIONS [203501]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1772||||1772|1594.8|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1772||||1772|0|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1772||||1772|251.2|1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1772||||1772||1647.96|251.2
36064643|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1772||||1772|886|1647.96|251.2
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1950||||1950|0|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1950||||1950|596.75|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1950||||1950|433.16|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1950||||1950|433.16|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1950||||1950|976.95|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1950||||1950|684.45|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1950||||1950|838.5|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1950||||1950|830.7|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1950||||1950|975|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1950||||1950|1267.5|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|CORESOURCE [1315]|CORESOURCE [131500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1950||||1950|1280.37|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1950||||1950|812.57|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|GEHA [1415]|GEHA [141500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1950||||1950|1316.37|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HEALTHNET [1495]|HEALTHNET [149500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1950||||1950|838.5|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1950||||1950|1813.5|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1950||||1950|1170|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1950||||1950|643.56|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1950||||1950|1431.31|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1950||||1950|418.34|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1950||||1950|789.82|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1950||||1950|596.75|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MULTIPLAN [1680]|HMA [168003]|1950||||1950|877.58|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MULTIPLAN [1680]|IHC HS [168011]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1950||||1950|450.22|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1950||||1950|643.56|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|Self-pay|Self-pay|1950||||1950|585|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1950||||1950|409.5|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1950||||1950|573.35|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1950||||1950|854.18|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|TRUSTMARK [2030]|STARMARK [203000]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1950||||1950|935.03|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|UMR [2035]|UMR OPTIONS [203501]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1950||||1950|398.42|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1950||||1950|1755|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1950||||1950|0|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1950||||1950|812.57|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1950||||1950|585.05|1813.5|398.42
36064644|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1950||||1950|975|1813.5|398.42
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|AETNA [1015]|AETNA ACO WILCO [101532]|772||||772|0|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|772||||772|386.77|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|772||||772|270.97|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|772||||772|331.96|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|772||||772|328.87|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|772||||772|386|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|772||||772|501.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|CORESOURCE [1315]|CORESOURCE [131500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|772||||772|506.9|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|GEHA [1415]|GEHA [141500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HEALTHNET [1495]|HEALTHNET [149500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|772||||772|331.96|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|772||||772|717.96|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|772||||772|463.2|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|772||||772|591.53|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MULTIPLAN [1680]|HMA [168003]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MULTIPLAN [1680]|IHC HS [168011]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|Self-pay|Self-pay|772||||772|231.6|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|772||||772|162.12|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|TRUSTMARK [2030]|STARMARK [203000]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|772||||772|370.17|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|UMR [2035]|UMR OPTIONS [203501]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|772||||772|694.8|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|772||||772|0|717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|772||||772||717.96|162.12
36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|772||||772|386|717.96|162.12
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA ACO WILCO [101532]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62.04||||62.04|31.08|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.04||||62.04|21.78|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.04||||62.04|26.68|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62.04||||62.04|26.43|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62.04||||62.04|31.02|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.04||||62.04|40.33|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CORESOURCE [1315]|CORESOURCE [131500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|CORVEL CORP [2235]|CORVEL CORP [223500]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62.04||||62.04|22.95|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|GEHA [1415]|GEHA [141500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHNET [1495]|HEALTHNET [149500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.04||||62.04|26.68|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HEALTHSMART [1505]|HEALTHSMART [150501]|62.04||||62.04|57.7|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.04||||62.04|37.22|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|HMA [168003]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MULTIPLAN [1680]|IHC HS [168011]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PENDING SSI [1616]|PENDING SSI RCA [161601]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|Self-pay|Self-pay|62.04||||62.04|18.61|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.04||||62.04|13.03|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|TRUSTMARK [2030]|STARMARK [203000]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.04||||62.04|29.75|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UMR [2035]|UMR OPTIONS [203501]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.04||||62.04|55.84|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62.04||||62.04|0|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62.04||||62.04|22.95|57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62.04||||62.04||57.7|13.03
36267|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.0375 MG/24 HR WEEKLY TRANSDERMAL PATCH|1 patch|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62.04||||62.04|31.02|57.7|13.03
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43.82||||43.82|21.95|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.82||||43.82|15.38|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.82||||43.82|18.84|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43.82||||43.82|18.67|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43.82||||43.82|21.91|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.82||||43.82|28.48|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43.82||||43.82|16.21|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.82||||43.82|18.84|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|43.82||||43.82|40.75|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.82||||43.82|26.29|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|Self-pay|Self-pay|43.82||||43.82|13.15|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.82||||43.82|9.2|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.82||||43.82|21.01|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.82||||43.82|39.44|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43.82||||43.82|0|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43.82||||43.82|16.21|40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43.82||||43.82||40.75|9.2
36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43.82||||43.82|21.91|40.75|9.2
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|AETNA [1015]|AETNA ACO WILCO [101532]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.07||||60.07|30.1|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.07||||60.07|21.08|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.07||||60.07|25.83|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.07||||60.07|25.59|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.07||||60.07|30.04|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.07||||60.07|39.05|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|CORESOURCE [1315]|CORESOURCE [131500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.07||||60.07|22.23|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|GEHA [1415]|GEHA [141500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HEALTHNET [1495]|HEALTHNET [149500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.07||||60.07|25.83|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|60.07||||60.07|55.87|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.07||||60.07|36.04|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MULTIPLAN [1680]|HMA [168003]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MULTIPLAN [1680]|IHC HS [168011]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|Self-pay|Self-pay|60.07||||60.07|18.02|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.07||||60.07|12.61|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|TRUSTMARK [2030]|STARMARK [203000]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.07||||60.07|28.8|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|UMR [2035]|UMR OPTIONS [203501]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.07||||60.07|54.06|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.07||||60.07|0|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.07||||60.07|22.23|55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.07||||60.07||55.87|12.61
365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|473 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.07||||60.07|30.04|55.87|12.61
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40.49||||40.49|20.29|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40.49||||40.49|14.21|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40.49||||40.49|17.41|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40.49||||40.49|17.25|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40.49||||40.49|20.25|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40.49||||40.49|26.32|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40.49||||40.49|14.98|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40.49||||40.49|17.41|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|40.49||||40.49|37.66|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40.49||||40.49|24.29|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|Self-pay|Self-pay|40.49||||40.49|12.15|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40.49||||40.49|8.5|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40.49||||40.49|19.41|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40.49||||40.49|36.44|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40.49||||40.49|0|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40.49||||40.49|14.98|37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40.49||||40.49||37.66|8.5
36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40.49||||40.49|20.25|37.66|8.5
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|177 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|20 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
36982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|AETNA ACO WILCO [101532]|1278.12||||1278.12|0|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1278.12||||1278.12|465|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1278.12||||1278.12|465|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1278.12||||1278.12|640.34|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1278.12||||1278.12|448.62|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1278.12||||1278.12|549.59|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1278.12||||1278.12|544.48|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1278.12||||1278.12|639.06|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1278.12||||1278.12|830.78|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CORESOURCE [1315]|CORESOURCE [131500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|1278.12||||1278.12|202.86|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1278.12||||1278.12|472.9|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|GEHA [1415]|GEHA [141500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHNET [1495]|HEALTHNET [149500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1278.12||||1278.12|549.59|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|1278.12||||1278.12|1188.65|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1278.12||||1278.12|766.87|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1278.12||||1278.12|265|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1278.12||||1278.12|452.93|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MULTIPLAN [1680]|HMA [168003]|1278.12||||1278.12|447.34|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MULTIPLAN [1680]|IHC HS [168011]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|1278.12||||1278.12|483.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|Self-pay|Self-pay|1278.12||||1278.12|383.44|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1278.12||||1278.12|268.41|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1278.12||||1278.12|84.8|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRUSTMARK [2030]|STARMARK [203000]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1278.12||||1278.12|612.86|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UMR [2035]|UMR OPTIONS [203501]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1278.12||||1278.12|431.35|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1278.12||||1278.12|1150.31|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1278.12||||1278.12|0|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1278.12||||1278.12|472.9|1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1278.12||||1278.12||1188.65|84.8
36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1278.12||||1278.12|639.06|1188.65|84.8
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5082||||5082|2546.08|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5082||||5082|1783.78|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5082||||5082|2185.26|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5082||||5082|2164.93|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5082||||5082|2541|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5082||||5082|3303.3|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|CORESOURCE [1315]|CORESOURCE [131500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5082||||5082|1880.34|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|GEHA [1415]|GEHA [141500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HEALTHNET [1495]|HEALTHNET [149500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5082||||5082|2185.26|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5082||||5082|4726.26|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5082||||5082|3049.2|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MULTIPLAN [1680]|HMA [168003]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MULTIPLAN [1680]|IHC HS [168011]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|Self-pay|Self-pay|5082||||5082|1524.6|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5082||||5082|1067.22|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|TRUSTMARK [2030]|STARMARK [203000]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5082||||5082|2436.82|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|UMR [2035]|UMR OPTIONS [203501]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5082||||5082|4573.8|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5082||||5082|0|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5082||||5082|1880.34|4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5082||||5082||4726.26|1067.22
37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5082||||5082|2541|4726.26|1067.22
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1143||||1143|572.64|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1143||||1143|401.19|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1143||||1143|491.49|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1143||||1143|486.92|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1143||||1143|571.5|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1143||||1143|742.95|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|CORESOURCE [1315]|CORESOURCE [131500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1143||||1143|422.91|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|GEHA [1415]|GEHA [141500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HEALTHNET [1495]|HEALTHNET [149500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1143||||1143|491.49|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1143||||1143|1062.99|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1143||||1143|685.8|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MULTIPLAN [1680]|HMA [168003]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MULTIPLAN [1680]|IHC HS [168011]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|Self-pay|Self-pay|1143||||1143|342.9|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1143||||1143|240.03|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|TRUSTMARK [2030]|STARMARK [203000]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1143||||1143|548.07|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|UMR [2035]|UMR OPTIONS [203501]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1143||||1143|1028.7|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1143||||1143|0|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1143||||1143|422.91|1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1143||||1143||1062.99|240.03
37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1143||||1143|571.5|1062.99|240.03
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2748||||2748|1376.75|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2748||||2748|964.55|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2748||||2748|1181.64|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2748||||2748|1170.65|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2748||||2748|1374|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2748||||2748|1786.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|CORESOURCE [1315]|CORESOURCE [131500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2748||||2748|1016.76|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|GEHA [1415]|GEHA [141500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HEALTHNET [1495]|HEALTHNET [149500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2748||||2748|1181.64|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2748||||2748|2555.64|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2748||||2748|1648.8|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MULTIPLAN [1680]|HMA [168003]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MULTIPLAN [1680]|IHC HS [168011]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|Self-pay|Self-pay|2748||||2748|824.4|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2748||||2748|577.08|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|TRUSTMARK [2030]|STARMARK [203000]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2748||||2748|1317.67|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|UMR [2035]|UMR OPTIONS [203501]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2748||||2748|2473.2|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2748||||2748|0|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2748||||2748|1016.76|2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2748||||2748||2555.64|577.08
37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2748||||2748|1374|2555.64|577.08
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3563||||3563|1785.06|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3563||||3563|1250.61|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3563||||3563|1532.09|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3563||||3563|1517.84|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3563||||3563|1781.5|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3563||||3563|2315.95|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|CORESOURCE [1315]|CORESOURCE [131500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3563||||3563|1318.31|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|GEHA [1415]|GEHA [141500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HEALTHNET [1495]|HEALTHNET [149500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3563||||3563|1532.09|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3563||||3563|3313.59|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3563||||3563|2137.8|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MULTIPLAN [1680]|HMA [168003]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MULTIPLAN [1680]|IHC HS [168011]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|Self-pay|Self-pay|3563||||3563|1068.9|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3563||||3563|748.23|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|TRUSTMARK [2030]|STARMARK [203000]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3563||||3563|1708.46|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|UMR [2035]|UMR OPTIONS [203501]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3563||||3563|3206.7|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3563||||3563|0|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3563||||3563|1318.31|3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3563||||3563||3313.59|748.23
37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3563||||3563|1781.5|3313.59|748.23
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1001||||1001|501.5|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1001||||1001|351.35|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1001||||1001|430.43|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1001||||1001|426.43|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1001||||1001|500.5|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1001||||1001|650.65|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|CORESOURCE [1315]|CORESOURCE [131500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1001||||1001|370.37|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|GEHA [1415]|GEHA [141500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HEALTHNET [1495]|HEALTHNET [149500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1001||||1001|430.43|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1001||||1001|930.93|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1001||||1001|600.6|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1001||||1001|500.5|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MULTIPLAN [1680]|HMA [168003]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MULTIPLAN [1680]|IHC HS [168011]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|Self-pay|Self-pay|1001||||1001|300.3|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1001||||1001|210.21|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|TRUSTMARK [2030]|STARMARK [203000]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1001||||1001|479.98|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|UMR [2035]|UMR OPTIONS [203501]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1001||||1001|900.9|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1001||||1001|0|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1001||||1001|370.37|930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1001||||1001||930.93|210.21
37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1001||||1001|500.5|930.93|210.21
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|914||||914|457.91|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|914||||914|320.81|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|914||||914|393.02|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|914||||914|389.36|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|914||||914|457|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|914||||914|594.1|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|914||||914|338.18|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|GEHA [1415]|GEHA [141500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|914||||914|393.02|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|914||||914|850.02|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|914||||914|548.4|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|914||||914|457|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|Self-pay|Self-pay|914||||914|274.2|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|914||||914|191.94|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|914||||914|438.26|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|914||||914|822.6|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|914||||914|0|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|914||||914|338.18|850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|914||||914||850.02|191.94
37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|914||||914|457|850.02|191.94
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|430||||430|215.43|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|430||||430|150.93|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|430||||430|184.9|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|430||||430|183.18|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|430||||430|215|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|430||||430|279.5|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|430||||430|159.1|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|GEHA [1415]|GEHA [141500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|430||||430|184.9|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|430||||430|399.9|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|430||||430|258|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|430||||430|215|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|Self-pay|Self-pay|430||||430|129|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|430||||430|90.3|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|430||||430|206.19|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|430||||430|387|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|430||||430|0|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|430||||430|159.1|399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|430||||430||399.9|90.3
37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|430||||430|215|399.9|90.3
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|AETNA [1015]|AETNA ACO WILCO [101532]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28.59||||28.59|14.32|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.59||||28.59|10.04|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.59||||28.59|12.29|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28.59||||28.59|12.18|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28.59||||28.59|14.3|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.59||||28.59|18.58|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|CORESOURCE [1315]|CORESOURCE [131500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|CORVEL CORP [2235]|CORVEL CORP [223500]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28.59||||28.59|10.58|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|GEHA [1415]|GEHA [141500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HEALTHNET [1495]|HEALTHNET [149500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.59||||28.59|12.29|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HEALTHSMART [1505]|HEALTHSMART [150501]|28.59||||28.59|26.59|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.59||||28.59|17.15|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MULTIPLAN [1680]|HMA [168003]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MULTIPLAN [1680]|IHC HS [168011]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|Self-pay|Self-pay|28.59||||28.59|8.58|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.59||||28.59|6|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|TRUSTMARK [2030]|STARMARK [203000]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.59||||28.59|13.71|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|UMR [2035]|UMR OPTIONS [203501]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.59||||28.59|25.73|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28.59||||28.59|0|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28.59||||28.59|10.58|26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28.59||||28.59||26.59|6
3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|30 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28.59||||28.59|14.3|26.59|6
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|AETNA ACO WILCO [101532]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50.5||||50.5|25.3|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.5||||50.5|17.73|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.5||||50.5|21.72|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50.5||||50.5|21.51|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50.5||||50.5|25.25|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.5||||50.5|32.83|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|CORESOURCE [1315]|CORESOURCE [131500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|CORVEL CORP [2235]|CORVEL CORP [223500]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50.5||||50.5|18.69|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|GEHA [1415]|GEHA [141500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HEALTHNET [1495]|HEALTHNET [149500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.5||||50.5|21.72|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HEALTHSMART [1505]|HEALTHSMART [150501]|50.5||||50.5|46.97|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.5||||50.5|30.3|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MULTIPLAN [1680]|HMA [168003]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MULTIPLAN [1680]|IHC HS [168011]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|PENDING SSI [1616]|PENDING SSI RCA [161601]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|Self-pay|Self-pay|50.5||||50.5|15.15|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.5||||50.5|10.61|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|TRUSTMARK [2030]|STARMARK [203000]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.5||||50.5|24.21|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|UMR [2035]|UMR OPTIONS [203501]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.5||||50.5|45.45|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50.5||||50.5|0|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50.5||||50.5|18.69|46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50.5||||50.5||46.97|10.61
3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|1 suppository|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50.5||||50.5|25.25|46.97|10.61
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|AETNA [1015]|AETNA ACO WILCO [101532]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.18||||13.18|6.6|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.18||||13.18|4.63|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.18||||13.18|5.67|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.18||||13.18|5.61|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.18||||13.18|6.59|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.18||||13.18|8.57|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|CORESOURCE [1315]|CORESOURCE [131500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.18||||13.18|4.88|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|GEHA [1415]|GEHA [141500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HEALTHNET [1495]|HEALTHNET [149500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.18||||13.18|5.67|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|13.18||||13.18|12.26|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.18||||13.18|7.91|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MULTIPLAN [1680]|HMA [168003]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MULTIPLAN [1680]|IHC HS [168011]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|Self-pay|Self-pay|13.18||||13.18|3.95|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.18||||13.18|2.77|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|TRUSTMARK [2030]|STARMARK [203000]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.18||||13.18|6.32|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|UMR [2035]|UMR OPTIONS [203501]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.18||||13.18|11.86|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.18||||13.18|0|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.18||||13.18|4.88|12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.18||||13.18||12.26|2.77
37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|30 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.18||||13.18|6.59|12.26|2.77
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
37616|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25.08||||25.08|12.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.08||||25.08|8.8|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.08||||25.08|10.78|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25.08||||25.08|10.68|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25.08||||25.08|12.54|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.08||||25.08|16.3|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|25.08||||25.08|3.29|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25.08||||25.08|9.28|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.08||||25.08|10.78|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|25.08||||25.08|23.32|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.08||||25.08|15.05|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|25.08||||25.08|8.78|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|Self-pay|Self-pay|25.08||||25.08|7.52|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.08||||25.08|5.27|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.08||||25.08|2.01|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.08||||25.08|12.03|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.08||||25.08|22.57|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25.08||||25.08|0|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25.08||||25.08|9.28|23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25.08||||25.08||23.32|2.01
38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25.08||||25.08|12.54|23.32|2.01
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89.86||||89.86|45.02|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89.86||||89.86|31.54|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89.86||||89.86|38.64|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89.86||||89.86|38.28|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89.86||||89.86|44.93|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89.86||||89.86|58.41|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89.86||||89.86|33.25|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89.86||||89.86|38.64|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|89.86||||89.86|83.57|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89.86||||89.86|53.92|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|Self-pay|Self-pay|89.86||||89.86|26.96|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89.86||||89.86|18.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89.86||||89.86|43.09|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89.86||||89.86|80.87|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89.86||||89.86|0|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89.86||||89.86|33.25|83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89.86||||89.86||83.57|18.87
38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89.86||||89.86|44.93|83.57|18.87
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.08||||10.08|5.05|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.08||||10.08|3.54|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.08||||10.08|4.33|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.08||||10.08|4.29|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.08||||10.08|5.04|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.08||||10.08|6.55|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.08||||10.08|3.73|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.08||||10.08|4.33|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10.08||||10.08|9.37|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.08||||10.08|6.05|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|Self-pay|Self-pay|10.08||||10.08|3.02|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.08||||10.08|2.12|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.08||||10.08|4.83|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.08||||10.08|9.07|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.08||||10.08|0|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.08||||10.08|3.73|9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.08||||10.08||9.37|2.12
38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.08||||10.08|5.04|9.37|2.12
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|Self-pay|Self-pay|10||||10|3|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|2.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|AETNA [1015]|AETNA ACO WILCO [101532]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|146.3||||146.3|73.3|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146.3||||146.3|51.35|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146.3||||146.3|62.91|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|146.3||||146.3|62.32|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|146.3||||146.3|73.15|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146.3||||146.3|95.1|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|CORESOURCE [1315]|CORESOURCE [131500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|146.3||||146.3|54.13|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|GEHA [1415]|GEHA [141500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HEALTHNET [1495]|HEALTHNET [149500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146.3||||146.3|62.91|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|146.3||||146.3|136.06|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146.3||||146.3|87.78|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MULTIPLAN [1680]|HMA [168003]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MULTIPLAN [1680]|IHC HS [168011]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|Self-pay|Self-pay|146.3||||146.3|43.89|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146.3||||146.3|30.72|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|TRUSTMARK [2030]|STARMARK [203000]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146.3||||146.3|70.15|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|UMR [2035]|UMR OPTIONS [203501]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146.3||||146.3|131.67|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|146.3||||146.3|0|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|146.3||||146.3|54.13|136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|146.3||||146.3||136.06|30.72
38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|3.5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|146.3||||146.3|73.15|136.06|30.72
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|119||||119|0|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119||||119|61.46|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119||||119|61.46|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119||||119|59.62|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119||||119|41.77|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119||||119|51.17|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119||||119|50.69|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119||||119|59.5|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119||||119|77.35|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119||||119|0|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119||||119|44.03|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|GEHA [1415]|GEHA [141500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119||||119|51.17|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119||||119|110.67|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119||||119|71.4|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119||||119|118.07|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119||||119|59.36|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MULTIPLAN [1680]|HMA [168003]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119||||119|63.88|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|Self-pay|Self-pay|119||||119|35.7|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119||||119|24.99|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119||||119|57.06|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|UMR [2035]|UMR OPTIONS [203501]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119||||119|56.53|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119||||119|107.1|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119||||119|0|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119||||119|44.03|118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119||||119||118.07|24.99
39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119||||119|59.5|118.07|24.99
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|435||||435|0|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435||||435|192.28|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435||||435|246.35|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435||||435|246.35|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|435||||435|217.94|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435||||435|152.69|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435||||435|187.05|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|435||||435|185.31|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|435||||435|217.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435||||435|282.75|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|435||||435|0|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|435||||435|160.95|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|GEHA [1415]|GEHA [141500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|435||||435|424.15|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435||||435|187.05|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|435||||435|404.55|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435||||435|261|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435||||435|207.36|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435||||435|435|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435||||435|237.93|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435||||435|254.49|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435||||435|192.28|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MULTIPLAN [1680]|HMA [168003]|435||||435|282.77|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|435||||435|256.05|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435||||435|207.36|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|Self-pay|Self-pay|435||||435|130.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435||||435|91.35|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|435||||435|184.74|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435||||435|275.23|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435||||435|208.58|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|UMR [2035]|UMR OPTIONS [203501]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435||||435|226.59|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435||||435|391.5|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|435||||435|0|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|435||||435|160.95|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|435||||435|188.51|435|91.35
39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|435||||435|217.5|435|91.35
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|126||||126|0|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126||||126|84.32|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126||||126|100.29|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126||||126|100.29|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|126||||126|63.13|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126||||126|44.23|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126||||126|54.18|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|126||||126|53.68|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|126||||126|63|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126||||126|81.9|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|126||||126|0|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|126||||126|46.62|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|GEHA [1415]|GEHA [141500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|126||||126|126|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126||||126|54.18|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|126||||126|117.18|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126||||126|75.6|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126||||126|90.93|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126||||126|126|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126||||126|96.86|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126||||126|111.6|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126||||126|84.32|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MULTIPLAN [1680]|HMA [168003]|126||||126|124|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|126||||126|104.24|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126||||126|90.93|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|Self-pay|Self-pay|126||||126|37.8|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126||||126|26.46|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|126||||126|81.01|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126||||126|120.69|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126||||126|60.42|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|UMR [2035]|UMR OPTIONS [203501]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126||||126|92.25|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126||||126|113.4|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|126||||126|0|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|126||||126|46.62|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|126||||126|82.66|126|26.46
39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|126||||126|63|126|26.46
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|349||||349|0|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349||||349|87.87|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349||||349|87.87|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349||||349|174.85|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349||||349|122.5|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349||||349|150.07|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349||||349|148.67|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349||||349|174.5|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349||||349|226.85|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349||||349|0|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349||||349|129.13|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|GEHA [1415]|GEHA [141500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349||||349|150.07|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349||||349|324.57|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349||||349|209.4|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349||||349|258.06|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349||||349|84.87|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MULTIPLAN [1680]|HMA [168003]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349||||349|91.33|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|Self-pay|Self-pay|349||||349|104.7|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349||||349|73.29|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349||||349|167.35|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|UMR [2035]|UMR OPTIONS [203501]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349||||349|80.82|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349||||349|314.1|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349||||349|0|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349||||349|129.13|324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349||||349||324.57|73.29
39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349||||349|174.5|324.57|73.29
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|435||||435|0|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435||||435|186.97|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435||||435|186.97|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|435||||435|217.94|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435||||435|152.69|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435||||435|187.05|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|435||||435|185.31|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|435||||435|217.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435||||435|282.75|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|435||||435|0|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|435||||435|160.95|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|GEHA [1415]|GEHA [141500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435||||435|187.05|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|435||||435|404.55|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435||||435|261|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435||||435|334.91|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435||||435|180.58|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MULTIPLAN [1680]|HMA [168003]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|435||||435|194.33|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|Self-pay|Self-pay|435||||435|130.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435||||435|91.35|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435||||435|208.58|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|UMR [2035]|UMR OPTIONS [203501]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435||||435|171.98|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435||||435|391.5|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|435||||435|0|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|435||||435|160.95|404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|435||||435||404.55|91.35
39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|435||||435|217.5|404.55|91.35
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|463||||463|0|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|463||||463|324.54|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|463||||463|324.54|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|463||||463|231.96|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|463||||463|162.51|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|463||||463|199.09|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|463||||463|197.24|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|463||||463|231.5|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|463||||463|300.95|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|CORESOURCE [1315]|CORESOURCE [131500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|463||||463|0|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|463||||463|171.31|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|GEHA [1415]|GEHA [141500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HEALTHNET [1495]|HEALTHNET [149500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|463||||463|199.09|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|463||||463|430.59|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|463||||463|277.8|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|463||||463|463|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|463||||463|313.45|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MULTIPLAN [1680]|HMA [168003]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MULTIPLAN [1680]|IHC HS [168011]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|463||||463|337.32|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|Self-pay|Self-pay|463||||463|138.9|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|463||||463|97.23|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|TRUSTMARK [2030]|STARMARK [203000]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|463||||463|222.01|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|UMR [2035]|UMR OPTIONS [203501]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|463||||463|298.52|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|463||||463|416.7|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|463||||463|0|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|463||||463|171.31|463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|463||||463||463|97.23
39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|463||||463|231.5|463|97.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|963||||963|0|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|963||||963|496.53|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|963||||963|675.61|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|963||||963|675.61|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|963||||963|482.46|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|963||||963|338.01|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|963||||963|414.09|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|963||||963|410.24|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|963||||963|481.5|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|963||||963|625.95|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|CORESOURCE [1315]|CORESOURCE [131500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|963||||963|0|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|963||||963|356.31|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|GEHA [1415]|GEHA [141500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|963||||963|963|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HEALTHNET [1495]|HEALTHNET [149500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|963||||963|414.09|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|963||||963|895.59|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|963||||963|577.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|963||||963|535.48|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|963||||963|963|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|963||||963|652.53|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|963||||963|657.18|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|963||||963|496.53|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MULTIPLAN [1680]|HMA [168003]|963||||963|730.2|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MULTIPLAN [1680]|IHC HS [168011]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|963||||963|702.21|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|963||||963|535.48|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|Self-pay|Self-pay|963||||963|288.9|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|963||||963|202.23|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|963||||963|477.06|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|963||||963|710.72|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|TRUSTMARK [2030]|STARMARK [203000]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|963||||963|461.76|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|UMR [2035]|UMR OPTIONS [203501]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|963||||963|621.44|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|963||||963|866.7|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|963||||963|0|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|963||||963|356.31|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|963||||963|486.8|963|202.23
39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|963||||963|481.5|963|202.23
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|AETNA [1015]|AETNA ACO WILCO [101532]|1039||||1039|0|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1039||||1039|892.57|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1039||||1039|892.57|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1039||||1039|520.54|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1039||||1039|364.69|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1039||||1039|446.77|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1039||||1039|442.61|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1039||||1039|519.5|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1039||||1039|675.35|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|CORESOURCE [1315]|CORESOURCE [131500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1039||||1039|0|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1039||||1039|384.43|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|GEHA [1415]|GEHA [141500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HEALTHNET [1495]|HEALTHNET [149500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1039||||1039|446.77|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1039||||1039|966.27|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1039||||1039|623.4|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1039||||1039|1039|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1039||||1039|862.09|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MULTIPLAN [1680]|HMA [168003]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MULTIPLAN [1680]|IHC HS [168011]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1039||||1039|927.71|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|Self-pay|Self-pay|1039||||1039|311.7|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1039||||1039|218.19|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|TRUSTMARK [2030]|STARMARK [203000]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1039||||1039|498.2|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|UMR [2035]|UMR OPTIONS [203501]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1039||||1039|821.01|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1039||||1039|935.1|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1039||||1039|0|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1039||||1039|384.43|1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1039||||1039||1039|218.19
39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1039||||1039|519.5|1039|218.19
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|656||||656|0|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|656||||656|480.09|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|656||||656|480.09|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|656||||656|328.66|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|656||||656|230.26|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|656||||656|282.08|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|656||||656|279.46|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|656||||656|328|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|656||||656|426.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|CORESOURCE [1315]|CORESOURCE [131500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|656||||656|0|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|656||||656|242.72|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|GEHA [1415]|GEHA [141500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HEALTHNET [1495]|HEALTHNET [149500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|656||||656|282.08|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|656||||656|610.08|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|656||||656|393.6|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|656||||656|656|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|656||||656|463.69|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MULTIPLAN [1680]|HMA [168003]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MULTIPLAN [1680]|IHC HS [168011]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|656||||656|498.99|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|Self-pay|Self-pay|656||||656|196.8|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|656||||656|137.76|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|TRUSTMARK [2030]|STARMARK [203000]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|656||||656|314.55|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|UMR [2035]|UMR OPTIONS [203501]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|656||||656|441.6|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|656||||656|590.4|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|656||||656|0|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|656||||656|242.72|656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|656||||656||656|137.76
39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|656||||656|328|656|137.76
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|507||||507|0|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|507||||507|323.25|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|507||||507|323.25|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|507||||507|254.01|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|507||||507|177.96|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|507||||507|218.01|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|507||||507|215.98|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|507||||507|253.5|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|507||||507|329.55|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|507||||507|0|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|507||||507|187.59|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|GEHA [1415]|GEHA [141500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|507||||507|218.01|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|507||||507|471.51|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|507||||507|304.2|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|507||||507|507|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|507||||507|312.21|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MULTIPLAN [1680]|HMA [168003]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MULTIPLAN [1680]|IHC HS [168011]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|507||||507|335.98|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|Self-pay|Self-pay|507||||507|152.1|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|507||||507|106.47|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|TRUSTMARK [2030]|STARMARK [203000]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|507||||507|243.11|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|UMR [2035]|UMR OPTIONS [203501]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|507||||507|297.33|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|507||||507|456.3|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|507||||507|0|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|507||||507|187.59|507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|507||||507||507|106.47
39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|507||||507|253.5|507|106.47
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|AETNA [1015]|AETNA ACO WILCO [101532]|131||||131|0|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131||||131|124.8|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131||||131|124.8|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131||||131|65.63|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131||||131|45.98|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131||||131|56.33|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131||||131|55.81|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131||||131|65.5|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131||||131|85.15|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|CORESOURCE [1315]|CORESOURCE [131500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|131||||131|0|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131||||131|48.47|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|GEHA [1415]|GEHA [141500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HEALTHNET [1495]|HEALTHNET [149500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131||||131|56.33|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|131||||131|121.83|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131||||131|78.6|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131||||131|131|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131||||131|120.55|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MULTIPLAN [1680]|HMA [168003]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MULTIPLAN [1680]|IHC HS [168011]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|131||||131|129.71|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|Self-pay|Self-pay|131||||131|39.3|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131||||131|27.51|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|TRUSTMARK [2030]|STARMARK [203000]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131||||131|62.81|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|UMR [2035]|UMR OPTIONS [203501]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131||||131|114.8|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131||||131|117.9|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131||||131|0|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131||||131|48.47|131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131||||131||131|27.51
39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131||||131|65.5|131|27.51
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|AETNA [1015]|AETNA ACO WILCO [101532]|119||||119|0|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119||||119|102.19|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119||||119|102.19|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119||||119|59.62|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119||||119|41.77|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119||||119|51.17|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119||||119|50.69|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119||||119|59.5|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119||||119|77.35|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|CORESOURCE [1315]|CORESOURCE [131500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119||||119|0|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119||||119|44.03|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|GEHA [1415]|GEHA [141500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HEALTHNET [1495]|HEALTHNET [149500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119||||119|51.17|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119||||119|110.67|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119||||119|71.4|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119||||119|119|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119||||119|98.7|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MULTIPLAN [1680]|HMA [168003]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MULTIPLAN [1680]|IHC HS [168011]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119||||119|106.21|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|Self-pay|Self-pay|119||||119|35.7|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119||||119|24.99|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|TRUSTMARK [2030]|STARMARK [203000]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119||||119|57.06|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|UMR [2035]|UMR OPTIONS [203501]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119||||119|93.99|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119||||119|107.1|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119||||119|0|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119||||119|44.03|119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119||||119||119|24.99
39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119||||119|59.5|119|24.99
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|AETNA [1015]|AETNA ACO WILCO [101532]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64.81||||64.81|32.47|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.81||||64.81|22.75|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.81||||64.81|27.87|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64.81||||64.81|27.61|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64.81||||64.81|32.41|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.81||||64.81|42.13|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|CORESOURCE [1315]|CORESOURCE [131500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|CORVEL CORP [2235]|CORVEL CORP [223500]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64.81||||64.81|23.98|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|GEHA [1415]|GEHA [141500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HEALTHNET [1495]|HEALTHNET [149500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.81||||64.81|27.87|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HEALTHSMART [1505]|HEALTHSMART [150501]|64.81||||64.81|60.27|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.81||||64.81|38.89|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MULTIPLAN [1680]|HMA [168003]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MULTIPLAN [1680]|IHC HS [168011]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|Self-pay|Self-pay|64.81||||64.81|19.44|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.81||||64.81|13.61|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|TRUSTMARK [2030]|STARMARK [203000]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.81||||64.81|31.08|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|UMR [2035]|UMR OPTIONS [203501]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.81||||64.81|58.33|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64.81||||64.81|0|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64.81||||64.81|23.98|60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64.81||||64.81||60.27|13.61
39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|15 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64.81||||64.81|32.41|60.27|13.61
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2060||||2060|0|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2060||||2060|376.94|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2060||||2060|300.64|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2060||||2060|300.64|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2060||||2060|366.07|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2060||||2060|1032.06|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2060||||2060|723.06|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2060||||2060|885.8|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2060||||2060|877.56|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2060||||2060|1030|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2060||||2060|1339|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|CORESOURCE [1315]|CORESOURCE [131500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2060||||2060|0|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2060||||2060|762.2|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|GEHA [1415]|GEHA [141500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2060||||2060|831.48|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HEALTHNET [1495]|HEALTHNET [149500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2060||||2060|885.8|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2060||||2060|1915.8|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2060||||2060|1236|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2060||||2060|402.67|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2060||||2060|915.21|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2060||||2060|290.38|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2060||||2060|498.89|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2060||||2060|376.94|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MULTIPLAN [1680]|HMA [168003]|2060||||2060|554.32|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MULTIPLAN [1680]|IHC HS [168011]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2060||||2060|312.48|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2060||||2060|402.67|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|Self-pay|Self-pay|2060||||2060|618|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2060||||2060|432.6|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2060||||2060|358.07|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2060||||2060|539.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|TRUSTMARK [2030]|STARMARK [203000]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2060||||2060|987.77|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|UMR [2035]|UMR OPTIONS [203501]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2060||||2060|276.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2060||||2060|1854|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2060||||2060|0|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2060||||2060|762.2|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2060||||2060|369.54|1915.8|276.54
39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2060||||2060|1030|1915.8|276.54
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35.51||||35.51|17.79|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35.51||||35.51|12.46|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35.51||||35.51|15.27|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35.51||||35.51|15.13|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35.51||||35.51|17.76|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35.51||||35.51|23.08|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35.51||||35.51|13.14|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35.51||||35.51|15.27|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|35.51||||35.51|33.02|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35.51||||35.51|21.31|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|Self-pay|Self-pay|35.51||||35.51|10.65|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35.51||||35.51|7.46|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35.51||||35.51|17.03|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35.51||||35.51|31.96|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35.51||||35.51|0|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35.51||||35.51|13.14|33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35.51||||35.51||33.02|7.46
39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35.51||||35.51|17.76|33.02|7.46
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|2.47|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.69|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|2.47
400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|2.47
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|3.24|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|Self-pay|Self-pay|29||||29|8.7|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|4.11|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|3.24
40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|20 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|3.24
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|AETNA [1015]|AETNA ACO WILCO [101532]|829||||829|149.97|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|829||||829|103.45|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|829||||829|128.35|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|829||||829|128.35|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|829||||829|100.46|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|829||||829|415.33|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|829||||829|290.98|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|829||||829|356.47|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|829||||829|353.15|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|829||||829|414.5|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|829||||829|538.85|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|829||||829|101.42|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|CORESOURCE [1315]|CORESOURCE [131500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|829||||829|134.67|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|829||||829|82.45|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|GEHA [1415]|GEHA [141500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|829||||829|225.62|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HEALTHNET [1495]|HEALTHNET [149500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|829||||829|356.47|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|829||||829|770.97|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|829||||829|497.4|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|829||||829|101.42|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|829||||829|110.51|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|829||||829|268.93|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|829||||829|123.97|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|829||||829|136.91|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|829||||829|103.45|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MULTIPLAN [1680]|HMA [168003]|829||||829|152.13|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MULTIPLAN [1680]|IHC HS [168011]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|829||||829|133.4|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|829||||829|110.51|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|Self-pay|Self-pay|829||||829|248.7|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|829||||829|174.09|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|829||||829|101.42|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|829||||829|98.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|829||||829|148.07|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|TRUSTMARK [2030]|STARMARK [203000]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|829||||829|397.51|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|UMR [2035]|UMR OPTIONS [203501]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|829||||829|118.07|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|829||||829|746.1|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|829||||829|0|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|829||||829|82.45|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|829||||829|100.27|770.97|82.45
40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|829||||829|414.5|770.97|82.45
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|AETNA [1015]|AETNA ACO WILCO [101532]|682||||682|106.58|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|682||||682|103.45|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|682||||682|82.41|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|682||||682|82.41|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|682||||682|100.46|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|682||||682|341.68|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|682||||682|239.38|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|682||||682|293.26|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|682||||682|290.53|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|682||||682|341|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|682||||682|443.3|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|CORESOURCE [1315]|CORESOURCE [131500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|682||||682|102.36|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|682||||682|62.67|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|GEHA [1415]|GEHA [141500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|682||||682|228.19|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HEALTHNET [1495]|HEALTHNET [149500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|682||||682|293.26|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|682||||682|634.26|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|682||||682|409.2|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|682||||682|110.51|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|682||||682|268.93|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|682||||682|79.6|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|682||||682|136.91|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|682||||682|103.45|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MULTIPLAN [1680]|HMA [168003]|682||||682|152.13|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MULTIPLAN [1680]|IHC HS [168011]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|682||||682|85.65|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|682||||682|110.51|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|Self-pay|Self-pay|682||||682|204.6|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|682||||682|143.22|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|682||||682|99.39|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|682||||682|148.07|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|TRUSTMARK [2030]|STARMARK [203000]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|682||||682|327.02|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|UMR [2035]|UMR OPTIONS [203501]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|682||||682|75.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|682||||682|613.8|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|682||||682|0|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|682||||682|62.67|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|682||||682|101.42|634.26|62.67
40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|682||||682|341|634.26|62.67
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1213||||1213|139.58|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1213||||1213|103.45|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1213||||1213|128.35|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1213||||1213|128.35|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1213||||1213|100.46|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1213||||1213|607.71|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1213||||1213|425.76|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1213||||1213|521.59|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1213||||1213|516.74|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1213||||1213|606.5|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1213||||1213|788.45|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1213||||1213|147.21|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1213||||1213|90.13|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|GEHA [1415]|GEHA [141500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1213||||1213|228.19|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1213||||1213|521.59|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1213||||1213|1128.09|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1213||||1213|727.8|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1213||||1213|110.51|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1213||||1213|268.93|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1213||||1213|123.97|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1213||||1213|136.91|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1213||||1213|103.45|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|1213||||1213|152.13|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1213||||1213|133.4|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1213||||1213|110.51|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|Self-pay|Self-pay|1213||||1213|363.9|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1213||||1213|254.73|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1213||||1213|99.39|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1213||||1213|148.07|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1213||||1213|581.63|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1213||||1213|118.07|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1213||||1213|1091.7|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1213||||1213|0|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1213||||1213|90.13|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1213||||1213|101.42|1128.09|90.13
40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1213||||1213|606.5|1128.09|90.13
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|1004||||1004|105.97|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1004||||1004|103.45|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1004||||1004|128.35|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1004||||1004|128.35|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1004||||1004|100.46|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1004||||1004|503|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1004||||1004|352.4|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1004||||1004|431.72|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1004||||1004|427.7|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1004||||1004|502|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1004||||1004|652.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1004||||1004|113.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1004||||1004|69.55|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|GEHA [1415]|GEHA [141500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1004||||1004|228.19|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1004||||1004|431.72|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1004||||1004|933.72|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1004||||1004|602.4|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1004||||1004|110.51|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1004||||1004|268.93|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1004||||1004|123.97|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1004||||1004|136.91|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1004||||1004|103.45|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MULTIPLAN [1680]|HMA [168003]|1004||||1004|152.13|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1004||||1004|133.4|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1004||||1004|110.51|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|Self-pay|Self-pay|1004||||1004|301.2|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1004||||1004|210.84|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1004||||1004|99.39|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1004||||1004|148.07|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1004||||1004|481.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1004||||1004|118.07|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1004||||1004|903.6|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1004||||1004|0|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1004||||1004|69.55|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1004||||1004|101.42|933.72|69.55
40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1004||||1004|502|933.72|69.55
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1069||||1069|130.41|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1069||||1069|103.45|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1069||||1069|128.35|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1069||||1069|128.35|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1069||||1069|100.46|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1069||||1069|535.57|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1069||||1069|375.22|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1069||||1069|459.67|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1069||||1069|455.39|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1069||||1069|534.5|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1069||||1069|694.85|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1069||||1069|138.93|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1069||||1069|85.06|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|GEHA [1415]|GEHA [141500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1069||||1069|225.62|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1069||||1069|459.67|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1069||||1069|994.17|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1069||||1069|641.4|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1069||||1069|101.42|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1069||||1069|110.51|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1069||||1069|268.93|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1069||||1069|123.97|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1069||||1069|136.91|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1069||||1069|103.45|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|1069||||1069|152.13|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1069||||1069|133.4|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1069||||1069|110.51|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|Self-pay|Self-pay|1069||||1069|320.7|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1069||||1069|224.49|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1069||||1069|101.42|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1069||||1069|98.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1069||||1069|148.07|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1069||||1069|512.59|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1069||||1069|118.07|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1069||||1069|962.1|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1069||||1069|0|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1069||||1069|85.06|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1069||||1069|100.27|994.17|85.06
40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1069||||1069|534.5|994.17|85.06
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|815||||815|50.95|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|815||||815|103.45|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|815||||815|128.35|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|815||||815|128.35|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|815||||815|100.46|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|815||||815|408.32|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|815||||815|286.07|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|815||||815|350.45|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|815||||815|347.19|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|815||||815|407.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|815||||815|529.75|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|815||||815|103.35|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|815||||815|63.28|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|GEHA [1415]|GEHA [141500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|815||||815|228.19|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|815||||815|350.45|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|815||||815|757.95|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|815||||815|489|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|815||||815|110.51|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|815||||815|268.93|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|815||||815|123.97|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|815||||815|136.91|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|815||||815|103.45|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MULTIPLAN [1680]|HMA [168003]|815||||815|152.13|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|815||||815|133.4|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|815||||815|110.51|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|Self-pay|Self-pay|815||||815|244.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|815||||815|171.15|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|815||||815|99.39|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|815||||815|148.07|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|815||||815|390.79|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|815||||815|118.07|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|815||||815|733.5|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|815||||815|0|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|815||||815|63.28|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|815||||815|101.42|757.95|50.95
40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|815||||815|407.5|757.95|50.95
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|AETNA [1015]|AETNA ACO WILCO [101532]|730||||730|201.93|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|730||||730|103.45|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|730||||730|128.35|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|730||||730|128.35|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|730||||730|100.46|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|730||||730|365.73|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|730||||730|256.23|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|730||||730|313.9|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|730||||730|310.98|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|730||||730|365|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|730||||730|474.5|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|CORESOURCE [1315]|CORESOURCE [131500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|CORVEL CORP [2235]|CORVEL CORP [223500]|730||||730|180.14|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|730||||730|110.29|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|GEHA [1415]|GEHA [141500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|730||||730|228.19|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HEALTHNET [1495]|HEALTHNET [149500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|730||||730|313.9|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HEALTHSMART [1505]|HEALTHSMART [150501]|730||||730|678.9|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|730||||730|438|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|730||||730|110.51|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|730||||730|268.93|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|730||||730|123.97|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|730||||730|136.91|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|730||||730|103.45|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MULTIPLAN [1680]|HMA [168003]|730||||730|152.13|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MULTIPLAN [1680]|IHC HS [168011]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|730||||730|133.4|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|730||||730|110.51|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|Self-pay|Self-pay|730||||730|219|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|730||||730|153.3|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|730||||730|99.39|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|730||||730|148.07|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|TRUSTMARK [2030]|STARMARK [203000]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|730||||730|350.04|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|UMR [2035]|UMR OPTIONS [203501]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|730||||730|118.07|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|730||||730|657|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|730||||730|0|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|730||||730|110.29|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|730||||730|101.42|678.9|99.39
40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|730||||730|365|678.9|99.39
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|968||||968|124.9|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|968||||968|103.45|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|968||||968|128.35|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|968||||968|128.35|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|968||||968|100.46|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|968||||968|484.97|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|968||||968|339.77|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|968||||968|416.24|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|968||||968|412.37|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|968||||968|484|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|968||||968|629.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|CORESOURCE [1315]|CORESOURCE [131500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|968||||968|143.21|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|968||||968|87.68|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|GEHA [1415]|GEHA [141500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|968||||968|228.19|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HEALTHNET [1495]|HEALTHNET [149500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|968||||968|416.24|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|968||||968|900.24|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|968||||968|580.8|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|968||||968|110.51|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|968||||968|268.93|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|968||||968|123.97|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|968||||968|136.91|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|968||||968|103.45|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MULTIPLAN [1680]|HMA [168003]|968||||968|152.13|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MULTIPLAN [1680]|IHC HS [168011]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|968||||968|133.4|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|968||||968|110.51|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|Self-pay|Self-pay|968||||968|290.4|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|968||||968|203.28|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|968||||968|99.39|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|968||||968|148.07|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|TRUSTMARK [2030]|STARMARK [203000]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|968||||968|464.16|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|UMR [2035]|UMR OPTIONS [203501]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|968||||968|118.07|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|968||||968|871.2|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|968||||968|0|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|968||||968|87.68|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|968||||968|101.42|900.24|87.68
40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|968||||968|484|900.24|87.68
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|AETNA [1015]|AETNA ACO WILCO [101532]|556||||556|37.28|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|556||||556|82.41|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|556||||556|82.41|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|556||||556|278.56|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|556||||556|195.16|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|556||||556|239.08|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|556||||556|236.86|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|556||||556|278|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|556||||556|361.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|CORESOURCE [1315]|CORESOURCE [131500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|556||||556|78.17|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|556||||556|47.86|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|GEHA [1415]|GEHA [141500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HEALTHNET [1495]|HEALTHNET [149500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|556||||556|239.08|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|556||||556|517.08|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|556||||556|333.6|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|556||||556|278|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|556||||556|79.6|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MULTIPLAN [1680]|HMA [168003]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MULTIPLAN [1680]|IHC HS [168011]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|556||||556|85.65|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|Self-pay|Self-pay|556||||556|166.8|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|556||||556|116.76|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|TRUSTMARK [2030]|STARMARK [203000]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|556||||556|266.6|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|UMR [2035]|UMR OPTIONS [203501]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|556||||556|75.8|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|556||||556|500.4|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|556||||556|0|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|556||||556|47.86|517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|556||||556||517.08|37.28
40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|556||||556|278|517.08|37.28
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|AETNA [1015]|AETNA ACO WILCO [101532]|930||||930|155.47|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930|103.45|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|930||||930|128.35|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|930||||930|128.35|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930|100.46|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|930||||930|465.93|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|930||||930|326.43|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|930||||930|399.9|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|930||||930|396.18|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|930||||930|465|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|930||||930|604.5|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|CORESOURCE [1315]|CORESOURCE [131500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|930||||930|165.18|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|930||||930|101.13|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|GEHA [1415]|GEHA [141500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|930||||930|228.19|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|399.9|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|930||||930|864.9|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|558|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|930||||930|110.51|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|268.93|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|123.97|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|930||||930|136.91|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|930||||930|103.45|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MULTIPLAN [1680]|HMA [168003]|930||||930|152.13|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|930||||930|133.4|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|930||||930|110.51|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|Self-pay|Self-pay|930||||930|279|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|930||||930|195.3|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|930||||930|99.39|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|930||||930|148.07|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|445.94|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|UMR [2035]|UMR OPTIONS [203501]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|930||||930|118.07|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|930||||930|837|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|101.13|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|930||||930|101.42|864.9|99.39
40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|930||||930|465|864.9|99.39
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|790||||790|88.84|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|790||||790|103.45|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|790||||790|82.41|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|790||||790|82.41|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|790||||790|100.46|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|790||||790|395.79|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|790||||790|277.29|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|790||||790|339.7|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|790||||790|336.54|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|790||||790|395|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|790||||790|513.5|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|790||||790|98.45|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|790||||790|60.28|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|GEHA [1415]|GEHA [141500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|790||||790|228.19|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|790||||790|339.7|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|790||||790|734.7|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|790||||790|474|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|790||||790|110.51|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|790||||790|268.93|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|790||||790|79.6|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|790||||790|136.91|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|790||||790|103.45|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MULTIPLAN [1680]|HMA [168003]|790||||790|152.13|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|790||||790|85.65|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|790||||790|110.51|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|Self-pay|Self-pay|790||||790|237|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|790||||790|165.9|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|790||||790|99.39|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|790||||790|148.07|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|790||||790|378.81|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|790||||790|75.8|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|790||||790|711|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|790||||790|0|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|790||||790|60.28|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|790||||790|101.42|734.7|60.28
40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|790||||790|395|734.7|60.28
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|600||||600|101.07|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|600||||600|103.45|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|600||||600|82.41|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|600||||600|82.41|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|600||||600|100.46|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|600||||600|300.6|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|600||||600|210.6|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|600||||600|258|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|600||||600|255.6|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|600||||600|300|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|600||||600|390|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|CORESOURCE [1315]|CORESOURCE [131500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|600||||600|113.1|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|600||||600|69.25|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|GEHA [1415]|GEHA [141500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|600||||600|228.19|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HEALTHNET [1495]|HEALTHNET [149500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|600||||600|258|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|600||||600|558|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|600||||600|360|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|600||||600|110.51|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|600||||600|268.93|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|600||||600|79.6|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|600||||600|136.91|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|600||||600|103.45|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MULTIPLAN [1680]|HMA [168003]|600||||600|152.13|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MULTIPLAN [1680]|IHC HS [168011]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|600||||600|85.65|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|600||||600|110.51|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|Self-pay|Self-pay|600||||600|180|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|600||||600|126|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|600||||600|99.39|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|600||||600|148.07|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|TRUSTMARK [2030]|STARMARK [203000]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|600||||600|287.7|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|UMR [2035]|UMR OPTIONS [203501]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|600||||600|75.8|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|600||||600|540|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|600||||600|0|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|600||||600|69.25|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|600||||600|101.42|558|69.25
40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|600||||600|300|558|69.25
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|AETNA [1015]|AETNA ACO WILCO [101532]|869||||869|149.97|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|869||||869|103.45|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|869||||869|128.35|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|869||||869|128.35|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|869||||869|100.46|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|869||||869|435.37|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|869||||869|305.02|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|869||||869|373.67|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|869||||869|370.19|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|869||||869|434.5|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|869||||869|564.85|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|CORESOURCE [1315]|CORESOURCE [131500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|869||||869|141.58|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|869||||869|86.68|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|GEHA [1415]|GEHA [141500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|869||||869|228.19|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HEALTHNET [1495]|HEALTHNET [149500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|869||||869|373.67|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|869||||869|808.17|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|869||||869|521.4|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|869||||869|110.51|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|869||||869|268.93|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|869||||869|123.97|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|869||||869|136.91|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|869||||869|103.45|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MULTIPLAN [1680]|HMA [168003]|869||||869|152.13|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MULTIPLAN [1680]|IHC HS [168011]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|869||||869|133.4|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|869||||869|110.51|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|Self-pay|Self-pay|869||||869|260.7|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|869||||869|182.49|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|869||||869|99.39|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|869||||869|148.07|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|TRUSTMARK [2030]|STARMARK [203000]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|869||||869|416.69|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|UMR [2035]|UMR OPTIONS [203501]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|869||||869|118.07|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|869||||869|782.1|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|869||||869|0|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|869||||869|86.68|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|869||||869|101.42|808.17|86.68
40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|869||||869|434.5|808.17|86.68
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|983||||983|129.18|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|983||||983|103.45|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|983||||983|128.35|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|983||||983|128.35|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|983||||983|100.46|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|983||||983|492.48|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|983||||983|345.03|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|983||||983|422.69|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|983||||983|418.76|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|983||||983|491.5|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|983||||983|638.95|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|983||||983|130.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|983||||983|79.85|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|GEHA [1415]|GEHA [141500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|983||||983|228.19|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|983||||983|422.69|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|983||||983|914.19|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|983||||983|589.8|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|983||||983|110.51|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|983||||983|268.93|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|983||||983|123.97|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|983||||983|136.91|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|983||||983|103.45|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|983||||983|152.13|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|983||||983|133.4|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|983||||983|110.51|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|Self-pay|Self-pay|983||||983|294.9|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|983||||983|206.43|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|983||||983|99.39|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|983||||983|148.07|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|983||||983|471.35|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|983||||983|118.07|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|983||||983|884.7|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|983||||983|0|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|983||||983|79.85|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|983||||983|101.42|914.19|79.85
40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|983||||983|491.5|914.19|79.85
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|AETNA [1015]|AETNA ACO WILCO [101532]|726||||726|41.17|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|726||||726|102.28|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|726||||726|82.41|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|726||||726|82.41|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|726||||726|100.46|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|726||||726|363.73|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|726||||726|254.83|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|726||||726|312.18|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|726||||726|309.28|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|726||||726|363|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|726||||726|471.9|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|CORESOURCE [1315]|CORESOURCE [131500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|726||||726|93.31|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|726||||726|57.13|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|GEHA [1415]|GEHA [141500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|726||||726|225.62|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HEALTHNET [1495]|HEALTHNET [149500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|726||||726|312.18|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|726||||726|675.18|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|726||||726|435.6|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|726||||726|101.42|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|726||||726|110.51|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|726||||726|268.93|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|726||||726|79.6|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|726||||726|136.91|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|726||||726|102.28|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MULTIPLAN [1680]|HMA [168003]|726||||726|150.41|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MULTIPLAN [1680]|IHC HS [168011]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|726||||726|85.65|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|726||||726|110.51|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|Self-pay|Self-pay|726||||726|217.8|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|726||||726|152.46|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|726||||726|101.42|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|726||||726|98.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|726||||726|148.07|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|TRUSTMARK [2030]|STARMARK [203000]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|726||||726|348.12|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|UMR [2035]|UMR OPTIONS [203501]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|726||||726|75.8|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|726||||726|653.4|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|726||||726|0|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|726||||726|57.13|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|726||||726|100.27|675.18|41.17
40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|726||||726|363|675.18|41.17
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|AETNA [1015]|AETNA ACO WILCO [101532]|933||||933|126.14|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|933||||933|103.45|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|933||||933|128.35|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|933||||933|128.35|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|933||||933|100.46|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|933||||933|467.43|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|933||||933|327.48|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|933||||933|401.19|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|933||||933|397.46|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|933||||933|466.5|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|933||||933|606.45|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|CORESOURCE [1315]|CORESOURCE [131500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|933||||933|108.53|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|933||||933|66.45|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|GEHA [1415]|GEHA [141500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|933||||933|228.19|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HEALTHNET [1495]|HEALTHNET [149500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|933||||933|401.19|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|933||||933|867.69|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|933||||933|559.8|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|933||||933|110.51|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|933||||933|268.93|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|933||||933|123.97|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|933||||933|136.91|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|933||||933|102.28|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MULTIPLAN [1680]|HMA [168003]|933||||933|152.13|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MULTIPLAN [1680]|IHC HS [168011]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|933||||933|133.4|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|933||||933|110.51|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|Self-pay|Self-pay|933||||933|279.9|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|933||||933|195.93|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|933||||933|99.39|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|933||||933|148.07|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|TRUSTMARK [2030]|STARMARK [203000]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|933||||933|447.37|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|UMR [2035]|UMR OPTIONS [203501]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|933||||933|118.07|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|933||||933|839.7|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|933||||933|0|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|933||||933|66.45|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|933||||933|101.42|867.69|66.45
40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|933||||933|466.5|867.69|66.45
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|817||||817|163.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|817||||817|103.45|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|817||||817|128.35|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|817||||817|128.35|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|817||||817|100.46|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|817||||817|409.32|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|817||||817|286.77|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|817||||817|351.31|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|817||||817|348.04|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|817||||817|408.5|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|817||||817|531.05|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|817||||817|144.81|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|817||||817|88.66|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|GEHA [1415]|GEHA [141500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|817||||817|228.19|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|817||||817|351.31|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|817||||817|759.81|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|817||||817|490.2|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|817||||817|110.51|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|817||||817|268.93|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|817||||817|123.97|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|817||||817|136.91|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|817||||817|103.45|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MULTIPLAN [1680]|HMA [168003]|817||||817|152.13|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MULTIPLAN [1680]|IHC HS [168011]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|817||||817|133.4|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|817||||817|110.51|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|Self-pay|Self-pay|817||||817|245.1|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|817||||817|171.57|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|817||||817|99.39|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|817||||817|148.07|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|TRUSTMARK [2030]|STARMARK [203000]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|817||||817|391.75|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|UMR [2035]|UMR OPTIONS [203501]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|817||||817|118.07|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|817||||817|735.3|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|817||||817|0|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|817||||817|88.66|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|817||||817|101.42|759.81|88.66
40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|817||||817|408.5|759.81|88.66
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|AETNA [1015]|AETNA ACO WILCO [101532]|6323||||6323|164.63|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6323||||6323|128.35|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6323||||6323|128.35|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6323||||6323|3167.82|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6323||||6323|2219.37|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6323||||6323|2718.89|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6323||||6323|2693.6|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6323||||6323|3161.5|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6323||||6323|4109.95|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|CORESOURCE [1315]|CORESOURCE [131500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6323||||6323|198.67|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6323||||6323|122.58|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|GEHA [1415]|GEHA [141500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HEALTHNET [1495]|HEALTHNET [149500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6323||||6323|2718.89|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6323||||6323|5880.39|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6323||||6323|3793.8|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6323||||6323|268.93|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6323||||6323|123.97|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MULTIPLAN [1680]|HMA [168003]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MULTIPLAN [1680]|IHC HS [168011]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6323||||6323|133.4|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|Self-pay|Self-pay|6323||||6323|1896.9|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6323||||6323|1327.83|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|TRUSTMARK [2030]|STARMARK [203000]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6323||||6323|3031.88|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|UMR [2035]|UMR OPTIONS [203501]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6323||||6323|118.07|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6323||||6323|5690.7|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6323||||6323|0|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6323||||6323|122.58|5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6323||||6323||5880.39|118.07
40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6323||||6323|3161.5|5880.39|118.07
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|541||||541|56.45|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|541||||541|103.45|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|541||||541|120.92|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|541||||541|120.92|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|541||||541|100.46|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|541||||541|271.04|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|541||||541|189.89|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|541||||541|232.63|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|541||||541|230.47|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|541||||541|270.5|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|541||||541|351.65|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|541||||541|55.88|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|541||||541|40.43|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|GEHA [1415]|GEHA [141500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|541||||541|225.62|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|541||||541|232.63|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|541||||541|503.13|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|541||||541|324.6|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|541||||541|110.51|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|541||||541|268.93|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|541||||541|116.79|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|541||||541|136.91|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|541||||541|102.28|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MULTIPLAN [1680]|HMA [168003]|541||||541|150.41|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|541||||541|125.68|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|541||||541|110.51|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|Self-pay|Self-pay|541||||541|162.3|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|541||||541|113.61|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|541||||541|98.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|541||||541|148.07|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|541||||541|259.41|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|541||||541|111.23|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|541||||541|486.9|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|541||||541|0|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|541||||541|40.43|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|541||||541|100.27|503.13|40.43
40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|541||||541|270.5|503.13|40.43
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|AETNA [1015]|AETNA ACO WILCO [101532]|884||||884|33.61|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|884||||884|0|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|884||||884|0|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|884||||884|442.88|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|884||||884|310.28|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|884||||884|380.12|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|884||||884|376.58|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|884||||884|442|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|884||||884|574.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|CORESOURCE [1315]|CORESOURCE [131500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|884||||884|37.46|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|884||||884|23.96|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|GEHA [1415]|GEHA [141500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HEALTHNET [1495]|HEALTHNET [149500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|884||||884|380.12|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|884||||884|822.12|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|884||||884|530.4|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|884||||884|442|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|884||||884|0|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MULTIPLAN [1680]|HMA [168003]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MULTIPLAN [1680]|IHC HS [168011]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|884||||884|0|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|Self-pay|Self-pay|884||||884|265.2|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|884||||884|185.64|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|TRUSTMARK [2030]|STARMARK [203000]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|884||||884|423.88|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|UMR [2035]|UMR OPTIONS [203501]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|884||||884|0|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|884||||884|795.6|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|884||||884|0|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|884||||884|23.96|822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|884||||884||822.12|23.96
40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|884||||884|442|822.12|23.96
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|AETNA [1015]|AETNA ACO WILCO [101532]|952||||952|43.01|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|952||||952|0|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|952||||952|0|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|952||||952|476.95|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|952||||952|334.15|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|952||||952|409.36|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|952||||952|405.55|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|952||||952|476|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|952||||952|618.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|CORESOURCE [1315]|CORESOURCE [131500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|952||||952|134.11|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|952||||952|82.11|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|GEHA [1415]|GEHA [141500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HEALTHNET [1495]|HEALTHNET [149500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|952||||952|409.36|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|952||||952|885.36|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|952||||952|571.2|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|952||||952|476|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|952||||952|0|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MULTIPLAN [1680]|HMA [168003]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MULTIPLAN [1680]|IHC HS [168011]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|952||||952|0|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|Self-pay|Self-pay|952||||952|285.6|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|952||||952|199.92|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|TRUSTMARK [2030]|STARMARK [203000]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|952||||952|456.48|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|UMR [2035]|UMR OPTIONS [203501]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|952||||952|0|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|952||||952|856.8|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|952||||952|0|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|952||||952|82.11|885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|952||||952||885.36|43.01
40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|952||||952|476|885.36|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1679||||1679|43.01|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1679||||1679|0|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1679||||1679|0|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1679||||1679|841.18|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1679||||1679|589.33|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1679||||1679|721.97|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1679||||1679|715.25|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1679||||1679|839.5|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1679||||1679|1091.35|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|CORESOURCE [1315]|CORESOURCE [131500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1679||||1679|206.07|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1679||||1679|126.17|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|GEHA [1415]|GEHA [141500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HEALTHNET [1495]|HEALTHNET [149500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1679||||1679|721.97|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1679||||1679|1561.47|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1679||||1679|1007.4|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1679||||1679|839.5|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1679||||1679|0|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MULTIPLAN [1680]|HMA [168003]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MULTIPLAN [1680]|IHC HS [168011]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1679||||1679|0|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|Self-pay|Self-pay|1679||||1679|503.7|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1679||||1679|352.59|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|TRUSTMARK [2030]|STARMARK [203000]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1679||||1679|805.08|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|UMR [2035]|UMR OPTIONS [203501]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1679||||1679|0|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1679||||1679|1511.1|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1679||||1679|0|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1679||||1679|126.17|1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1679||||1679||1561.47|43.01
40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1679||||1679|839.5|1561.47|43.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|AETNA [1015]|AETNA ACO WILCO [101532]|5500||||5500|2498.64|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5500||||5500|1405.3|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5500||||5500|1368.53|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5500||||5500|1368.53|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5500||||5500|1364.78|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5500||||5500|2755.5|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5500||||5500|1930.5|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5500||||5500|2365|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5500||||5500|2343|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5500||||5500|2750|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5500||||5500|3575|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|CORESOURCE [1315]|CORESOURCE [131500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5500||||5500|2187.25|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5500||||5500|1339.14|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|GEHA [1415]|GEHA [141500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5500||||5500|3099.93|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HEALTHNET [1495]|HEALTHNET [149500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5500||||5500|2365|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5500||||5500|5115|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5500||||5500|3300|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5500||||5500|1501.26|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5500||||5500|3287.87|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5500||||5500|1321.78|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5500||||5500|1859.96|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5500||||5500|1405.3|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MULTIPLAN [1680]|HMA [168003]|5500||||5500|2066.62|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MULTIPLAN [1680]|IHC HS [168011]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5500||||5500|1422.42|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5500||||5500|1501.26|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|Self-pay|Self-pay|5500||||5500|1650|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5500||||5500|1155|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5500||||5500|1350.19|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5500||||5500|2011.51|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|TRUSTMARK [2030]|STARMARK [203000]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5500||||5500|2637.25|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|UMR [2035]|UMR OPTIONS [203501]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5500||||5500|1258.81|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5500||||5500|4950|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5500||||5500|0|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5500||||5500|1339.14|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5500||||5500|1377.75|5115|1155
40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5500||||5500|2750|5115|1155
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|AETNA [1015]|AETNA ACO WILCO [101532]|5885||||5885|2498.64|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5885||||5885|1405.3|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5885||||5885|1368.53|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5885||||5885|1368.53|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5885||||5885|1364.78|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5885||||5885|2948.39|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5885||||5885|2065.64|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5885||||5885|2530.55|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5885||||5885|2507.01|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5885||||5885|2942.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5885||||5885|3825.25|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|CORESOURCE [1315]|CORESOURCE [131500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5885||||5885|2188.37|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5885||||5885|1339.82|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|GEHA [1415]|GEHA [141500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5885||||5885|3099.93|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HEALTHNET [1495]|HEALTHNET [149500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5885||||5885|2530.55|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5885||||5885|5473.05|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5885||||5885|3531|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5885||||5885|1501.26|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5885||||5885|3287.87|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5885||||5885|1321.78|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5885||||5885|1859.96|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5885||||5885|1405.3|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MULTIPLAN [1680]|HMA [168003]|5885||||5885|2066.62|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MULTIPLAN [1680]|IHC HS [168011]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5885||||5885|1422.42|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5885||||5885|1501.26|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|Self-pay|Self-pay|5885||||5885|1765.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5885||||5885|1235.85|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5885||||5885|1350.19|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5885||||5885|2011.51|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|TRUSTMARK [2030]|STARMARK [203000]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5885||||5885|2821.86|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|UMR [2035]|UMR OPTIONS [203501]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5885||||5885|1258.81|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5885||||5885|5296.5|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5885||||5885|0|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5885||||5885|1339.82|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5885||||5885|1377.75|5473.05|1235.85
40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5885||||5885|2942.5|5473.05|1235.85
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|2 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA [1015]|AETNA ACO WILCO [101532]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|611.99||||611.99|306.61|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|611.99||||611.99|214.81|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|611.99||||611.99|263.16|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|611.99||||611.99|260.71|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|611.99||||611.99|306|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|611.99||||611.99|397.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CORESOURCE [1315]|CORESOURCE [131500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CORVEL CORP [2235]|CORVEL CORP [223500]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|611.99||||611.99|226.44|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|GEHA [1415]|GEHA [141500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHNET [1495]|HEALTHNET [149500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|611.99||||611.99|263.16|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHSMART [1505]|HEALTHSMART [150501]|611.99||||611.99|569.15|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|611.99||||611.99|367.19|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MULTIPLAN [1680]|HMA [168003]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MULTIPLAN [1680]|IHC HS [168011]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|Self-pay|Self-pay|611.99||||611.99|183.6|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|611.99||||611.99|128.52|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TRUSTMARK [2030]|STARMARK [203000]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|611.99||||611.99|293.45|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UMR [2035]|UMR OPTIONS [203501]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|611.99||||611.99|550.79|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|611.99||||611.99|0|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|611.99||||611.99|226.44|569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|611.99||||611.99||569.15|128.52
40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|611.99||||611.99|306|569.15|128.52
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA [1015]|AETNA ACO WILCO [101532]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|950.6||||950.6|476.25|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|950.6||||950.6|333.66|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|950.6||||950.6|408.76|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|950.6||||950.6|404.96|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|950.6||||950.6|475.3|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|950.6||||950.6|617.89|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CORESOURCE [1315]|CORESOURCE [131500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|CORVEL CORP [2235]|CORVEL CORP [223500]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|950.6||||950.6|351.72|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|GEHA [1415]|GEHA [141500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHNET [1495]|HEALTHNET [149500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|950.6||||950.6|408.76|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HEALTHSMART [1505]|HEALTHSMART [150501]|950.6||||950.6|884.06|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|950.6||||950.6|570.36|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MULTIPLAN [1680]|HMA [168003]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MULTIPLAN [1680]|IHC HS [168011]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|Self-pay|Self-pay|950.6||||950.6|285.18|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|950.6||||950.6|199.63|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|TRUSTMARK [2030]|STARMARK [203000]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|950.6||||950.6|455.81|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UMR [2035]|UMR OPTIONS [203501]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|950.6||||950.6|855.54|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|950.6||||950.6|0|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|950.6||||950.6|351.72|884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|950.6||||950.6||884.06|199.63
40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|12 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|950.6||||950.6|475.3|884.06|199.63
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|AETNA [1015]|AETNA ACO WILCO [101532]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|56.05||||56.05|28.08|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56.05||||56.05|19.67|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56.05||||56.05|24.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|56.05||||56.05|23.88|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|56.05||||56.05|28.03|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56.05||||56.05|36.43|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|CORESOURCE [1315]|CORESOURCE [131500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|56.05||||56.05|20.74|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|GEHA [1415]|GEHA [141500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HEALTHNET [1495]|HEALTHNET [149500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56.05||||56.05|24.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|56.05||||56.05|52.13|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56.05||||56.05|33.63|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MULTIPLAN [1680]|HMA [168003]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MULTIPLAN [1680]|IHC HS [168011]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|Self-pay|Self-pay|56.05||||56.05|16.81|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56.05||||56.05|11.77|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|TRUSTMARK [2030]|STARMARK [203000]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56.05||||56.05|26.88|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|UMR [2035]|UMR OPTIONS [203501]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56.05||||56.05|50.45|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|56.05||||56.05|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|56.05||||56.05|20.74|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|56.05||||56.05||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|30 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|56.05||||56.05|28.03|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|Self-pay|Self-pay|29||||29|8.7|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||52.13|6.09
408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|52.13|6.09
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|201.21||||201.21|100.81|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201.21||||201.21|70.62|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201.21||||201.21|86.52|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|201.21||||201.21|85.72|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|201.21||||201.21|100.61|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201.21||||201.21|130.79|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|CORESOURCE [1315]|CORESOURCE [131500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|201.21||||201.21|8.29|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|201.21||||201.21|74.45|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|GEHA [1415]|GEHA [141500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HEALTHNET [1495]|HEALTHNET [149500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201.21||||201.21|86.52|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|201.21||||201.21|187.13|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201.21||||201.21|120.73|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MULTIPLAN [1680]|HMA [168003]|201.21||||201.21|70.42|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MULTIPLAN [1680]|IHC HS [168011]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|Self-pay|Self-pay|201.21||||201.21|60.36|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201.21||||201.21|42.25|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201.21||||201.21|8.08|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|TRUSTMARK [2030]|STARMARK [203000]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201.21||||201.21|96.48|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|UMR [2035]|UMR OPTIONS [203501]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201.21||||201.21|181.09|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|201.21||||201.21|0|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|201.21||||201.21|74.45|187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|201.21||||201.21||187.13|8.08
40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|0.2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|201.21||||201.21|100.61|187.13|8.08
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|AETNA [1015]|AETNA ACO WILCO [101532]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17.95||||17.95|8.99|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.95||||17.95|6.3|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.95||||17.95|7.72|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17.95||||17.95|7.65|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17.95||||17.95|8.98|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.95||||17.95|11.67|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|CORESOURCE [1315]|CORESOURCE [131500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|CORVEL CORP [2235]|CORVEL CORP [223500]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17.95||||17.95|6.64|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|GEHA [1415]|GEHA [141500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HEALTHNET [1495]|HEALTHNET [149500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.95||||17.95|7.72|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HEALTHSMART [1505]|HEALTHSMART [150501]|17.95||||17.95|16.69|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.95||||17.95|10.77|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MULTIPLAN [1680]|HMA [168003]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MULTIPLAN [1680]|IHC HS [168011]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|Self-pay|Self-pay|17.95||||17.95|5.38|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.95||||17.95|3.77|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|TRUSTMARK [2030]|STARMARK [203000]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.95||||17.95|8.61|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|UMR [2035]|UMR OPTIONS [203501]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.95||||17.95|16.16|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17.95||||17.95|0|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17.95||||17.95|6.64|16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17.95||||17.95||16.69|3.77
40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|454 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17.95||||17.95|8.98|16.69|3.77
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82.59||||82.59|41.38|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82.59||||82.59|28.99|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82.59||||82.59|35.51|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82.59||||82.59|35.18|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82.59||||82.59|41.3|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82.59||||82.59|53.68|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82.59||||82.59|30.56|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|GEHA [1415]|GEHA [141500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82.59||||82.59|35.51|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|82.59||||82.59|76.81|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82.59||||82.59|49.55|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MULTIPLAN [1680]|HMA [168003]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MULTIPLAN [1680]|IHC HS [168011]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|Self-pay|Self-pay|82.59||||82.59|24.78|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82.59||||82.59|17.34|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|TRUSTMARK [2030]|STARMARK [203000]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82.59||||82.59|39.6|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|UMR [2035]|UMR OPTIONS [203501]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82.59||||82.59|74.33|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82.59||||82.59|0|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82.59||||82.59|30.56|76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82.59||||82.59||76.81|17.34
408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82.59||||82.59|41.3|76.81|17.34
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.72|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|0.11|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|0.11
408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|0.11
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|AETNA [1015]|AETNA ACO WILCO [101532]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36.28||||36.28|18.18|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.28||||36.28|12.73|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.28||||36.28|15.6|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36.28||||36.28|15.46|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36.28||||36.28|18.14|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.28||||36.28|23.58|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|CORESOURCE [1315]|CORESOURCE [131500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|CORVEL CORP [2235]|CORVEL CORP [223500]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36.28||||36.28|13.42|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|GEHA [1415]|GEHA [141500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HEALTHNET [1495]|HEALTHNET [149500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.28||||36.28|15.6|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HEALTHSMART [1505]|HEALTHSMART [150501]|36.28||||36.28|33.74|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.28||||36.28|21.77|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MULTIPLAN [1680]|HMA [168003]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MULTIPLAN [1680]|IHC HS [168011]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|Self-pay|Self-pay|36.28||||36.28|10.88|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.28||||36.28|7.62|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|TRUSTMARK [2030]|STARMARK [203000]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.28||||36.28|17.4|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|UMR [2035]|UMR OPTIONS [203501]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.28||||36.28|32.65|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36.28||||36.28|0|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36.28||||36.28|13.42|33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36.28||||36.28||33.74|7.62
408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|4 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36.28||||36.28|18.14|33.74|7.62
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|AETNA [1015]|AETNA ACO WILCO [101532]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11.6||||11.6|5.81|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.6||||11.6|4.07|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.6||||11.6|4.99|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11.6||||11.6|4.94|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11.6||||11.6|5.8|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.6||||11.6|7.54|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|CORESOURCE [1315]|CORESOURCE [131500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|CORVEL CORP [2235]|CORVEL CORP [223500]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11.6||||11.6|4.29|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|GEHA [1415]|GEHA [141500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HEALTHNET [1495]|HEALTHNET [149500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.6||||11.6|4.99|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HEALTHSMART [1505]|HEALTHSMART [150501]|11.6||||11.6|10.79|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.6||||11.6|6.96|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MULTIPLAN [1680]|HMA [168003]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MULTIPLAN [1680]|IHC HS [168011]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|Self-pay|Self-pay|11.6||||11.6|3.48|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.6||||11.6|2.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|TRUSTMARK [2030]|STARMARK [203000]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.6||||11.6|5.56|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|UMR [2035]|UMR OPTIONS [203501]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.6||||11.6|10.44|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11.6||||11.6|0|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11.6||||11.6|4.29|10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11.6||||11.6||10.79|2.44
40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|30 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11.6||||11.6|5.8|10.79|2.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|154.47||||154.47|77.39|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154.47||||154.47|54.22|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154.47||||154.47|66.42|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|154.47||||154.47|65.8|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|154.47||||154.47|77.24|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154.47||||154.47|100.41|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|154.47||||154.47|57.15|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|GEHA [1415]|GEHA [141500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154.47||||154.47|66.42|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|154.47||||154.47|143.66|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154.47||||154.47|92.68|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MULTIPLAN [1680]|HMA [168003]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MULTIPLAN [1680]|IHC HS [168011]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|Self-pay|Self-pay|154.47||||154.47|46.34|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154.47||||154.47|32.44|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|TRUSTMARK [2030]|STARMARK [203000]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154.47||||154.47|74.07|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|UMR [2035]|UMR OPTIONS [203501]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154.47||||154.47|139.02|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|154.47||||154.47|0|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|154.47||||154.47|57.15|143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|154.47||||154.47||143.66|32.44
4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|154.47||||154.47|77.24|143.66|32.44
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|AETNA [1015]|AETNA ACO WILCO [101532]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.84||||13.84|6.93|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.84||||13.84|4.86|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.84||||13.84|5.95|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.84||||13.84|5.9|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.84||||13.84|6.92|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.84||||13.84|9|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|CORESOURCE [1315]|CORESOURCE [131500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.84||||13.84|5.12|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|GEHA [1415]|GEHA [141500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HEALTHNET [1495]|HEALTHNET [149500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.84||||13.84|5.95|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|13.84||||13.84|12.87|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.84||||13.84|8.3|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MULTIPLAN [1680]|HMA [168003]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MULTIPLAN [1680]|IHC HS [168011]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|Self-pay|Self-pay|13.84||||13.84|4.15|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.84||||13.84|2.91|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|TRUSTMARK [2030]|STARMARK [203000]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.84||||13.84|6.64|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|UMR [2035]|UMR OPTIONS [203501]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.84||||13.84|12.46|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.84||||13.84|0|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.84||||13.84|5.12|12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.84||||13.84||12.87|2.91
40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|93.75 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.84||||13.84|6.92|12.87|2.91
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|Self-pay|Self-pay|10||||10|3|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|28 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|736||||736|368.74|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|736||||736|258.34|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|736||||736|316.48|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|736||||736|313.54|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|736||||736|368|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|736||||736|478.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|736||||736|272.32|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|GEHA [1415]|GEHA [141500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|736||||736|316.48|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|736||||736|684.48|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|736||||736|441.6|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|736||||736|368|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MULTIPLAN [1680]|HMA [168003]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MULTIPLAN [1680]|IHC HS [168011]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|Self-pay|Self-pay|736||||736|220.8|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|736||||736|154.56|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|TRUSTMARK [2030]|STARMARK [203000]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|736||||736|352.91|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|UMR [2035]|UMR OPTIONS [203501]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|736||||736|662.4|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|736||||736|0|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|736||||736|272.32|684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|736||||736||684.48|154.56
40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|4 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|736||||736|368|684.48|154.56
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|550||||550|275.55|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|550||||550|193.05|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|550||||550|236.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|550||||550|234.3|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|550||||550|275|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|550||||550|357.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|550||||550|203.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|GEHA [1415]|GEHA [141500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|550||||550|236.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|550||||550|511.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|550||||550|330|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|550||||550|275|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MULTIPLAN [1680]|HMA [168003]|550||||550|192.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MULTIPLAN [1680]|IHC HS [168011]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|Self-pay|Self-pay|550||||550|165|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|550||||550|115.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|TRUSTMARK [2030]|STARMARK [203000]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|550||||550|263.73|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|UMR [2035]|UMR OPTIONS [203501]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|550||||550|495|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|550||||550|0|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|550||||550|203.5|511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|550||||550||511.5|115.5
40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|30 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|550||||550|275|511.5|115.5
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|590||||590|295.59|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|590||||590|207.09|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|590||||590|253.7|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|590||||590|251.34|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|590||||590|295|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|590||||590|383.5|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|590||||590|218.3|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|GEHA [1415]|GEHA [141500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|590||||590|253.7|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|590||||590|548.7|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|590||||590|354|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|590||||590|295|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MULTIPLAN [1680]|HMA [168003]|590||||590|206.5|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MULTIPLAN [1680]|IHC HS [168011]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|Self-pay|Self-pay|590||||590|177|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|590||||590|123.9|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|TRUSTMARK [2030]|STARMARK [203000]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|590||||590|282.91|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|UMR [2035]|UMR OPTIONS [203501]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|590||||590|531|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|590||||590|0|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|590||||590|218.3|548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|590||||590||548.7|123.9
40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|15 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|590||||590|295|548.7|123.9
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|513||||513|257.01|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|513||||513|180.06|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|513||||513|220.59|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|513||||513|218.54|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|513||||513|256.5|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|513||||513|333.45|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|513||||513|189.81|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|GEHA [1415]|GEHA [141500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|513||||513|220.59|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|513||||513|477.09|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|513||||513|307.8|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|513||||513|256.5|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MULTIPLAN [1680]|HMA [168003]|513||||513|179.55|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MULTIPLAN [1680]|IHC HS [168011]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|Self-pay|Self-pay|513||||513|153.9|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|513||||513|107.73|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|TRUSTMARK [2030]|STARMARK [203000]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|513||||513|245.98|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|UMR [2035]|UMR OPTIONS [203501]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|513||||513|461.7|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|513||||513|0|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|513||||513|189.81|477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|513||||513||477.09|107.73
40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|10 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|513||||513|256.5|477.09|107.73
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19.23||||19.23|9.63|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.23||||19.23|6.75|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.23||||19.23|8.27|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19.23||||19.23|8.19|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19.23||||19.23|9.62|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.23||||19.23|12.5|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19.23||||19.23|7.12|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|GEHA [1415]|GEHA [141500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.23||||19.23|8.27|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|19.23||||19.23|17.88|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.23||||19.23|11.54|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.23||||19.23|9.62|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MULTIPLAN [1680]|HMA [168003]|19.23||||19.23|6.73|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MULTIPLAN [1680]|IHC HS [168011]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|Self-pay|Self-pay|19.23||||19.23|5.77|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.23||||19.23|4.04|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|TRUSTMARK [2030]|STARMARK [203000]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.23||||19.23|9.22|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|UMR [2035]|UMR OPTIONS [203501]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.23||||19.23|17.31|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19.23||||19.23|0|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19.23||||19.23|7.12|17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19.23||||19.23||17.88|4.04
40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|1 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19.23||||19.23|9.62|17.88|4.04
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|358||||358|179.36|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|358||||358|125.66|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|358||||358|153.94|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|358||||358|152.51|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|358||||358|179|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|358||||358|232.7|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|358||||358|132.46|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|GEHA [1415]|GEHA [141500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|358||||358|153.94|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|358||||358|332.94|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|358||||358|214.8|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|358||||358|179|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MULTIPLAN [1680]|HMA [168003]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MULTIPLAN [1680]|IHC HS [168011]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|Self-pay|Self-pay|358||||358|107.4|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|358||||358|75.18|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|TRUSTMARK [2030]|STARMARK [203000]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|358||||358|171.66|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|UMR [2035]|UMR OPTIONS [203501]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|358||||358|322.2|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|358||||358|0|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|358||||358|132.46|332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|358||||358||332.94|75.18
40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|25 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|358||||358|179|332.94|75.18
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2163||||2163|1083.66|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2163||||2163|759.21|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2163||||2163|930.09|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2163||||2163|921.44|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2163||||2163|1081.5|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2163||||2163|1405.95|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2163||||2163|800.31|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|GEHA [1415]|GEHA [141500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2163||||2163|930.09|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|2163||||2163|2011.59|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2163||||2163|1297.8|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2163||||2163|1081.5|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MULTIPLAN [1680]|HMA [168003]|2163||||2163|757.05|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MULTIPLAN [1680]|IHC HS [168011]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|Self-pay|Self-pay|2163||||2163|648.9|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2163||||2163|454.23|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|TRUSTMARK [2030]|STARMARK [203000]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2163||||2163|1037.16|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|UMR [2035]|UMR OPTIONS [203501]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2163||||2163|1946.7|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2163||||2163|0|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2163||||2163|800.31|2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2163||||2163||2011.59|454.23
40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|25 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2163||||2163|1081.5|2011.59|454.23
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1351||||1351|676.85|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1351||||1351|474.2|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1351||||1351|580.93|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1351||||1351|575.53|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1351||||1351|675.5|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1351||||1351|878.15|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1351||||1351|499.87|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|GEHA [1415]|GEHA [141500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1351||||1351|580.93|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|1351||||1351|1256.43|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1351||||1351|810.6|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1351||||1351|675.5|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MULTIPLAN [1680]|HMA [168003]|1351||||1351|472.85|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MULTIPLAN [1680]|IHC HS [168011]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|Self-pay|Self-pay|1351||||1351|405.3|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1351||||1351|283.71|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|TRUSTMARK [2030]|STARMARK [203000]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1351||||1351|647.8|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|UMR [2035]|UMR OPTIONS [203501]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1351||||1351|1215.9|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1351||||1351|0|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1351||||1351|499.87|1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1351||||1351||1256.43|283.71
40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|30 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1351||||1351|675.5|1256.43|283.71
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|448||||448|224.45|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|448||||448|157.25|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|448||||448|192.64|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|448||||448|190.85|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|448||||448|224|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|448||||448|291.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|CORESOURCE [1315]|CORESOURCE [131500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|448||||448|165.76|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|GEHA [1415]|GEHA [141500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HEALTHNET [1495]|HEALTHNET [149500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|448||||448|192.64|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|448||||448|416.64|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|448||||448|268.8|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|448||||448|224|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MULTIPLAN [1680]|HMA [168003]|448||||448|156.8|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MULTIPLAN [1680]|IHC HS [168011]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|Self-pay|Self-pay|448||||448|134.4|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|448||||448|94.08|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|TRUSTMARK [2030]|STARMARK [203000]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|448||||448|214.82|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|UMR [2035]|UMR OPTIONS [203501]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|448||||448|403.2|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|448||||448|0|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|448||||448|165.76|416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|448||||448||416.64|94.08
40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|448||||448|224|416.64|94.08
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|4426||||4426|0|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4426||||4426|1271.72|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4426||||4426|1271.72|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4426||||4426|2217.43|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4426||||4426|1553.53|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4426||||4426|1903.18|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4426||||4426|1885.48|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4426||||4426|2213|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4426||||4426|2876.9|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|4426||||4426|0|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4426||||4426|1637.62|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|GEHA [1415]|GEHA [141500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4426||||4426|1903.18|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|4426||||4426|4116.18|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4426||||4426|2655.6|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4426||||4426|2213|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4426||||4426|1228.28|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MULTIPLAN [1680]|HMA [168003]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MULTIPLAN [1680]|IHC HS [168011]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|4426||||4426|1321.79|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|Self-pay|Self-pay|4426||||4426|1327.8|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4426||||4426|929.46|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|TRUSTMARK [2030]|STARMARK [203000]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4426||||4426|2122.27|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|UMR [2035]|UMR OPTIONS [203501]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4426||||4426|1169.76|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4426||||4426|3983.4|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4426||||4426|0|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4426||||4426|1637.62|4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4426||||4426||4116.18|929.46
40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|1 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4426||||4426|2213|4116.18|929.46
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6371||||6371|3191.87|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6371||||6371|2236.22|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6371||||6371|2739.53|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6371||||6371|2714.05|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6371||||6371|3185.5|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6371||||6371|4141.15|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6371||||6371|2357.27|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|GEHA [1415]|GEHA [141500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6371||||6371|2739.53|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|6371||||6371|5925.03|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6371||||6371|3822.6|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6371||||6371|3185.5|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MULTIPLAN [1680]|HMA [168003]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MULTIPLAN [1680]|IHC HS [168011]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|Self-pay|Self-pay|6371||||6371|1911.3|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6371||||6371|1337.91|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|TRUSTMARK [2030]|STARMARK [203000]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6371||||6371|3054.89|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|UMR [2035]|UMR OPTIONS [203501]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6371||||6371|5733.9|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6371||||6371|0|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6371||||6371|2357.27|5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6371||||6371||5925.03|1337.91
40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|5 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6371||||6371|3185.5|5925.03|1337.91
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|GEHA [1415]|GEHA [141500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|Self-pay|Self-pay|10||||10|3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|AETNA [1015]|AETNA ACO WILCO [101532]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18.66||||18.66|9.35|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.66||||18.66|6.55|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.66||||18.66|8.02|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18.66||||18.66|7.95|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18.66||||18.66|9.33|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.66||||18.66|12.13|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|CORESOURCE [1315]|CORESOURCE [131500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18.66||||18.66|6.9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|GEHA [1415]|GEHA [141500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HEALTHNET [1495]|HEALTHNET [149500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.66||||18.66|8.02|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|18.66||||18.66|17.35|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.66||||18.66|11.2|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MULTIPLAN [1680]|HMA [168003]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MULTIPLAN [1680]|IHC HS [168011]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|Self-pay|Self-pay|18.66||||18.66|5.6|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.66||||18.66|3.92|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|TRUSTMARK [2030]|STARMARK [203000]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.66||||18.66|8.95|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|UMR [2035]|UMR OPTIONS [203501]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.66||||18.66|16.79|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18.66||||18.66|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18.66||||18.66|6.9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18.66||||18.66||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|118 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18.66||||18.66|9.33|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|Self-pay|Self-pay|10||||10|3|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||17.35|2.1
40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|17.35|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.65|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|2.1
40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|2.1
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|AETNA [1015]|AETNA ACO WILCO [101532]|492.33||||492.33|0|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|492.33||||492.33|175.17|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|492.33||||492.33|259.32|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|492.33||||492.33|259.32|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|492.33||||492.33|246.66|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|492.33||||492.33|172.81|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|492.33||||492.33|211.7|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|492.33||||492.33|209.73|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|492.33||||492.33|246.17|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|492.33||||492.33|320.01|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|CORESOURCE [1315]|CORESOURCE [131500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|492.33||||492.33|215.52|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|492.33||||492.33|182.16|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|GEHA [1415]|GEHA [141500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|492.33||||492.33|386.41|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HEALTHNET [1495]|HEALTHNET [149500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|492.33||||492.33|211.7|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|492.33||||492.33|457.87|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|492.33||||492.33|295.4|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|492.33||||492.33|188.91|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|492.33||||492.33|300.33|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|492.33||||492.33|250.47|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|492.33||||492.33|231.84|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|492.33||||492.33|175.17|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MULTIPLAN [1680]|HMA [168003]|492.33||||492.33|172.32|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MULTIPLAN [1680]|IHC HS [168011]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|492.33||||492.33|269.53|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|492.33||||492.33|188.91|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|Self-pay|Self-pay|492.33||||492.33|147.7|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|492.33||||492.33|103.39|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|492.33||||492.33|168.3|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|492.33||||492.33|224.5|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|TRUSTMARK [2030]|STARMARK [203000]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|492.33||||492.33|236.07|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|UMR [2035]|UMR OPTIONS [203501]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|492.33||||492.33|238.53|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|492.33||||492.33|443.1|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|492.33||||492.33|0|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|492.33||||492.33|182.16|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|492.33||||492.33|171.74|457.87|103.39
40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|1 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|492.33||||492.33|246.17|457.87|103.39
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|237.19||||237.19|118.83|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237.19||||237.19|83.25|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237.19||||237.19|101.99|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|237.19||||237.19|101.04|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|237.19||||237.19|118.6|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237.19||||237.19|154.17|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|237.19||||237.19|87.76|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|GEHA [1415]|GEHA [141500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237.19||||237.19|101.99|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|237.19||||237.19|220.59|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237.19||||237.19|142.31|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MULTIPLAN [1680]|HMA [168003]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MULTIPLAN [1680]|IHC HS [168011]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|Self-pay|Self-pay|237.19||||237.19|71.16|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237.19||||237.19|49.81|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|TRUSTMARK [2030]|STARMARK [203000]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237.19||||237.19|113.73|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|UMR [2035]|UMR OPTIONS [203501]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237.19||||237.19|213.47|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|237.19||||237.19|0|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|237.19||||237.19|87.76|220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|237.19||||237.19||220.59|49.81
40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|237.19||||237.19|118.6|220.59|49.81
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62.82||||62.82|31.47|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.82||||62.82|22.05|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.82||||62.82|27.01|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62.82||||62.82|26.76|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62.82||||62.82|31.41|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.82||||62.82|40.83|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62.82||||62.82|23.24|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|GEHA [1415]|GEHA [141500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.82||||62.82|27.01|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|62.82||||62.82|58.42|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.82||||62.82|37.69|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MULTIPLAN [1680]|HMA [168003]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|Self-pay|Self-pay|62.82||||62.82|18.85|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.82||||62.82|13.19|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.82||||62.82|30.12|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.82||||62.82|56.54|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62.82||||62.82|0|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62.82||||62.82|23.24|58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62.82||||62.82||58.42|13.19
40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62.82||||62.82|31.41|58.42|13.19
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0.62|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|Self-pay|Self-pay|90||||90|27|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|0.67|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|0.62
40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|250 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|0.62
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|AETNA [1015]|AETNA ACO WILCO [101532]|14||||14|0|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14||||14|13.2|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14||||14|13.2|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14||||14|7.01|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14||||14|4.91|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14||||14|6.02|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14||||14|5.96|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14||||14|7|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14||||14|9.1|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|CORESOURCE [1315]|CORESOURCE [131500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|CORVEL CORP [2235]|CORVEL CORP [223500]|14||||14|0|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14||||14|5.18|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|FIRST HEALTH [1375]|QUALCHOICE [137513]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|FMH BENEFIT SERVICES [1390]|FMH [139000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|GEHA [1415]|GEHA [141500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HEALTHNET [1495]|HEALTHNET [149500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14||||14|6.02|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HEALTHSMART [1505]|HEALTHSMART [150501]|14||||14|13.02|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14||||14|8.4|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14||||14|7|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14||||14|12.75|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MULTIPLAN [1680]|HMA [168003]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MULTIPLAN [1680]|IHC HS [168011]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|PENDING SSI [1616]|PENDING SSI RCA [161601]|14||||14|13.72|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|Self-pay|Self-pay|14||||14|4.2|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14||||14|2.94|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|TRUSTMARK [2030]|STARMARK [203000]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14||||14|6.71|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|UMR [2035]|UMR OPTIONS [203501]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14||||14|12.14|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14||||14|12.6|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14||||14|0|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14||||14|5.18|13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14||||14||13.72|2.94
40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|1 Dose|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14||||14|7|13.72|2.94
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.53|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|Self-pay|Self-pay|29||||29|8.7|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.67|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|2.53
40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|2.53
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|5.06|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|Self-pay|Self-pay|29||||29|8.7|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|5.34|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|5.06
40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|5.06
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11.64||||11.64|5.83|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.64||||11.64|4.09|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.64||||11.64|5.01|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11.64||||11.64|4.96|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11.64||||11.64|5.82|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.64||||11.64|7.57|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11.64||||11.64|4.31|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|GEHA [1415]|GEHA [141500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.64||||11.64|5.01|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|11.64||||11.64|10.83|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.64||||11.64|6.98|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MULTIPLAN [1680]|HMA [168003]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MULTIPLAN [1680]|IHC HS [168011]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|Self-pay|Self-pay|11.64||||11.64|3.49|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.64||||11.64|2.44|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|TRUSTMARK [2030]|STARMARK [203000]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.64||||11.64|5.58|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|UMR [2035]|UMR OPTIONS [203501]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.64||||11.64|10.48|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11.64||||11.64|0|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11.64||||11.64|4.31|10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11.64||||11.64||10.83|2.44
40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11.64||||11.64|5.82|10.83|2.44
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|156.24||||156.24|78.28|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156.24||||156.24|54.84|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156.24||||156.24|67.18|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|156.24||||156.24|66.56|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|156.24||||156.24|78.12|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156.24||||156.24|101.56|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORESOURCE [1315]|CORESOURCE [131500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|156.24||||156.24|3.93|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|156.24||||156.24|57.81|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GEHA [1415]|GEHA [141500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHNET [1495]|HEALTHNET [149500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156.24||||156.24|67.18|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|156.24||||156.24|145.3|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156.24||||156.24|93.74|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|HMA [168003]|156.24||||156.24|54.68|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|IHC HS [168011]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|Self-pay|Self-pay|156.24||||156.24|46.87|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156.24||||156.24|32.81|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156.24||||156.24|3.9|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUSTMARK [2030]|STARMARK [203000]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156.24||||156.24|74.92|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR [2035]|UMR OPTIONS [203501]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156.24||||156.24|140.62|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|156.24||||156.24|0|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|156.24||||156.24|57.81|145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|156.24||||156.24||145.3|3.9
40842070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|156.24||||156.24|78.12|145.3|3.9
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|78.37||||78.37|39.26|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78.37||||78.37|27.51|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78.37||||78.37|33.7|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|78.37||||78.37|33.39|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|78.37||||78.37|39.19|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78.37||||78.37|50.94|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORESOURCE [1315]|CORESOURCE [131500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|78.37||||78.37|29|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GEHA [1415]|GEHA [141500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHNET [1495]|HEALTHNET [149500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78.37||||78.37|33.7|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|78.37||||78.37|72.88|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78.37||||78.37|47.02|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|HMA [168003]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|IHC HS [168011]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|Self-pay|Self-pay|78.37||||78.37|23.51|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78.37||||78.37|16.46|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUSTMARK [2030]|STARMARK [203000]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78.37||||78.37|37.58|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR [2035]|UMR OPTIONS [203501]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78.37||||78.37|70.53|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|78.37||||78.37|0|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|78.37||||78.37|29|72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|78.37||||78.37||72.88|16.46
40842072|ERX|0250 - PHARMACY-GENERAL|AMPICILLIN-SULBACTAM 3 GRAMS 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|78.37||||78.37|39.19|72.88|16.46
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65.53||||65.53|32.83|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65.53||||65.53|23|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65.53||||65.53|28.18|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65.53||||65.53|27.92|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65.53||||65.53|32.77|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65.53||||65.53|42.59|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORESOURCE [1315]|CORESOURCE [131500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|65.53||||65.53|5.71|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65.53||||65.53|24.25|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GEHA [1415]|GEHA [141500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHNET [1495]|HEALTHNET [149500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65.53||||65.53|28.18|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|65.53||||65.53|60.94|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65.53||||65.53|39.32|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|HMA [168003]|65.53||||65.53|22.94|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|IHC HS [168011]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|Self-pay|Self-pay|65.53||||65.53|19.66|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65.53||||65.53|13.76|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65.53||||65.53|5.25|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUSTMARK [2030]|STARMARK [203000]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65.53||||65.53|31.42|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR [2035]|UMR OPTIONS [203501]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65.53||||65.53|58.98|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65.53||||65.53|0|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65.53||||65.53|24.25|60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65.53||||65.53||60.94|5.25
40842090|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65.53||||65.53|32.77|60.94|5.25
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46.68||||46.68|23.39|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.68||||46.68|16.38|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.68||||46.68|20.07|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46.68||||46.68|19.89|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46.68||||46.68|23.34|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.68||||46.68|30.34|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORESOURCE [1315]|CORESOURCE [131500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46.68||||46.68|17.27|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GEHA [1415]|GEHA [141500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHNET [1495]|HEALTHNET [149500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.68||||46.68|20.07|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|46.68||||46.68|43.41|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.68||||46.68|28.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|HMA [168003]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|IHC HS [168011]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|Self-pay|Self-pay|46.68||||46.68|14|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.68||||46.68|9.8|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUSTMARK [2030]|STARMARK [203000]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.68||||46.68|22.38|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR [2035]|UMR OPTIONS [203501]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.68||||46.68|42.01|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46.68||||46.68|0|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46.68||||46.68|17.27|43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46.68||||46.68||43.41|9.8
40842091|ERX|0250 - PHARMACY-GENERAL|PIPERACILLIN-TAZOBACTAM 2.25 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46.68||||46.68|23.34|43.41|9.8
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.64||||60.64|30.38|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.64||||60.64|21.28|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.64||||60.64|26.08|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.64||||60.64|25.83|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.64||||60.64|30.32|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.64||||60.64|39.42|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORESOURCE [1315]|CORESOURCE [131500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|60.64||||60.64|7.61|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.64||||60.64|22.44|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GEHA [1415]|GEHA [141500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHNET [1495]|HEALTHNET [149500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.64||||60.64|26.08|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|60.64||||60.64|56.4|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.64||||60.64|36.38|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|HMA [168003]|60.64||||60.64|21.22|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MULTIPLAN [1680]|IHC HS [168011]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|Self-pay|Self-pay|60.64||||60.64|18.19|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.64||||60.64|12.73|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.64||||60.64|7|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|TRUSTMARK [2030]|STARMARK [203000]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.64||||60.64|29.08|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UMR [2035]|UMR OPTIONS [203501]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.64||||60.64|54.58|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.64||||60.64|0|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.64||||60.64|22.44|56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.64||||60.64||56.4|7
40842092|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM 100 ML NS MINI-BAG PLUS ASSEMBLED|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.64||||60.64|30.32|56.4|7
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.88|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|1.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.1
4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.1
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.72|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|1.98|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.98
4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.72|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|1.98|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.98
4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.98
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|161.53||||161.53|80.93|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161.53||||161.53|56.7|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161.53||||161.53|69.46|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|161.53||||161.53|68.81|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|161.53||||161.53|80.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161.53||||161.53|104.99|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|161.53||||161.53|59.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|GEHA [1415]|GEHA [141500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161.53||||161.53|69.46|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|161.53||||161.53|150.22|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161.53||||161.53|96.92|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MULTIPLAN [1680]|HMA [168003]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MULTIPLAN [1680]|IHC HS [168011]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|Self-pay|Self-pay|161.53||||161.53|48.46|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161.53||||161.53|33.92|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|TRUSTMARK [2030]|STARMARK [203000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161.53||||161.53|77.45|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|UMR [2035]|UMR OPTIONS [203501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|161.53||||161.53|59.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|161.53||||161.53|80.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|161.53||||161.53|80.93|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161.53||||161.53|56.7|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161.53||||161.53|69.46|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|161.53||||161.53|68.81|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|161.53||||161.53|80.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161.53||||161.53|104.99|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|161.53||||161.53|59.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|GEHA [1415]|GEHA [141500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161.53||||161.53|69.46|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|161.53||||161.53|150.22|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161.53||||161.53|96.92|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MULTIPLAN [1680]|HMA [168003]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MULTIPLAN [1680]|IHC HS [168011]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|Self-pay|Self-pay|161.53||||161.53|48.46|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161.53||||161.53|33.92|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|TRUSTMARK [2030]|STARMARK [203000]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161.53||||161.53|77.45|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|UMR [2035]|UMR OPTIONS [203501]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161.53||||161.53|145.38|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|161.53||||161.53|0|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|161.53||||161.53|59.77|150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|161.53||||161.53||150.22|33.92
408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|161.53||||161.53|80.77|150.22|33.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|AETNA [1015]|AETNA ACO WILCO [101532]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18.68||||18.68|9.36|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.68||||18.68|6.56|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.68||||18.68|8.03|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18.68||||18.68|7.96|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18.68||||18.68|9.34|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.68||||18.68|12.14|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|CORESOURCE [1315]|CORESOURCE [131500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|CORVEL CORP [2235]|CORVEL CORP [223500]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18.68||||18.68|6.91|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|GEHA [1415]|GEHA [141500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HEALTHNET [1495]|HEALTHNET [149500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.68||||18.68|8.03|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HEALTHSMART [1505]|HEALTHSMART [150501]|18.68||||18.68|17.37|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.68||||18.68|11.21|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MULTIPLAN [1680]|HMA [168003]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MULTIPLAN [1680]|IHC HS [168011]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|Self-pay|Self-pay|18.68||||18.68|5.6|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.68||||18.68|3.92|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|TRUSTMARK [2030]|STARMARK [203000]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.68||||18.68|8.96|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|UMR [2035]|UMR OPTIONS [203501]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.68||||18.68|16.81|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18.68||||18.68|0|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18.68||||18.68|6.91|17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18.68||||18.68||17.37|3.92
4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|29 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18.68||||18.68|9.34|17.37|3.92
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|AETNA [1015]|AETNA ACO WILCO [101532]|1263||||1263|0|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1263||||1263|251.04|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1263||||1263|218.34|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1263||||1263|218.34|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1263||||1263|243.8|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1263||||1263|632.76|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1263||||1263|443.31|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1263||||1263|543.09|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1263||||1263|538.04|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1263||||1263|631.5|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1263||||1263|820.95|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|CORESOURCE [1315]|CORESOURCE [131500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1263||||1263|0|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1263||||1263|467.31|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|GEHA [1415]|GEHA [141500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1263||||1263|553.77|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HEALTHNET [1495]|HEALTHNET [149500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1263||||1263|543.09|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1263||||1263|1174.59|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1263||||1263|757.8|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1263||||1263|268.18|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1263||||1263|603.08|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1263||||1263|210.88|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1263||||1263|332.26|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1263||||1263|251.04|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MULTIPLAN [1680]|HMA [168003]|1263||||1263|369.18|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MULTIPLAN [1680]|IHC HS [168011]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1263||||1263|226.94|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1263||||1263|268.18|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|Self-pay|Self-pay|1263||||1263|378.9|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1263||||1263|265.23|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1263||||1263|241.2|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1263||||1263|359.33|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|TRUSTMARK [2030]|STARMARK [203000]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1263||||1263|605.61|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|UMR [2035]|UMR OPTIONS [203501]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1263||||1263|200.83|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1263||||1263|1136.7|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1263||||1263|0|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1263||||1263|467.31|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1263||||1263|246.12|1174.59|200.83
41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1263||||1263|631.5|1174.59|200.83
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|6169||||6169|0|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6169||||6169|455.47|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6169||||6169|258.31|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6169||||6169|258.31|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6169||||6169|447.39|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6169||||6169|3090.67|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6169||||6169|2165.32|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6169||||6169|2652.67|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6169||||6169|2627.99|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6169||||6169|3084.5|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6169||||6169|4009.85|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6169||||6169|0|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6169||||6169|2282.53|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|GEHA [1415]|GEHA [141500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6169||||6169|1004.72|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6169||||6169|2652.67|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6169||||6169|5737.17|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6169||||6169|3701.4|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6169||||6169|492.12|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6169||||6169|1218.95|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6169||||6169|249.48|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6169||||6169|602.83|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6169||||6169|455.47|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MULTIPLAN [1680]|HMA [168003]|6169||||6169|669.81|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MULTIPLAN [1680]|IHC HS [168011]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6169||||6169|268.48|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6169||||6169|492.12|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|Self-pay|Self-pay|6169||||6169|1850.7|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6169||||6169|1295.49|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6169||||6169|437.61|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6169||||6169|651.95|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|TRUSTMARK [2030]|STARMARK [203000]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6169||||6169|2958.04|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|UMR [2035]|UMR OPTIONS [203501]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6169||||6169|237.6|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6169||||6169|5552.1|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6169||||6169|0|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6169||||6169|2282.53|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6169||||6169|446.54|5737.17|237.6
41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6169||||6169|3084.5|5737.17|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|5804||||5804|0|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5804||||5804|258.31|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5804||||5804|258.31|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5804||||5804|2907.8|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5804||||5804|2037.2|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5804||||5804|2495.72|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5804||||5804|2472.5|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5804||||5804|2902|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5804||||5804|3772.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5804||||5804|0|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5804||||5804|2147.48|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|GEHA [1415]|GEHA [141500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5804||||5804|2495.72|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5804||||5804|5397.72|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5804||||5804|3482.4|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5804||||5804|1218.95|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5804||||5804|249.48|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MULTIPLAN [1680]|HMA [168003]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MULTIPLAN [1680]|IHC HS [168011]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5804||||5804|268.48|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|Self-pay|Self-pay|5804||||5804|1741.2|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5804||||5804|1218.84|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|TRUSTMARK [2030]|STARMARK [203000]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5804||||5804|2783.02|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|UMR [2035]|UMR OPTIONS [203501]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5804||||5804|237.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5804||||5804|5223.6|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5804||||5804|0|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5804||||5804|2147.48|5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5804||||5804||5397.72|237.6
41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5804||||5804|2902|5397.72|237.6
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|AETNA [1015]|AETNA ACO WILCO [101532]|311||||311|0|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|311||||311|178.36|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|311||||311|217.1|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|311||||311|217.1|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|311||||311|173.22|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|311||||311|155.81|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|311||||311|109.16|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|311||||311|133.73|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|311||||311|132.49|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|311||||311|155.5|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|311||||311|202.15|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|CORESOURCE [1315]|CORESOURCE [131500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|CORVEL CORP [2235]|CORVEL CORP [223500]|311||||311|0|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|311||||311|115.07|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|GEHA [1415]|GEHA [141500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|311||||311|311|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HEALTHNET [1495]|HEALTHNET [149500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|311||||311|133.73|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HEALTHSMART [1505]|HEALTHSMART [150501]|311||||311|289.23|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|311||||311|186.6|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|311||||311|190.54|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|311||||311|311|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|311||||311|209.69|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|311||||311|236.06|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|311||||311|176.35|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MULTIPLAN [1680]|HMA [168003]|311||||311|262.29|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MULTIPLAN [1680]|IHC HS [168011]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|311||||311|225.65|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|311||||311|190.54|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|Self-pay|Self-pay|311||||311|93.3|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|311||||311|65.31|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|311||||311|171.37|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|311||||311|252.42|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|TRUSTMARK [2030]|STARMARK [203000]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|311||||311|149.12|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|UMR [2035]|UMR OPTIONS [203501]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|311||||311|199.7|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|311||||311|279.9|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|311||||311|0|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|311||||311|115.07|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|311||||311|174.86|311|65.31
41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|311||||311|155.5|311|65.31
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|AETNA [1015]|AETNA ACO WILCO [101532]|390||||390|0|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390||||390|106.28|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390||||390|173.73|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390||||390|173.73|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390||||390|103.21|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|390||||390|195.39|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390||||390|136.89|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390||||390|167.7|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|390||||390|166.14|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|390||||390|195|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390||||390|253.5|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|CORESOURCE [1315]|CORESOURCE [131500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|390||||390|0|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|390||||390|144.3|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|GEHA [1415]|GEHA [141500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|390||||390|234.43|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HEALTHNET [1495]|HEALTHNET [149500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390||||390|167.7|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|390||||390|362.7|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390||||390|234|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390||||390|113.53|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390||||390|254.52|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390||||390|167.79|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390||||390|140.66|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390||||390|106.28|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MULTIPLAN [1680]|HMA [168003]|390||||390|156.29|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MULTIPLAN [1680]|IHC HS [168011]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|390||||390|180.57|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390||||390|113.53|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|Self-pay|Self-pay|390||||390|117|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390||||390|81.9|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|390||||390|102.11|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390||||390|152.12|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|TRUSTMARK [2030]|STARMARK [203000]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390||||390|187.01|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|UMR [2035]|UMR OPTIONS [203501]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390||||390|159.8|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390||||390|351|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|390||||390|0|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|390||||390|144.3|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|390||||390|104.19|362.7|81.9
41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|390||||390|195|362.7|81.9
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|AETNA [1015]|AETNA ACO WILCO [101532]|249||||249|0|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|249||||249|59.51|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|249||||249|59.51|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|249||||249|124.75|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|249||||249|87.4|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|249||||249|107.07|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|249||||249|106.07|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|249||||249|124.5|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|249||||249|161.85|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|CORESOURCE [1315]|CORESOURCE [131500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|249||||249|0|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|249||||249|92.13|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|GEHA [1415]|GEHA [141500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HEALTHNET [1495]|HEALTHNET [149500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|249||||249|107.07|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|249||||249|231.57|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|249||||249|149.4|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|249||||249|124.5|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|249||||249|57.47|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MULTIPLAN [1680]|HMA [168003]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MULTIPLAN [1680]|IHC HS [168011]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|249||||249|61.85|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|Self-pay|Self-pay|249||||249|74.7|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|249||||249|52.29|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|TRUSTMARK [2030]|STARMARK [203000]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|249||||249|119.4|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|UMR [2035]|UMR OPTIONS [203501]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|249||||249|54.73|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|249||||249|224.1|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|249||||249|0|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|249||||249|92.13|231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|249||||249||231.57|52.29
41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|249||||249|124.5|231.57|52.29
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|773||||773|0|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|773||||773|178.36|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|773||||773|127.33|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|773||||773|127.33|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|773||||773|173.22|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|773||||773|387.27|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|773||||773|271.32|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|773||||773|332.39|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|773||||773|329.3|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|773||||773|386.5|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|773||||773|502.45|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|773||||773|0|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|773||||773|286.01|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|GEHA [1415]|GEHA [141500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|773||||773|393.44|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|773||||773|332.39|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|773||||773|718.89|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|773||||773|463.8|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|773||||773|190.54|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|773||||773|457.98|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|773||||773|122.98|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|773||||773|236.06|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|773||||773|178.36|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MULTIPLAN [1680]|HMA [168003]|773||||773|262.29|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MULTIPLAN [1680]|IHC HS [168011]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|773||||773|132.34|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|773||||773|190.54|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|Self-pay|Self-pay|773||||773|231.9|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|773||||773|162.33|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|773||||773|171.37|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|773||||773|255.3|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|TRUSTMARK [2030]|STARMARK [203000]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|773||||773|370.65|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|UMR [2035]|UMR OPTIONS [203501]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|773||||773|117.12|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|773||||773|695.7|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|773||||773|0|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|773||||773|286.01|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|773||||773|174.86|718.89|117.12
41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|773||||773|386.5|718.89|117.12
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|351||||351|0|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351||||351|178.36|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351||||351|217.1|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351||||351|217.1|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351||||351|173.22|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|351||||351|175.85|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351||||351|123.2|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351||||351|150.93|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|351||||351|149.53|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|351||||351|175.5|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351||||351|228.15|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|CORESOURCE [1315]|CORESOURCE [131500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|351||||351|0|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|351||||351|129.87|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|GEHA [1415]|GEHA [141500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|351||||351|351|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HEALTHNET [1495]|HEALTHNET [149500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351||||351|150.93|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|351||||351|326.43|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351||||351|210.6|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351||||351|190.54|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351||||351|351|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351||||351|209.69|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351||||351|236.06|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351||||351|178.36|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MULTIPLAN [1680]|HMA [168003]|351||||351|262.29|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MULTIPLAN [1680]|IHC HS [168011]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|351||||351|225.65|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351||||351|190.54|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|Self-pay|Self-pay|351||||351|105.3|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351||||351|73.71|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|351||||351|171.37|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351||||351|255.3|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|TRUSTMARK [2030]|STARMARK [203000]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351||||351|168.3|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|UMR [2035]|UMR OPTIONS [203501]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351||||351|199.7|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351||||351|315.9|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|351||||351|0|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|351||||351|129.87|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|351||||351|174.86|351|73.71
41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|351||||351|175.5|351|73.71
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|183||||183|0|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183||||183|106.28|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183||||183|217.1|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183||||183|217.1|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183||||183|103.21|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|183||||183|91.68|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183||||183|64.23|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183||||183|78.69|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|183||||183|77.96|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|183||||183|91.5|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183||||183|118.95|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|183||||183|0|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|183||||183|67.71|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|GEHA [1415]|GEHA [141500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|183||||183|183|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183||||183|78.69|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|183||||183|170.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183||||183|109.8|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183||||183|113.53|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183||||183|183|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183||||183|183|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183||||183|140.66|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183||||183|106.28|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MULTIPLAN [1680]|HMA [168003]|183||||183|156.29|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MULTIPLAN [1680]|IHC HS [168011]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|183||||183|183|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183||||183|113.53|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|Self-pay|Self-pay|183||||183|54.9|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183||||183|38.43|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|183||||183|102.11|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183||||183|152.12|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|TRUSTMARK [2030]|STARMARK [203000]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183||||183|87.75|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|UMR [2035]|UMR OPTIONS [203501]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183||||183|183|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183||||183|164.7|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|183||||183|0|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|183||||183|67.71|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|183||||183|104.19|217.1|38.43
41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|183||||183|91.5|217.1|38.43
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|125||||125|0|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125||||125|106.28|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125||||125|69.06|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125||||125|69.06|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125||||125|103.21|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|125||||125|62.63|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125||||125|43.88|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125||||125|53.75|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|125||||125|53.25|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|125||||125|62.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125||||125|81.25|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|CORESOURCE [1315]|CORESOURCE [131500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|125||||125|0|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|125||||125|46.25|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|GEHA [1415]|GEHA [141500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|125||||125|125|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HEALTHNET [1495]|HEALTHNET [149500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125||||125|53.75|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|125||||125|116.25|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125||||125|75|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125||||125|113.53|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125||||125|125|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125||||125|66.71|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125||||125|125|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125||||125|106.28|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MULTIPLAN [1680]|HMA [168003]|125||||125|125|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MULTIPLAN [1680]|IHC HS [168011]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|125||||125|71.78|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125||||125|113.53|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|Self-pay|Self-pay|125||||125|37.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125||||125|26.25|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|125||||125|102.11|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125||||125|125|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|TRUSTMARK [2030]|STARMARK [203000]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125||||125|59.94|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|UMR [2035]|UMR OPTIONS [203501]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125||||125|63.53|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125||||125|112.5|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|125||||125|0|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|125||||125|46.25|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|125||||125|104.19|125|26.25
41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|125||||125|62.5|125|26.25
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|74||||74|0|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74||||74|24.9|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74||||74|27.88|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74||||74|27.88|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74||||74|24.18|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74||||74|37.07|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74||||74|25.97|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74||||74|31.82|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74||||74|31.52|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74||||74|37|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74||||74|48.1|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74||||74|0|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74||||74|27.38|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|GEHA [1415]|GEHA [141500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74||||74|54.93|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74||||74|31.82|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74||||74|68.82|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74||||74|44.4|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74||||74|26.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74||||74|74|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74||||74|26.92|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74||||74|32.96|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74||||74|24.9|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MULTIPLAN [1680]|HMA [168003]|74||||74|36.62|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74||||74|28.98|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74||||74|26.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|Self-pay|Self-pay|74||||74|22.2|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74||||74|15.54|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74||||74|23.92|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74||||74|35.64|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74||||74|35.48|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|UMR [2035]|UMR OPTIONS [203501]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74||||74|25.64|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74||||74|66.6|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74||||74|0|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74||||74|27.38|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74||||74|24.41|74|15.54
41099406|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING 3-10 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74||||74|37|74|15.54
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|82||||82|0|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82||||82|24.9|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82||||82|27.88|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82||||82|27.88|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82||||82|24.18|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82||||82|41.08|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82||||82|28.78|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82||||82|35.26|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82||||82|34.93|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82||||82|41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82||||82|53.3|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82||||82|0|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82||||82|30.34|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|GEHA [1415]|GEHA [141500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82||||82|54.93|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82||||82|35.26|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82||||82|76.26|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82||||82|49.2|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82||||82|26.6|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82||||82|79.78|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82||||82|26.92|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82||||82|32.96|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82||||82|24.9|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MULTIPLAN [1680]|HMA [168003]|82||||82|36.62|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82||||82|28.98|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82||||82|26.6|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|Self-pay|Self-pay|82||||82|24.6|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82||||82|17.22|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82||||82|23.92|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82||||82|35.64|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82||||82|39.32|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|UMR [2035]|UMR OPTIONS [203501]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82||||82|25.64|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82||||82|73.8|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82||||82|0|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82||||82|30.34|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82||||82|24.41|79.78|17.22
41099407|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC BEHAV CHNG SMOKING > 10 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82||||82|41|79.78|17.22
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|241.37||||241.37|120.93|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|241.37||||241.37|84.72|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|241.37||||241.37|103.79|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|241.37||||241.37|102.82|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|241.37||||241.37|120.69|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|241.37||||241.37|156.89|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|241.37||||241.37|19.74|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|241.37||||241.37|89.31|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|241.37||||241.37|103.79|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|241.37||||241.37|224.47|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|241.37||||241.37|144.82|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|241.37||||241.37|120.69|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|Self-pay|Self-pay|241.37||||241.37|72.41|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|241.37||||241.37|50.69|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|241.37||||241.37|19.19|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|241.37||||241.37|115.74|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|241.37||||241.37|217.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|241.37||||241.37|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|241.37||||241.37|89.31|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|241.37||||241.37||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|241.37||||241.37|120.69|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|298.7||||298.7|149.65|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|298.7||||298.7|104.84|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|298.7||||298.7|128.44|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|298.7||||298.7|127.25|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|298.7||||298.7|149.35|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|298.7||||298.7|194.16|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|298.7||||298.7|29.61|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|298.7||||298.7|110.52|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|GEHA [1415]|GEHA [141500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|298.7||||298.7|128.44|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|298.7||||298.7|277.79|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|298.7||||298.7|179.22|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|298.7||||298.7|149.35|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MULTIPLAN [1680]|HMA [168003]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MULTIPLAN [1680]|IHC HS [168011]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|Self-pay|Self-pay|298.7||||298.7|89.61|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|298.7||||298.7|62.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|298.7||||298.7|28.78|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|TRUSTMARK [2030]|STARMARK [203000]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|298.7||||298.7|143.23|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|UMR [2035]|UMR OPTIONS [203501]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|298.7||||298.7|268.83|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|298.7||||298.7|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|298.7||||298.7|110.52|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|298.7||||298.7||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|298.7||||298.7|149.35|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|AETNA [1015]|AETNA ACO WILCO [101532]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|368.85||||368.85|184.79|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368.85||||368.85|129.47|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368.85||||368.85|158.61|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|368.85||||368.85|157.13|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|368.85||||368.85|184.43|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368.85||||368.85|239.75|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|CORESOURCE [1315]|CORESOURCE [131500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|368.85||||368.85|39.47|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|368.85||||368.85|136.47|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|GEHA [1415]|GEHA [141500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HEALTHNET [1495]|HEALTHNET [149500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368.85||||368.85|158.61|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|368.85||||368.85|343.03|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368.85||||368.85|221.31|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368.85||||368.85|184.43|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MULTIPLAN [1680]|HMA [168003]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MULTIPLAN [1680]|IHC HS [168011]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|Self-pay|Self-pay|368.85||||368.85|110.65|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368.85||||368.85|77.46|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368.85||||368.85|38.37|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|TRUSTMARK [2030]|STARMARK [203000]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368.85||||368.85|176.86|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|UMR [2035]|UMR OPTIONS [203501]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368.85||||368.85|331.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|368.85||||368.85|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|368.85||||368.85|136.47|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|368.85||||368.85||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|20 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|368.85||||368.85|184.43|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123.03||||123.03|61.64|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.03||||123.03|43.18|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.03||||123.03|52.9|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123.03||||123.03|52.41|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123.03||||123.03|61.52|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.03||||123.03|79.97|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|123.03||||123.03|9.87|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123.03||||123.03|45.52|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.03||||123.03|52.9|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|123.03||||123.03|114.42|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.03||||123.03|73.82|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.03||||123.03|61.52|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|Self-pay|Self-pay|123.03||||123.03|36.91|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.03||||123.03|25.84|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.03||||123.03|9.59|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.03||||123.03|58.99|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.03||||123.03|110.73|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123.03||||123.03|0|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123.03||||123.03|45.52|343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123.03||||123.03||343.03|9.59
41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123.03||||123.03|61.52|343.03|9.59
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|AETNA [1015]|AETNA ACO WILCO [101532]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|984.93||||984.93|493.45|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|984.93||||984.93|345.71|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|984.93||||984.93|423.52|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|984.93||||984.93|419.58|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|984.93||||984.93|492.47|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|984.93||||984.93|640.2|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|CORESOURCE [1315]|CORESOURCE [131500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|CORVEL CORP [2235]|CORVEL CORP [223500]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|984.93||||984.93|364.42|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|GEHA [1415]|GEHA [141500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HEALTHNET [1495]|HEALTHNET [149500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|984.93||||984.93|423.52|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HEALTHSMART [1505]|HEALTHSMART [150501]|984.93||||984.93|915.98|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|984.93||||984.93|590.96|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MULTIPLAN [1680]|HMA [168003]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MULTIPLAN [1680]|IHC HS [168011]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|Self-pay|Self-pay|984.93||||984.93|295.48|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|984.93||||984.93|206.84|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|TRUSTMARK [2030]|STARMARK [203000]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|984.93||||984.93|472.27|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|UMR [2035]|UMR OPTIONS [203501]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|984.93||||984.93|886.44|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|984.93||||984.93|0|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|984.93||||984.93|364.42|915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|984.93||||984.93||915.98|206.84
41142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER|12.9 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|984.93||||984.93|492.47|915.98|206.84
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|AETNA [1015]|AETNA ACO WILCO [101532]|328.14||||328.14|0|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|328.14||||328.14|49.67|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|328.14||||328.14|65.5|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|328.14||||328.14|65.5|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|328.14||||328.14|164.4|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|328.14||||328.14|115.18|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|328.14||||328.14|141.1|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|328.14||||328.14|139.79|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|328.14||||328.14|164.07|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|328.14||||328.14|213.29|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|CORESOURCE [1315]|CORESOURCE [131500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|328.14||||328.14|50.72|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|328.14||||328.14|121.41|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|GEHA [1415]|GEHA [141500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|328.14||||328.14|109.58|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HEALTHNET [1495]|HEALTHNET [149500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|328.14||||328.14|141.1|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|328.14||||328.14|305.17|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|328.14||||328.14|196.88|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|328.14||||328.14|53.57|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|328.14||||328.14|0|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|328.14||||328.14|69.85|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|328.14||||328.14|65.75|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|328.14||||328.14|49.67|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MULTIPLAN [1680]|HMA [168003]|328.14||||328.14|114.85|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MULTIPLAN [1680]|IHC HS [168011]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|328.14||||328.14|68.08|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|328.14||||328.14|53.57|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|Self-pay|Self-pay|328.14||||328.14|98.44|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|328.14||||328.14|68.91|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|328.14||||328.14|47.73|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|328.14||||328.14|62.54|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|TRUSTMARK [2030]|STARMARK [203000]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|328.14||||328.14|157.34|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|UMR [2035]|UMR OPTIONS [203501]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|328.14||||328.14|66.52|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|328.14||||328.14|295.33|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|328.14||||328.14|0|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|328.14||||328.14|121.41|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|328.14||||328.14|48.7|305.17|47.73
41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|50 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|328.14||||328.14|164.07|305.17|47.73
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|0|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|62.92|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|12.88|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|21.65|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|21.65|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|104.06|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|0|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|0|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242||225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|104.06|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|13.89|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|20.91|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|17.05|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|12.88|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MULTIPLAN [1680]|HMA [168003]|242||||242||225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242||225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|22.5|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|13.89|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|Self-pay|Self-pay|242||||242|72.6|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|12.38|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|18.44|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|19.91|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|156|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|0|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|12.63|225.06|12.38
42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|12.38
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|AETNA [1015]|AETNA ACO WILCO [101532]|730||||730|0|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|730||||730|208.59|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|730||||730|208.59|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|730||||730|365.73|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|730||||730|256.23|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|730||||730|313.9|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|730||||730|310.98|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|730||||730|365|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|730||||730|474.5|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|CORESOURCE [1315]|CORESOURCE [131500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|730||||730|0|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|730||||730|282.84|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|GEHA [1415]|GEHA [141500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HEALTHNET [1495]|HEALTHNET [149500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|730||||730|313.9|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|730||||730|678.9|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|730||||730|438|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|730||||730|563.08|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|730||||730|201.46|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MULTIPLAN [1680]|HMA [168003]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MULTIPLAN [1680]|IHC HS [168011]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|730||||730|216.8|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|Self-pay|Self-pay|730||||730|219|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|730||||730|153.3|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|TRUSTMARK [2030]|STARMARK [203000]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|730||||730|350.04|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|UMR [2035]|UMR OPTIONS [203501]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|730||||730|191.86|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|730||||730|657|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|730||||730|156|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|730||||730|282.84|678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|730||||730||678.9|153.3
42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|730||||730|365|678.9|153.3
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA [1015]|AETNA ACO WILCO [101532]|142||||142|0|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142||||142|43.99|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142||||142|92.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142||||142|92.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142||||142|71.14|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142||||142|49.84|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142||||142|61.06|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142||||142|60.49|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142||||142|71|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142||||142|92.3|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CORESOURCE [1315]|CORESOURCE [131500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142||||142|0|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142||||142|0|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|GEHA [1415]|GEHA [141500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142||||142|97.04|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHNET [1495]|HEALTHNET [149500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142||||142|61.06|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142||||142|132.06|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142||||142|85.2|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142||||142|47.44|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142||||142|0|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142||||142|88.98|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142||||142|58.23|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142||||142|43.99|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MULTIPLAN [1680]|HMA [168003]|142||||142|64.7|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MULTIPLAN [1680]|IHC HS [168011]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142||||142|95.76|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142||||142|47.44|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|Self-pay|Self-pay|142||||142|42.6|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142||||142|29.82|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142||||142|42.27|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142||||142|60.38|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TRUSTMARK [2030]|STARMARK [203000]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142||||142|68.09|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UMR [2035]|UMR OPTIONS [203501]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142||||142|0|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142||||142|127.8|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142||||142|142|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142||||142|0|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142||||142|43.13|142|29.82
42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142||||142|71|142|29.82
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA [1015]|AETNA ACO WILCO [101532]|79||||79|0|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79||||79|37.94|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79||||79|37.94|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79||||79|39.58|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79||||79|27.73|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79||||79|33.97|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79||||79|33.65|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79||||79|39.5|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79||||79|51.35|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CORESOURCE [1315]|CORESOURCE [131500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79||||79|0|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79||||79|0|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|GEHA [1415]|GEHA [141500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHNET [1495]|HEALTHNET [149500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79||||79|33.97|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79||||79|73.47|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79||||79|47.4|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79||||79|0|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79||||79|36.65|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MULTIPLAN [1680]|HMA [168003]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MULTIPLAN [1680]|IHC HS [168011]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79||||79|39.43|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|Self-pay|Self-pay|79||||79|23.7|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79||||79|16.59|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TRUSTMARK [2030]|STARMARK [203000]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79||||79|37.88|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UMR [2035]|UMR OPTIONS [203501]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79||||79|0|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79||||79|71.1|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79||||79|79|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79||||79|0|79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79||||79||79|16.59
42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79||||79|39.5|79|16.59
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|AETNA [1015]|AETNA ACO WILCO [101532]|211||||211|0|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211||||211|37.28|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211||||211|125.24|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211||||211|125.24|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|211||||211|105.71|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211||||211|74.06|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211||||211|90.73|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|211||||211|89.89|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|211||||211|105.5|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211||||211|137.15|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|CORESOURCE [1315]|CORESOURCE [131500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|211||||211|0|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|211||||211|74.85|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|GEHA [1415]|GEHA [141500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|211||||211|82.24|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HEALTHNET [1495]|HEALTHNET [149500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211||||211|90.73|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|211||||211|196.23|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211||||211|126.6|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211||||211|40.21|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211||||211|105.5|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211||||211|120.96|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211||||211|49.34|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211||||211|37.28|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MULTIPLAN [1680]|HMA [168003]|211||||211|54.83|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MULTIPLAN [1680]|IHC HS [168011]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|211||||211|130.17|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211||||211|40.21|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|Self-pay|Self-pay|211||||211|63.3|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211||||211|44.31|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|211||||211|35.82|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211||||211|51.17|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|TRUSTMARK [2030]|STARMARK [203000]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211||||211|101.17|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|UMR [2035]|UMR OPTIONS [203501]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211||||211|115.2|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211||||211|189.9|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|211||||211|156|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|211||||211|74.85|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|211||||211|36.55|196.23|35.82
42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|211||||211|105.5|196.23|35.82
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87||||87|22.62|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA [1015]|AETNA ACO WILCO [101532]|87||||87|0|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87||||87|22.62|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87||||87|22.14|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87||||87|22.14|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87||||87|43.59|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87||||87|30.54|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87||||87|37.41|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87||||87|37.06|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87||||87|43.5|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87||||87|56.55|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CORESOURCE [1315]|CORESOURCE [131500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87||||87|12.73|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87||||87|12.99|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|GEHA [1415]|GEHA [141500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHNET [1495]|HEALTHNET [149500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87||||87|37.41|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87||||87|80.91|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87||||87|52.2|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87||||87|43.5|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87||||87|21.38|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MULTIPLAN [1680]|HMA [168003]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MULTIPLAN [1680]|IHC HS [168011]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87||||87|23.01|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|Self-pay|Self-pay|87||||87|26.1|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87||||87|18.27|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87||||87|54.03|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TRUSTMARK [2030]|STARMARK [203000]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87||||87|41.72|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UMR [2035]|UMR OPTIONS [203501]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87||||87|20.36|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87||||87|78.3|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87||||87|87|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87||||87|65.25|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87||||87|12.99|87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87||||87||87|12.73
42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87||||87|43.5|87|12.73
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|162||||162|0|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162||||162|14.74|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162||||162|19.05|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162||||162|19.05|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|162||||162|81.16|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162||||162|56.86|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162||||162|69.66|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|162||||162|69.01|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|162||||162|81|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162||||162|105.3|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|CORESOURCE [1315]|CORESOURCE [131500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|162||||162|26.26|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|162||||162|26.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|GEHA [1415]|GEHA [141500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|162||||162|32.51|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HEALTHNET [1495]|HEALTHNET [149500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162||||162|69.66|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|162||||162|150.66|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162||||162|97.2|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162||||162|15.9|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162||||162|81|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162||||162|18.4|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162||||162|19.51|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162||||162|14.74|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MULTIPLAN [1680]|HMA [168003]|162||||162|21.68|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MULTIPLAN [1680]|IHC HS [168011]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|162||||162|19.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162||||162|15.9|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|Self-pay|Self-pay|162||||162|48.6|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162||||162|34.02|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|162||||162|14.16|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162||||162|21.1|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|TRUSTMARK [2030]|STARMARK [203000]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162||||162|77.68|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|UMR [2035]|UMR OPTIONS [203501]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162||||162|17.52|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162||||162|145.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|162||||162|156|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|162||||162|26.8|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|162||||162|14.45|156|14.16
42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|162||||162|81|156|14.16
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|124||||124|0|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124||||124|5.74|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124||||124|8.02|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124||||124|8.02|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124||||124|62.12|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124||||124|43.52|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124||||124|53.32|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124||||124|52.82|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124||||124|62|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124||||124|80.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CORESOURCE [1315]|CORESOURCE [131500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124||||124|18.07|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124||||124|18.44|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|GEHA [1415]|GEHA [141500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124||||124|12.67|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHNET [1495]|HEALTHNET [149500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124||||124|53.32|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124||||124|115.32|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124||||124|74.4|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124||||124|6.19|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124||||124|62|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124||||124|7.75|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124||||124|7.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124||||124|5.74|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MULTIPLAN [1680]|HMA [168003]|124||||124|8.45|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MULTIPLAN [1680]|IHC HS [168011]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124||||124|8.34|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124||||124|6.19|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|Self-pay|Self-pay|124||||124|37.2|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124||||124|26.04|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124||||124|5.52|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124||||124|8.22|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TRUSTMARK [2030]|STARMARK [203000]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124||||124|59.46|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UMR [2035]|UMR OPTIONS [203501]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124||||124|7.38|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124||||124|111.6|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124||||124|124|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124||||124|18.44|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124||||124|5.63|124|5.52
42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124||||124|62|124|5.52
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA [1015]|AETNA ACO WILCO [101532]|140||||140|0|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|140||||140|14.74|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|140||||140|20.41|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|140||||140|20.41|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|140||||140|70.14|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|140||||140|49.14|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|140||||140|60.2|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|140||||140|59.64|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|140||||140|70|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|140||||140|91|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CORESOURCE [1315]|CORESOURCE [131500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|140||||140|29.49|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|140||||140|30.09|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|GEHA [1415]|GEHA [141500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|140||||140|32.51|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHNET [1495]|HEALTHNET [149500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|140||||140|60.2|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|140||||140|130.2|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|140||||140|84|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|140||||140|15.9|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|140||||140|70|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|140||||140|19.71|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|140||||140|19.51|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|140||||140|14.74|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MULTIPLAN [1680]|HMA [168003]|140||||140|21.68|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MULTIPLAN [1680]|IHC HS [168011]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|140||||140|21.21|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|140||||140|15.9|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|Self-pay|Self-pay|140||||140|42|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|140||||140|29.4|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|140||||140|14.16|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|140||||140|21.1|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TRUSTMARK [2030]|STARMARK [203000]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|140||||140|67.13|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UMR [2035]|UMR OPTIONS [203501]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|140||||140|18.77|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|140||||140|126|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|140||||140|140|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|140||||140|30.09|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|140||||140|14.45|140|14.16
42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|140||||140|70|140|14.16
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|445||||445|0|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|445||||445|19.87|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|445||||445|25.89|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|445||||445|25.89|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|445||||445|222.95|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|445||||445|156.2|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|445||||445|191.35|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|445||||445|189.57|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|445||||445|222.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|445||||445|289.25|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|445||||445|44.39|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|445||||445|45.3|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|GEHA [1415]|GEHA [141500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|445||||445|43.83|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|445||||445|191.35|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|445||||445|413.85|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|445||||445|267|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|445||||445|21.43|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|445||||445|222.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|445||||445|25|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|445||||445|26.3|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|445||||445|19.87|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|445||||445|29.22|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|445||||445|26.91|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|445||||445|21.43|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|Self-pay|Self-pay|445||||445|133.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|445||||445|93.45|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|445||||445|19.09|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|445||||445|28.44|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|445||||445|213.38|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|445||||445|23.81|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|445||||445|400.5|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|445||||445|156|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|445||||445|45.3|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|445||||445|19.48|413.85|19.09
42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|445||||445|222.5|413.85|19.09
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|235||||235|0|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235||||235|14.27|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235||||235|15.66|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235||||235|15.66|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|235||||235|117.74|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235||||235|82.49|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235||||235|101.05|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|235||||235|100.11|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|235||||235|117.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235||||235|152.75|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|235||||235|22.73|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|235||||235|23.19|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|GEHA [1415]|GEHA [141500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|235||||235|31.48|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235||||235|101.05|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|235||||235|218.55|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235||||235|141|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235||||235|15.39|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235||||235|117.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235||||235|15.13|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235||||235|18.89|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235||||235|14.27|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|235||||235|20.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|235||||235|16.28|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235||||235|15.39|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|Self-pay|Self-pay|235||||235|70.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235||||235|49.35|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|235||||235|13.71|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235||||235|20.43|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235||||235|112.68|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235||||235|14.41|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235||||235|211.5|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|235||||235|156|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|235||||235|23.19|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|235||||235|13.99|218.55|13.71
42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|235||||235|117.5|218.55|13.71
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|85||||85|0|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85||||85|15.87|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85||||85|15.87|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|85||||85|42.59|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85||||85|29.84|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85||||85|36.55|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|85||||85|36.21|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|85||||85|42.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85||||85|55.25|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CORESOURCE [1315]|CORESOURCE [131500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|85||||85|0|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|85||||85|20.71|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|GEHA [1415]|GEHA [141500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHNET [1495]|HEALTHNET [149500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85||||85|36.55|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|85||||85|79.05|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85||||85|51|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85||||85|42.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85||||85|15.33|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MULTIPLAN [1680]|HMA [168003]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MULTIPLAN [1680]|IHC HS [168011]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|85||||85|16.49|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|Self-pay|Self-pay|85||||85|25.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85||||85|17.85|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TRUSTMARK [2030]|STARMARK [203000]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85||||85|40.76|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UMR [2035]|UMR OPTIONS [203501]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85||||85|14.6|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85||||85|76.5|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|85||||85|85|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|85||||85|20.71|85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|85||||85||85|14.6
42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|85||||85|42.5|85|14.6
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|203||||203|0|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203||||203|29.6|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203||||203|36.03|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203||||203|36.03|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|203||||203|101.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203||||203|71.25|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203||||203|87.29|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|203||||203|86.48|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|203||||203|101.5|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203||||203|131.95|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|203||||203|50.21|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|203||||203|51.23|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|GEHA [1415]|GEHA [141500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|203||||203|65.3|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203||||203|87.29|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|203||||203|188.79|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203||||203|121.8|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203||||203|31.92|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203||||203|101.5|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203||||203|34.8|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203||||203|39.18|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203||||203|29.6|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|203||||203|43.53|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|203||||203|37.45|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203||||203|31.92|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|Self-pay|Self-pay|203||||203|60.9|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203||||203|42.63|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|203||||203|28.44|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203||||203|42.37|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203||||203|97.34|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203||||203|33.15|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203||||203|182.7|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|203||||203|156|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|203||||203|51.23|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|203||||203|29.02|188.79|28.44
42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|203||||203|101.5|188.79|28.44
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|213||||213|0|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213||||213|34.25|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213||||213|37.37|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213||||213|37.37|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213||||213|106.71|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213||||213|74.76|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213||||213|91.59|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213||||213|90.74|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213||||213|106.5|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213||||213|138.45|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|213||||213|53.65|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213||||213|56.02|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|GEHA [1415]|GEHA [141500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213||||213|75.56|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213||||213|91.59|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|213||||213|198.09|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213||||213|127.8|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213||||213|36.94|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213||||213|106.5|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213||||213|36.09|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213||||213|45.33|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213||||213|34.25|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|213||||213|50.37|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|213||||213|38.84|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213||||213|36.94|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|Self-pay|Self-pay|213||||213|63.9|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213||||213|44.73|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213||||213|32.91|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213||||213|49.03|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213||||213|102.13|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213||||213|34.37|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213||||213|191.7|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213||||213|156|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213||||213|56.02|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213||||213|33.58|198.09|32.91
42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213||||213|106.5|198.09|32.91
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA [1015]|AETNA ACO WILCO [101532]|201||||201|0|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201||||201|37.05|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201||||201|40.48|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201||||201|40.48|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|201||||201|100.7|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201||||201|70.55|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201||||201|86.43|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|201||||201|85.63|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|201||||201|100.5|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201||||201|130.65|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CORESOURCE [1315]|CORESOURCE [131500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|201||||201|58.94|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|201||||201|60.14|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|GEHA [1415]|GEHA [141500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|201||||201|81.72|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHNET [1495]|HEALTHNET [149500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201||||201|86.43|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|201||||201|186.93|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201||||201|120.6|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201||||201|39.95|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201||||201|100.5|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201||||201|39.09|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201||||201|49.03|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201||||201|37.05|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MULTIPLAN [1680]|HMA [168003]|201||||201|54.48|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MULTIPLAN [1680]|IHC HS [168011]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|201||||201|42.07|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201||||201|39.95|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|Self-pay|Self-pay|201||||201|60.3|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201||||201|42.21|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|201||||201|35.59|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201||||201|53.03|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TRUSTMARK [2030]|STARMARK [203000]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201||||201|96.38|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UMR [2035]|UMR OPTIONS [203501]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201||||201|37.23|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201||||201|180.9|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|201||||201|156|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|201||||201|60.14|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|201||||201|36.32|186.93|35.59
42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|201||||201|100.5|186.93|35.59
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|233||||233|0|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233||||233|29.6|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|233||||233|31.67|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|233||||233|31.67|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|233||||233|116.73|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|233||||233|81.78|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|233||||233|100.19|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|233||||233|99.26|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|233||||233|116.5|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233||||233|151.45|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|233||||233|43.58|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|233||||233|45.52|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|GEHA [1415]|GEHA [141500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|233||||233|65.3|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233||||233|100.19|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|233||||233|216.69|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|233||||233|139.8|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|233||||233|31.92|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|233||||233|116.5|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|233||||233|30.59|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|233||||233|39.18|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233||||233|29.6|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|233||||233|43.53|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|233||||233|32.92|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|233||||233|31.92|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|Self-pay|Self-pay|233||||233|69.9|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|233||||233|48.93|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|233||||233|28.44|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|233||||233|42.37|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233||||233|111.72|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|233||||233|29.13|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|233||||233|209.7|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|233||||233|156|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|233||||233|45.52|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|233||||233|29.02|216.69|28.44
42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|233||||233|116.5|216.69|28.44
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|130||||130|0|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130||||130|28.5|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130||||130|28.67|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130||||130|28.67|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|130||||130|65.13|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130||||130|45.63|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130||||130|55.9|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|130||||130|55.38|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|130||||130|65|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130||||130|84.5|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|130||||130|46.02|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|130||||130|46.96|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|GEHA [1415]|GEHA [141500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|130||||130|62.87|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130||||130|55.9|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|130||||130|120.9|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130||||130|78|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130||||130|30.73|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130||||130|65|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130||||130|27.69|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130||||130|37.72|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130||||130|28.5|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|130||||130|41.91|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|130||||130|29.8|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130||||130|30.73|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|Self-pay|Self-pay|130||||130|39|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130||||130|27.3|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|130||||130|27.38|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130||||130|40.79|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130||||130|62.34|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130||||130|26.37|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130||||130|117|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|130||||130|130|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|130||||130|46.96|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|130||||130|27.94|130|26.37
42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY EACH 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|130||||130|65|130|26.37
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|260||||260|0|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260||||260|27.3|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260||||260|33.64|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260||||260|33.64|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|260||||260|130.26|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260||||260|91.26|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260||||260|111.8|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|260||||260|110.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|260||||260|130|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260||||260|169|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|260||||260|46.49|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|260||||260|47.44|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|GEHA [1415]|GEHA [141500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|260||||260|60.21|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260||||260|111.8|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|260||||260|241.8|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260||||260|156|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260||||260|29.44|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260||||260|130|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260||||260|32.49|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260||||260|36.13|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260||||260|27.3|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|260||||260|40.14|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|260||||260|34.96|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260||||260|29.44|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|Self-pay|Self-pay|260||||260|78|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260||||260|54.6|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|260||||260|26.22|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260||||260|39.07|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260||||260|124.67|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260||||260|30.94|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260||||260|234|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|260||||260|156|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|260||||260|47.44|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|260||||260|26.76|241.8|26.22
42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|260||||260|130|241.8|26.22
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA [1015]|AETNA ACO WILCO [101532]|479||||479|0|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|479||||479|17.75|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|479||||479|22.34|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|479||||479|22.34|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|479||||479|239.98|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|479||||479|168.13|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|479||||479|205.97|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|479||||479|204.05|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|479||||479|239.5|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|479||||479|311.35|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CORESOURCE [1315]|CORESOURCE [131500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|479||||479|30.74|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|479||||479|31.37|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|GEHA [1415]|GEHA [141500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|479||||479|39.15|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHNET [1495]|HEALTHNET [149500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|479||||479|205.97|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|479||||479|445.47|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|479||||479|287.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|479||||479|19.14|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|479||||479|239.5|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|479||||479|21.58|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|479||||479|23.49|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|479||||479|17.75|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MULTIPLAN [1680]|HMA [168003]|479||||479|26.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MULTIPLAN [1680]|IHC HS [168011]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|479||||479|23.22|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|479||||479|19.14|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|Self-pay|Self-pay|479||||479|143.7|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|479||||479|100.59|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|479||||479|17.05|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|479||||479|25.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TRUSTMARK [2030]|STARMARK [203000]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|479||||479|229.68|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UMR [2035]|UMR OPTIONS [203501]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|479||||479|20.55|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|479||||479|431.1|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|479||||479|156|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|479||||479|31.37|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|479||||479|17.4|445.47|17.05
42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|479||||479|239.5|445.47|17.05
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|284||||284|0|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|284||||284|37.85|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|284||||284|37.32|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|284||||284|37.32|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|284||||284|142.28|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|284||||284|99.68|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|284||||284|122.12|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|284||||284|120.98|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|284||||284|142|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|284||||284|184.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|284||||284|56.07|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|284||||284|58.44|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|GEHA [1415]|GEHA [141500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|284||||284|83.5|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|284||||284|122.12|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|284||||284|264.12|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|284||||284|170.4|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|284||||284|40.82|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|284||||284|142|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|284||||284|36.05|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|284||||284|50.1|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|284||||284|37.85|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|284||||284|55.67|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|284||||284|38.79|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|284||||284|40.82|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|Self-pay|Self-pay|284||||284|85.2|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|284||||284|59.64|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|284||||284|36.37|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|284||||284|54.18|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|284||||284|136.18|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|284||||284|34.33|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|284||||284|255.6|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|284||||284|156|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|284||||284|58.44|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|284||||284|37.11|264.12|34.33
42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|284||||284|142|264.12|34.33
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|208||||208|0|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208||||208|57.46|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208||||208|33.69|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208||||208|33.69|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|208||||208|104.21|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208||||208|73.01|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208||||208|89.44|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|208||||208|88.61|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|208||||208|104|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208||||208|135.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|208||||208|51.57|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|208||||208|62.87|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|GEHA [1415]|GEHA [141500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|208||||208|126.74|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208||||208|89.44|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|208||||208|193.44|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208||||208|124.8|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208||||208|61.96|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208||||208|104|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208||||208|32.53|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208||||208|76.05|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208||||208|57.46|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MULTIPLAN [1680]|HMA [168003]|208||||208|84.5|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MULTIPLAN [1680]|IHC HS [168011]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|208||||208|35.02|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208||||208|61.96|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|Self-pay|Self-pay|208||||208|62.4|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208||||208|43.68|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|208||||208|55.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208||||208|82.24|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TRUSTMARK [2030]|STARMARK [203000]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208||||208|99.74|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UMR [2035]|UMR OPTIONS [203501]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208||||208|30.98|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208||||208|187.2|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|208||||208|156|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|208||||208|62.87|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|208||||208|56.33|193.44|30.98
42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|208||||208|104|193.44|30.98
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|299||||299|0|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|299||||299|32.79|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|299||||299|38.27|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|299||||299|38.27|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|299||||299|149.8|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|299||||299|104.95|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|299||||299|128.57|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|299||||299|127.37|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|299||||299|149.5|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|299||||299|194.35|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|299||||299|54.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|299||||299|55.77|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|GEHA [1415]|GEHA [141500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|299||||299|72.34|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|299||||299|128.57|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|299||||299|278.07|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|299||||299|179.4|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|299||||299|35.37|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|299||||299|149.5|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|299||||299|36.95|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|299||||299|43.4|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|299||||299|32.79|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|299||||299|48.23|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|299||||299|39.78|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|299||||299|35.37|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|Self-pay|Self-pay|299||||299|89.7|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|299||||299|62.79|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|299||||299|31.51|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|299||||299|46.94|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|299||||299|143.37|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|299||||299|35.19|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|299||||299|269.1|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|299||||299|156|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|299||||299|55.77|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|299||||299|32.15|278.07|31.51
42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|299||||299|149.5|278.07|31.51
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|142||||142|0|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142||||142|31.63|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142||||142|35.12|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142||||142|35.12|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142||||142|71.14|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142||||142|49.84|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142||||142|61.06|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142||||142|60.49|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142||||142|71|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142||||142|92.3|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142||||142|51.99|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142||||142|53.51|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|GEHA [1415]|GEHA [141500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142||||142|69.77|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142||||142|61.06|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142||||142|132.06|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142||||142|85.2|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142||||142|34.11|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142||||142|71|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142||||142|33.92|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142||||142|41.86|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142||||142|31.63|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|142||||142|46.52|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142||||142|36.5|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142||||142|34.11|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|Self-pay|Self-pay|142||||142|42.6|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142||||142|29.82|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142||||142|30.39|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142||||142|45.27|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142||||142|68.09|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142||||142|32.3|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142||||142|127.8|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142||||142|142|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142||||142|53.51|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142||||142|31.01|142|29.82
42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142||||142|71|142|29.82
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|276||||276|0|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|276||||276|31.95|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|276||||276|36.03|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|276||||276|36.03|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|276||||276|138.28|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|276||||276|96.88|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|276||||276|118.68|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|276||||276|117.58|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|276||||276|138|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|276||||276|179.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|276||||276|52.54|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|276||||276|54.08|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|GEHA [1415]|GEHA [141500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|276||||276|70.47|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|276||||276|118.68|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|276||||276|256.68|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|276||||276|165.6|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|276||||276|34.45|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|276||||276|138|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|276||||276|34.8|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|276||||276|42.28|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|276||||276|31.95|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|276||||276|46.98|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|276||||276|37.45|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|276||||276|34.45|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|Self-pay|Self-pay|276||||276|82.8|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|276||||276|57.96|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|276||||276|30.69|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|276||||276|45.73|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|276||||276|132.34|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|276||||276|33.15|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|276||||276|248.4|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|276||||276|156|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|276||||276|54.08|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|276||||276|31.32|256.68|30.69
42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|276||||276|138|256.68|30.69
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|4749||||4749|0|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4749||||4749|170.44|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4749||||4749|137.06|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4749||||4749|137.06|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4749||||4749|165.53|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4749||||4749|2379.25|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4749||||4749|1666.9|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4749||||4749|2042.07|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4749||||4749|2023.07|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4749||||4749|2374.5|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4749||||4749|3086.85|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|CORESOURCE [1315]|CORESOURCE [131500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4749||||4749|120.78|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4749||||4749|130.21|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|GEHA [1415]|GEHA [141500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4749||||4749|375.98|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HEALTHNET [1495]|HEALTHNET [149500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4749||||4749|2042.07|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4749||||4749|4416.57|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4749||||4749|2849.4|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4749||||4749|182.08|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4749||||4749|421.76|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4749||||4749|132.37|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4749||||4749|225.59|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4749||||4749|170.44|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MULTIPLAN [1680]|HMA [168003]|4749||||4749|250.65|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MULTIPLAN [1680]|IHC HS [168011]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4749||||4749|142.46|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4749||||4749|182.08|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|Self-pay|Self-pay|4749||||4749|1424.7|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4749||||4749|997.29|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4749||||4749|163.76|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4749||||4749|243.97|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|TRUSTMARK [2030]|STARMARK [203000]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4749||||4749|2277.15|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|UMR [2035]|UMR OPTIONS [203501]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4749||||4749|126.07|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4749||||4749|4274.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4749||||4749|156|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4749||||4749|130.21|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4749||||4749|167.1|4416.57|120.78
42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4749||||4749|2374.5|4416.57|120.78
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|4806||||4806|0|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4806||||4806|137.06|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4806||||4806|137.06|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4806||||4806|2407.81|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4806||||4806|1686.91|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4806||||4806|2066.58|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4806||||4806|2047.36|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4806||||4806|2403|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4806||||4806|3123.9|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CORESOURCE [1315]|CORESOURCE [131500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4806||||4806|84.37|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4806||||4806|86.09|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|GEHA [1415]|GEHA [141500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHNET [1495]|HEALTHNET [149500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4806||||4806|2066.58|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4806||||4806|4469.58|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4806||||4806|2883.6|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4806||||4806|2403|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MULTIPLAN [1680]|HMA [168003]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MULTIPLAN [1680]|IHC HS [168011]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|Self-pay|Self-pay|4806||||4806|1441.8|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4806||||4806|1009.26|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TRUSTMARK [2030]|STARMARK [203000]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4806||||4806|2304.48|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UMR [2035]|UMR OPTIONS [203501]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4806||||4806|4325.4|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4806||||4806|156|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4806||||4806|86.09|4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4806||||4806||4469.58|84.37
42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4806||||4806|2403|4469.58|84.37
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA [1015]|AETNA ACO WILCO [101532]|618||||618|0|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|618||||618|170.44|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|618||||618|78.16|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|618||||618|78.16|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|618||||618|165.53|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|618||||618|309.62|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|618||||618|216.92|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|618||||618|265.74|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|618||||618|263.27|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|618||||618|309|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|618||||618|401.7|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CORESOURCE [1315]|CORESOURCE [131500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|618||||618|62.89|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|618||||618|67.51|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|GEHA [1415]|GEHA [141500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|618||||618|375.98|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHNET [1495]|HEALTHNET [149500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|618||||618|265.74|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|618||||618|574.74|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|618||||618|370.8|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|618||||618|182.08|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|618||||618|421.76|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|618||||618|75.48|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|618||||618|225.59|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|618||||618|170.44|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MULTIPLAN [1680]|HMA [168003]|618||||618|250.65|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MULTIPLAN [1680]|IHC HS [168011]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|618||||618|81.24|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|618||||618|182.08|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|Self-pay|Self-pay|618||||618|185.4|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|618||||618|129.78|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|618||||618|163.76|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|618||||618|243.97|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TRUSTMARK [2030]|STARMARK [203000]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|618||||618|296.33|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UMR [2035]|UMR OPTIONS [203501]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|618||||618|71.89|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|618||||618|556.2|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|618||||618|156|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|618||||618|67.51|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|618||||618|167.1|574.74|62.89
42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|618||||618|309|574.74|62.89
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|713||||713|0|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713||||713|170.44|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713||||713|129.9|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713||||713|129.9|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713||||713|165.53|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|713||||713|357.21|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713||||713|250.26|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713||||713|306.59|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|713||||713|303.74|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|713||||713|356.5|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713||||713|463.45|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CORESOURCE [1315]|CORESOURCE [131500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|713||||713|59.99|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|713||||713|63.44|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|GEHA [1415]|GEHA [141500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|713||||713|375.98|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHNET [1495]|HEALTHNET [149500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713||||713|306.59|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|713||||713|663.09|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713||||713|427.8|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713||||713|182.08|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713||||713|421.76|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713||||713|125.46|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713||||713|225.59|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713||||713|170.44|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MULTIPLAN [1680]|HMA [168003]|713||||713|250.65|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MULTIPLAN [1680]|IHC HS [168011]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|713||||713|135.01|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713||||713|182.08|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|Self-pay|Self-pay|713||||713|213.9|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713||||713|149.73|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|713||||713|163.76|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713||||713|243.97|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TRUSTMARK [2030]|STARMARK [203000]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713||||713|341.88|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UMR [2035]|UMR OPTIONS [203501]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713||||713|119.48|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713||||713|641.7|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|713||||713|156|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|713||||713|63.44|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|713||||713|167.1|663.09|59.99
42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|713||||713|356.5|663.09|59.99
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|1228||||1228|0|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1228||||1228|328.31|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1228||||1228|137.06|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1228||||1228|137.06|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1228||||1228|318.85|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1228||||1228|615.23|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1228||||1228|431.03|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1228||||1228|528.04|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1228||||1228|523.13|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1228||||1228|614|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1228||||1228|798.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CORESOURCE [1315]|CORESOURCE [131500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1228||||1228|70.38|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1228||||1228|74.78|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|GEHA [1415]|GEHA [141500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1228||||1228|724.22|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHNET [1495]|HEALTHNET [149500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1228||||1228|528.04|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1228||||1228|1142.04|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1228||||1228|736.8|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1228||||1228|350.73|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1228||||1228|750.73|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1228||||1228|132.37|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1228||||1228|434.53|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1228||||1228|328.31|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MULTIPLAN [1680]|HMA [168003]|1228||||1228|482.81|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MULTIPLAN [1680]|IHC HS [168011]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1228||||1228|142.46|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1228||||1228|350.73|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|Self-pay|Self-pay|1228||||1228|368.4|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1228||||1228|257.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1228||||1228|315.44|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1228||||1228|469.94|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TRUSTMARK [2030]|STARMARK [203000]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1228||||1228|588.83|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UMR [2035]|UMR OPTIONS [203501]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1228||||1228|126.07|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1228||||1228|1105.2|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1228||||1228|156|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1228||||1228|74.78|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1228||||1228|321.88|1142.04|70.38
42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1228||||1228|614|1142.04|70.38
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|146||||146|0|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146||||146|33.43|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146||||146|38.27|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146||||146|38.27|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|146||||146|73.15|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146||||146|51.25|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146||||146|62.78|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|146||||146|62.2|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|146||||146|73|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146||||146|94.9|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|146||||146|57.61|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|146||||146|58.79|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|GEHA [1415]|GEHA [141500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|146||||146|73.73|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146||||146|62.78|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|146||||146|135.78|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146||||146|87.6|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146||||146|36.05|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146||||146|73|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146||||146|36.95|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146||||146|44.24|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146||||146|33.43|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|146||||146|49.16|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|146||||146|39.78|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146||||146|36.05|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|Self-pay|Self-pay|146||||146|43.8|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146||||146|30.66|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|146||||146|32.11|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146||||146|47.84|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146||||146|70.01|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146||||146|35.19|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146||||146|131.4|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|146||||146|146|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|146||||146|58.79|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|146||||146|32.77|146|30.66
42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|146||||146|73|146|30.66
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|0|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254|47.96|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|39.65|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|39.65|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|109.22|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|67.76|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|77.55|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254|105.8|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|109.22|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254|51.72|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|127|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|38.3|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254|63.48|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254|47.96|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MULTIPLAN [1680]|HMA [168003]|254||||254|70.53|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|41.21|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254|51.72|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|Self-pay|Self-pay|254||||254|76.2|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254|46.08|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254|68.65|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|36.47|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|156|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|77.55|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254|47.02|236.22|36.47
42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|36.47
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|0|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254|40.95|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|36.48|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|36.48|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|109.22|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|55.62|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|59.23|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254|90.34|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|109.22|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254|44.17|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|127|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|35.23|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254|54.2|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254|40.95|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|254||||254|60.23|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|37.92|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254|44.17|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|Self-pay|Self-pay|254||||254|76.2|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254|39.35|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254|58.62|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|33.55|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|156|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|59.23|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254|40.15|236.22|33.55
42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|33.55
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|AETNA [1015]|AETNA ACO WILCO [101532]|89||||89|0|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89||||89|52.36|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89||||89|57.93|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89||||89|57.93|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89||||89|44.59|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89||||89|31.24|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89||||89|38.27|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89||||89|37.91|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89||||89|44.5|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89||||89|57.85|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|CORESOURCE [1315]|CORESOURCE [131500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89||||89|0|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89||||89|84.94|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|GEHA [1415]|GEHA [141500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89||||89|89|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HEALTHNET [1495]|HEALTHNET [149500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89||||89|38.27|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89||||89|82.77|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89||||89|53.4|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89||||89|56.46|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89||||89|44.5|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89||||89|55.96|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89||||89|69.3|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89||||89|52.36|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MULTIPLAN [1680]|HMA [168003]|89||||89|77|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MULTIPLAN [1680]|IHC HS [168011]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89||||89|60.21|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89||||89|56.46|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|Self-pay|Self-pay|89||||89|26.7|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89||||89|18.69|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89||||89|50.3|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89||||89|74.94|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|TRUSTMARK [2030]|STARMARK [203000]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89||||89|42.68|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|UMR [2035]|UMR OPTIONS [203501]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89||||89|0|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89||||89|80.1|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89||||89|89|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89||||89|84.94|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89||||89|51.33|89|18.69
42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89||||89|44.5|89|18.69
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172||||172|44.72|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172||||172|44.72|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|172||||172|86.17|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172||||172|60.37|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172||||172|73.96|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|172||||172|73.27|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|172||||172|86|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172||||172|111.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CORESOURCE [1315]|CORESOURCE [131500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|GEHA [1415]|GEHA [141500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHNET [1495]|HEALTHNET [149500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172||||172|73.96|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|172||||172|159.96|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172||||172|103.2|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172||||172|86|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MULTIPLAN [1680]|HMA [168003]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MULTIPLAN [1680]|IHC HS [168011]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|Self-pay|Self-pay|172||||172|51.6|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172||||172|36.12|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172||||172|106.81|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TRUSTMARK [2030]|STARMARK [203000]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172||||172|82.47|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UMR [2035]|UMR OPTIONS [203501]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172||||172|43|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172||||172|154.8|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|172||||172|156|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|172||||172|129|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|172||||172|0|159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|172||||172||159.96|36.12
42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|172||||172|86|159.96|36.12
4210001|EAP||HH PT ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|Self-pay|Self-pay|||||139.73|41.92|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||139.73|0|69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||139.73||69.87|29.34
4210001|EAP||HH PT ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|GEHA [1415]|GEHA [141500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|Self-pay|Self-pay|||||139.73|41.92|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||139.73|0|69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||139.73||69.87|29.34
4210002|EAP||HH PT INITIAL VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|Self-pay|Self-pay|||||139.73|41.92|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||139.73|0|69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||139.73||69.87|29.34
4210003|EAP||HH PTA ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|GEHA [1415]|GEHA [141500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MULTIPLAN [1680]|HMA [168003]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MULTIPLAN [1680]|IHC HS [168011]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|Self-pay|Self-pay|||||139.73|41.92|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|TRUSTMARK [2030]|STARMARK [203000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|UMR [2035]|UMR OPTIONS [203501]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||139.73|0|69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||139.73||69.87|29.34
4210004|EAP||HH PT MAINTENANCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||139.73|0|69.87|29.34
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37.71||||37.71|18.89|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.71||||37.71|13.24|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.71||||37.71|16.22|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37.71||||37.71|16.06|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37.71||||37.71|18.86|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.71||||37.71|24.51|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37.71||||37.71|13.95|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.71||||37.71|16.22|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|37.71||||37.71|35.07|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.71||||37.71|22.63|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|Self-pay|Self-pay|37.71||||37.71|11.31|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.71||||37.71|7.92|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.71||||37.71|18.08|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.71||||37.71|33.94|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37.71||||37.71|0|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37.71||||37.71|13.95|35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37.71||||37.71||35.07|7.92
42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37.71||||37.71|18.86|35.07|7.92
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41.48||||41.48|20.78|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.48||||41.48|14.56|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.48||||41.48|17.84|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41.48||||41.48|17.67|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41.48||||41.48|20.74|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.48||||41.48|26.96|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41.48||||41.48|15.35|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.48||||41.48|17.84|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|41.48||||41.48|38.58|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.48||||41.48|24.89|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|Self-pay|Self-pay|41.48||||41.48|12.44|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.48||||41.48|8.71|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.48||||41.48|19.89|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.48||||41.48|37.33|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41.48||||41.48|0|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41.48||||41.48|15.35|38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41.48||||41.48||38.58|8.71
42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41.48||||41.48|20.74|38.58|8.71
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
42164|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 75 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41.48||||41.48|20.78|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.48||||41.48|14.56|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.48||||41.48|17.84|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41.48||||41.48|17.67|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41.48||||41.48|20.74|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.48||||41.48|26.96|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41.48||||41.48|15.35|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.48||||41.48|17.84|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|41.48||||41.48|38.58|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.48||||41.48|24.89|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|Self-pay|Self-pay|41.48||||41.48|12.44|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.48||||41.48|8.71|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.48||||41.48|19.89|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.48||||41.48|37.33|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41.48||||41.48|0|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41.48||||41.48|15.35|38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41.48||||41.48||38.58|8.71
42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41.48||||41.48|20.74|38.58|8.71
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37.71||||37.71|18.89|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.71||||37.71|13.24|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.71||||37.71|16.22|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37.71||||37.71|16.06|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37.71||||37.71|18.86|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.71||||37.71|24.51|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37.71||||37.71|13.95|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.71||||37.71|16.22|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|37.71||||37.71|35.07|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.71||||37.71|22.63|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|Self-pay|Self-pay|37.71||||37.71|11.31|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.71||||37.71|7.92|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.71||||37.71|18.08|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.71||||37.71|33.94|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37.71||||37.71|0|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37.71||||37.71|13.95|35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37.71||||37.71||35.07|7.92
42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37.71||||37.71|18.86|35.07|7.92
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|866||||866|0|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|866||||866|99.3|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|866||||866|30.04|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|866||||866|30.04|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|866||||866|433.87|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|866||||866|303.97|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|866||||866|372.38|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|866||||866|368.92|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|866||||866|433|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|866||||866|562.9|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|CORESOURCE [1315]|CORESOURCE [131500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|866||||866|127.87|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|866||||866|130.48|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|GEHA [1415]|GEHA [141500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|866||||866|219.04|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HEALTHNET [1495]|HEALTHNET [149500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|866||||866|372.38|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|866||||866|805.38|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|866||||866|519.6|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|866||||866|107.09|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|866||||866|433|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|866||||866|29.01|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|866||||866|131.42|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|866||||866|99.3|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MULTIPLAN [1680]|HMA [168003]|866||||866|146.03|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MULTIPLAN [1680]|IHC HS [168011]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|866||||866|31.22|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|866||||866|107.09|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|Self-pay|Self-pay|866||||866|259.8|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|866||||866|181.86|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|866||||866|95.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|866||||866|142.13|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|TRUSTMARK [2030]|STARMARK [203000]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|866||||866|415.25|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|UMR [2035]|UMR OPTIONS [203501]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|866||||866|27.63|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|866||||866|779.4|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|866||||866|156|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|866||||866|130.48|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|866||||866|97.35|805.38|27.63
42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|866||||866|433|805.38|27.63
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|953||||953|0|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|953||||953|99.3|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|953||||953|60.06|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|953||||953|60.06|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|953||||953|477.45|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|953||||953|334.5|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|953||||953|409.79|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|953||||953|405.98|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|953||||953|476.5|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|953||||953|619.45|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|CORESOURCE [1315]|CORESOURCE [131500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|953||||953|127.87|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|953||||953|130.48|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|GEHA [1415]|GEHA [141500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|953||||953|219.04|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HEALTHNET [1495]|HEALTHNET [149500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|953||||953|409.79|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|953||||953|886.29|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|953||||953|571.8|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|953||||953|107.09|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|953||||953|476.5|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|953||||953|58.01|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|953||||953|131.42|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|953||||953|99.3|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MULTIPLAN [1680]|HMA [168003]|953||||953|146.03|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MULTIPLAN [1680]|IHC HS [168011]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|953||||953|62.42|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|953||||953|107.09|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|Self-pay|Self-pay|953||||953|285.9|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|953||||953|200.13|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|953||||953|95.4|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|953||||953|142.13|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|TRUSTMARK [2030]|STARMARK [203000]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|953||||953|456.96|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|UMR [2035]|UMR OPTIONS [203501]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|953||||953|55.24|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|953||||953|857.7|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|953||||953|156|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|953||||953|130.48|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|953||||953|97.35|886.29|55.24
42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|953||||953|476.5|886.29|55.24
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1048||||1048|0|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1048||||1048|99.3|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1048||||1048|91.02|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1048||||1048|91.02|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1048||||1048|525.05|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1048||||1048|367.85|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1048||||1048|450.64|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1048||||1048|446.45|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1048||||1048|524|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1048||||1048|681.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|CORESOURCE [1315]|CORESOURCE [131500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1048||||1048|140.8|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1048||||1048|143.87|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|GEHA [1415]|GEHA [141500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1048||||1048|219.04|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HEALTHNET [1495]|HEALTHNET [149500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1048||||1048|450.64|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1048||||1048|974.64|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1048||||1048|628.8|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1048||||1048|107.09|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1048||||1048|524|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1048||||1048|87.91|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1048||||1048|131.42|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1048||||1048|99.3|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MULTIPLAN [1680]|HMA [168003]|1048||||1048|146.03|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MULTIPLAN [1680]|IHC HS [168011]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1048||||1048|94.6|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1048||||1048|107.09|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|Self-pay|Self-pay|1048||||1048|314.4|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1048||||1048|220.08|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1048||||1048|95.4|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1048||||1048|142.13|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|TRUSTMARK [2030]|STARMARK [203000]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1048||||1048|502.52|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|UMR [2035]|UMR OPTIONS [203501]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1048||||1048|83.72|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1048||||1048|943.2|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1048||||1048|156|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1048||||1048|143.87|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1048||||1048|97.35|974.64|83.72
42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1048||||1048|524|974.64|83.72
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|332||||332|0|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|332||||332|67.72|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|332||||332|16.26|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|332||||332|16.26|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|332||||332|166.33|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|332||||332|116.53|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|332||||332|142.76|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|332||||332|141.43|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|332||||332|166|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|332||||332|215.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|CORESOURCE [1315]|CORESOURCE [131500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|332||||332|86.48|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|332||||332|88.24|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|GEHA [1415]|GEHA [141500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|332||||332|149.38|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HEALTHNET [1495]|HEALTHNET [149500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|332||||332|142.76|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|332||||332|308.76|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|332||||332|199.2|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|332||||332|73.03|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|332||||332|166|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|332||||332|15.71|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|332||||332|89.63|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|332||||332|67.72|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MULTIPLAN [1680]|HMA [168003]|332||||332|99.59|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MULTIPLAN [1680]|IHC HS [168011]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|332||||332|16.9|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|332||||332|73.03|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|Self-pay|Self-pay|332||||332|99.6|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|332||||332|69.72|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|332||||332|65.06|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|332||||332|96.93|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|TRUSTMARK [2030]|STARMARK [203000]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|332||||332|159.19|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|UMR [2035]|UMR OPTIONS [203501]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|332||||332|14.96|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|332||||332|298.8|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|332||||332|156|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|332||||332|88.24|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|332||||332|66.39|308.76|14.96
42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|332||||332|166|308.76|14.96
4300001|EAP||HH OT MAINTENANCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|GEHA [1415]|GEHA [141500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MULTIPLAN [1680]|HMA [168003]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MULTIPLAN [1680]|IHC HS [168011]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|Self-pay|Self-pay|||||140.68|42.2|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|TRUSTMARK [2030]|STARMARK [203000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|UMR [2035]|UMR OPTIONS [203501]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||140.68|0|70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||140.68||70.34|29.54
4300001|EAP||HH OT MAINTENANCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||140.68|0|70.34|29.54
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|0|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242|62.92|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242|12.88|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|21.65|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|21.65|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|104.06|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|0|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|0|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242||225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|104.06|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242|13.89|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|20.91|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242|17.05|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242|12.88|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MULTIPLAN [1680]|HMA [168003]|242||||242||225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242||225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|22.5|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242|13.89|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|Self-pay|Self-pay|242||||242|72.6|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242|12.38|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242|18.44|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|19.91|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|156|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|0|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242|12.63|225.06|12.38
43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|12.38
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|AETNA [1015]|AETNA ACO WILCO [101532]|801||||801|0|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|801||||801|93.71|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|801||||801|93.71|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|801||||801|401.3|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|801||||801|281.15|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|801||||801|344.43|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|801||||801|341.23|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|801||||801|400.5|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|801||||801|520.65|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|CORESOURCE [1315]|CORESOURCE [131500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|801||||801|0|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|801||||801|176.24|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|GEHA [1415]|GEHA [141500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HEALTHNET [1495]|HEALTHNET [149500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|801||||801|344.43|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|801||||801|744.93|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|801||||801|480.6|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|801||||801|321.78|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|801||||801|90.51|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MULTIPLAN [1680]|HMA [168003]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MULTIPLAN [1680]|IHC HS [168011]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|801||||801|97.4|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|Self-pay|Self-pay|801||||801|240.3|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|801||||801|168.21|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|TRUSTMARK [2030]|STARMARK [203000]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|801||||801|384.08|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|UMR [2035]|UMR OPTIONS [203501]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|801||||801|86.2|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|801||||801|720.9|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|801||||801|156|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|801||||801|176.24|744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|801||||801||744.93|86.2
43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|801||||801|400.5|744.93|86.2
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|1175||||1175|0|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1175||||1175|106.28|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1175||||1175|173.73|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1175||||1175|173.73|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1175||||1175|103.21|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1175||||1175|588.68|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1175||||1175|412.43|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1175||||1175|505.25|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1175||||1175|500.55|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1175||||1175|587.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1175||||1175|763.75|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|CORESOURCE [1315]|CORESOURCE [131500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1175||||1175|0|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1175||||1175|130.08|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|GEHA [1415]|GEHA [141500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1175||||1175|234.43|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HEALTHNET [1495]|HEALTHNET [149500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1175||||1175|505.25|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1175||||1175|1092.75|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1175||||1175|705|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1175||||1175|113.53|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1175||||1175|254.52|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1175||||1175|167.79|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1175||||1175|140.66|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1175||||1175|106.28|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MULTIPLAN [1680]|HMA [168003]|1175||||1175|156.29|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MULTIPLAN [1680]|IHC HS [168011]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1175||||1175|180.57|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1175||||1175|113.53|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|Self-pay|Self-pay|1175||||1175|352.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1175||||1175|246.75|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1175||||1175|102.11|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1175||||1175|152.12|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|TRUSTMARK [2030]|STARMARK [203000]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1175||||1175|563.41|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|UMR [2035]|UMR OPTIONS [203501]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1175||||1175|159.8|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1175||||1175|1057.5|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1175||||1175|156|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1175||||1175|130.08|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1175||||1175|104.19|1092.75|102.11
43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1175||||1175|587.5|1092.75|102.11
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|2035||||2035|0|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2035||||2035|69.06|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2035||||2035|69.06|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2035||||2035|1019.54|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2035||||2035|714.29|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2035||||2035|875.05|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2035||||2035|866.91|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2035||||2035|1017.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2035||||2035|1322.75|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|CORESOURCE [1315]|CORESOURCE [131500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2035||||2035|0|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2035||||2035|166.78|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|GEHA [1415]|GEHA [141500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HEALTHNET [1495]|HEALTHNET [149500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2035||||2035|875.05|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2035||||2035|1892.55|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2035||||2035|1221|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2035||||2035|254.52|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2035||||2035|66.71|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MULTIPLAN [1680]|HMA [168003]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MULTIPLAN [1680]|IHC HS [168011]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2035||||2035|71.78|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|Self-pay|Self-pay|2035||||2035|610.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2035||||2035|427.35|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|TRUSTMARK [2030]|STARMARK [203000]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2035||||2035|975.78|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|UMR [2035]|UMR OPTIONS [203501]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2035||||2035|63.53|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2035||||2035|1831.5|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2035||||2035|156|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2035||||2035|166.78|1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2035||||2035||1892.55|63.53
43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2035||||2035|1017.5|1892.55|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|628||||628|0|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|628||||628|69.06|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|628||||628|69.06|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|628||||628|314.63|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|628||||628|220.43|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|628||||628|270.04|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|628||||628|267.53|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|628||||628|314|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|628||||628|408.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|CORESOURCE [1315]|CORESOURCE [131500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|628||||628|0|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|628||||628|89.75|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|GEHA [1415]|GEHA [141500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HEALTHNET [1495]|HEALTHNET [149500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|628||||628|270.04|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|628||||628|584.04|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|628||||628|376.8|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|628||||628|133.61|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|628||||628|66.71|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MULTIPLAN [1680]|HMA [168003]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MULTIPLAN [1680]|IHC HS [168011]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|628||||628|71.78|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|Self-pay|Self-pay|628||||628|188.4|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|628||||628|131.88|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|TRUSTMARK [2030]|STARMARK [203000]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|628||||628|301.13|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|UMR [2035]|UMR OPTIONS [203501]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|628||||628|63.53|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|628||||628|565.2|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|628||||628|156|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|628||||628|89.75|584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|628||||628||584.04|63.53
43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|628||||628|314|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|628||||628|0|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|628||||628|69.06|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|628||||628|69.06|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|628||||628|314.63|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|628||||628|220.43|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|628||||628|270.04|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|628||||628|267.53|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|628||||628|314|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|628||||628|408.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|CORESOURCE [1315]|CORESOURCE [131500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|628||||628|0|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|628||||628|112.92|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|GEHA [1415]|GEHA [141500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HEALTHNET [1495]|HEALTHNET [149500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|628||||628|270.04|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|628||||628|584.04|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|628||||628|376.8|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|628||||628|133.61|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|628||||628|66.71|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MULTIPLAN [1680]|HMA [168003]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MULTIPLAN [1680]|IHC HS [168011]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|628||||628|71.78|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|Self-pay|Self-pay|628||||628|188.4|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|628||||628|131.88|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|TRUSTMARK [2030]|STARMARK [203000]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|628||||628|301.13|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|UMR [2035]|UMR OPTIONS [203501]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|628||||628|63.53|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|628||||628|565.2|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|628||||628|156|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|628||||628|112.92|584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|628||||628||584.04|63.53
43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|628||||628|314|584.04|63.53
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA [1015]|AETNA ACO WILCO [101532]|142||||142|0|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142||||142|43.99|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142||||142|92.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142||||142|92.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142||||142|71.14|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142||||142|49.84|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142||||142|61.06|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142||||142|60.49|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142||||142|71|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142||||142|92.3|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CORESOURCE [1315]|CORESOURCE [131500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142||||142|0|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142||||142|0|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|GEHA [1415]|GEHA [141500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142||||142|97.04|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHNET [1495]|HEALTHNET [149500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142||||142|61.06|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142||||142|132.06|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142||||142|85.2|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142||||142|47.44|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142||||142|0|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142||||142|88.98|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142||||142|58.23|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142||||142|43.99|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MULTIPLAN [1680]|HMA [168003]|142||||142|64.7|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MULTIPLAN [1680]|IHC HS [168011]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142||||142|95.76|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142||||142|47.44|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|Self-pay|Self-pay|142||||142|42.6|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142||||142|29.82|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142||||142|42.27|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142||||142|60.38|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|TRUSTMARK [2030]|STARMARK [203000]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142||||142|68.09|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UMR [2035]|UMR OPTIONS [203501]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142||||142|0|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142||||142|127.8|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142||||142|142|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142||||142|0|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142||||142|43.13|142|29.82
43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142||||142|71|142|29.82
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA [1015]|AETNA ACO WILCO [101532]|79||||79|0|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79||||79|37.94|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79||||79|37.94|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79||||79|39.58|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79||||79|27.73|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79||||79|33.97|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79||||79|33.65|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79||||79|39.5|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79||||79|51.35|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CORESOURCE [1315]|CORESOURCE [131500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79||||79|0|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79||||79|0|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|GEHA [1415]|GEHA [141500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHNET [1495]|HEALTHNET [149500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79||||79|33.97|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79||||79|73.47|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79||||79|47.4|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79||||79|0|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79||||79|36.65|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MULTIPLAN [1680]|HMA [168003]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MULTIPLAN [1680]|IHC HS [168011]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79||||79|39.43|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|Self-pay|Self-pay|79||||79|23.7|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79||||79|16.59|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|TRUSTMARK [2030]|STARMARK [203000]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79||||79|37.88|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UMR [2035]|UMR OPTIONS [203501]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79||||79|0|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79||||79|71.1|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79||||79|79|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79||||79|0|79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79||||79||79|16.59
43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79||||79|39.5|79|16.59
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87||||87|22.62|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA [1015]|AETNA ACO WILCO [101532]|87||||87|0|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87||||87|22.62|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87||||87|22.14|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87||||87|22.14|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87||||87|43.59|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87||||87|30.54|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87||||87|37.41|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87||||87|37.06|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87||||87|43.5|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87||||87|56.55|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CORESOURCE [1315]|CORESOURCE [131500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87||||87|12.73|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87||||87|12.99|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|GEHA [1415]|GEHA [141500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHNET [1495]|HEALTHNET [149500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87||||87|37.41|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87||||87|80.91|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87||||87|52.2|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87||||87|43.5|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87||||87|21.38|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MULTIPLAN [1680]|HMA [168003]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MULTIPLAN [1680]|IHC HS [168011]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87||||87|23.01|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|Self-pay|Self-pay|87||||87|26.1|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87||||87|18.27|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87||||87|54.03|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|TRUSTMARK [2030]|STARMARK [203000]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87||||87|41.72|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UMR [2035]|UMR OPTIONS [203501]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87||||87|20.36|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87||||87|78.3|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87||||87|87|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87||||87|65.25|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87||||87|12.99|87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87||||87||87|12.73
43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87||||87|43.5|87|12.73
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA [1015]|AETNA ACO WILCO [101532]|124||||124|0|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124||||124|5.74|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124||||124|8.02|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124||||124|8.02|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124||||124|62.12|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124||||124|43.52|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124||||124|53.32|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124||||124|52.82|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124||||124|62|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124||||124|80.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CORESOURCE [1315]|CORESOURCE [131500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124||||124|18.07|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124||||124|18.44|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|GEHA [1415]|GEHA [141500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124||||124|12.67|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHNET [1495]|HEALTHNET [149500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124||||124|53.32|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124||||124|115.32|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124||||124|74.4|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124||||124|6.19|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124||||124|62|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124||||124|7.75|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124||||124|7.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124||||124|5.74|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MULTIPLAN [1680]|HMA [168003]|124||||124|8.45|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MULTIPLAN [1680]|IHC HS [168011]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124||||124|8.34|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124||||124|6.19|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|Self-pay|Self-pay|124||||124|37.2|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124||||124|26.04|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124||||124|5.52|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124||||124|8.22|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|TRUSTMARK [2030]|STARMARK [203000]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124||||124|59.46|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UMR [2035]|UMR OPTIONS [203501]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124||||124|7.38|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124||||124|111.6|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124||||124|124|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124||||124|18.44|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124||||124|5.63|124|5.52
43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124||||124|62|124|5.52
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|AETNA [1015]|AETNA ACO WILCO [101532]|297||||297|0|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297||||297|18.59|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297||||297|18.59|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|297||||297|148.8|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297||||297|104.25|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297||||297|127.71|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|297||||297|126.52|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|297||||297|148.5|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297||||297|193.05|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|CORESOURCE [1315]|CORESOURCE [131500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|297||||297|36.45|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|297||||297|37.19|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|GEHA [1415]|GEHA [141500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HEALTHNET [1495]|HEALTHNET [149500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297||||297|127.71|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|297||||297|276.21|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297||||297|178.2|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297||||297|148.5|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297||||297|17.95|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MULTIPLAN [1680]|HMA [168003]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MULTIPLAN [1680]|IHC HS [168011]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|297||||297|19.32|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|Self-pay|Self-pay|297||||297|89.1|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297||||297|62.37|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|TRUSTMARK [2030]|STARMARK [203000]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297||||297|142.41|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|UMR [2035]|UMR OPTIONS [203501]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297||||297|17.1|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297||||297|267.3|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|297||||297|156|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|297||||297|37.19|276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|297||||297||276.21|17.1
43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|297||||297|148.5|276.21|17.1
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA [1015]|AETNA ACO WILCO [101532]|140||||140|0|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|140||||140|14.74|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|140||||140|20.41|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|140||||140|20.41|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|140||||140|70.14|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|140||||140|49.14|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|140||||140|60.2|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|140||||140|59.64|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|140||||140|70|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|140||||140|91|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CORESOURCE [1315]|CORESOURCE [131500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|140||||140|29.49|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|140||||140|30.09|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|GEHA [1415]|GEHA [141500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|140||||140|32.51|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHNET [1495]|HEALTHNET [149500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|140||||140|60.2|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|140||||140|130.2|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|140||||140|84|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|140||||140|15.9|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|140||||140|70|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|140||||140|19.71|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|140||||140|19.51|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|140||||140|14.74|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MULTIPLAN [1680]|HMA [168003]|140||||140|21.68|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MULTIPLAN [1680]|IHC HS [168011]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|140||||140|21.21|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|140||||140|15.9|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|Self-pay|Self-pay|140||||140|42|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|140||||140|29.4|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|140||||140|14.16|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|140||||140|21.1|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|TRUSTMARK [2030]|STARMARK [203000]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|140||||140|67.13|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UMR [2035]|UMR OPTIONS [203501]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|140||||140|18.77|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|140||||140|126|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|140||||140|140|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|140||||140|30.09|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|140||||140|14.45|140|14.16
43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|140||||140|70|140|14.16
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|445||||445|0|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|445||||445|19.87|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|445||||445|25.89|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|445||||445|25.89|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|445||||445|222.95|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|445||||445|156.2|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|445||||445|191.35|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|445||||445|189.57|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|445||||445|222.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|445||||445|289.25|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|445||||445|44.39|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|445||||445|45.3|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|GEHA [1415]|GEHA [141500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|445||||445|43.83|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|445||||445|191.35|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|445||||445|413.85|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|445||||445|267|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|445||||445|21.43|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|445||||445|222.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|445||||445|25|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|445||||445|26.3|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|445||||445|19.87|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|445||||445|29.22|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|445||||445|26.91|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|445||||445|21.43|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|Self-pay|Self-pay|445||||445|133.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|445||||445|93.45|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|445||||445|19.09|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|445||||445|28.44|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|445||||445|213.38|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|445||||445|23.81|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|445||||445|400.5|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|445||||445|156|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|445||||445|45.3|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|445||||445|19.48|413.85|19.09
43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|445||||445|222.5|413.85|19.09
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|235||||235|0|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235||||235|14.27|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235||||235|15.66|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235||||235|15.66|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|235||||235|117.74|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235||||235|82.49|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235||||235|101.05|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|235||||235|100.11|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|235||||235|117.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235||||235|152.75|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|235||||235|22.73|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|235||||235|23.19|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|GEHA [1415]|GEHA [141500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|235||||235|31.48|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235||||235|101.05|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|235||||235|218.55|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235||||235|141|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235||||235|15.39|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235||||235|117.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235||||235|15.13|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235||||235|18.89|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235||||235|14.27|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|235||||235|20.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|235||||235|16.28|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235||||235|15.39|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|Self-pay|Self-pay|235||||235|70.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235||||235|49.35|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|235||||235|13.71|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235||||235|20.43|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235||||235|112.68|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235||||235|14.41|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235||||235|211.5|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|235||||235|156|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|235||||235|23.19|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|235||||235|13.99|218.55|13.71
43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|235||||235|117.5|218.55|13.71
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|85||||85|0|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85||||85|15.87|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85||||85|15.87|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|85||||85|42.59|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85||||85|29.84|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85||||85|36.55|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|85||||85|36.21|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|85||||85|42.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85||||85|55.25|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CORESOURCE [1315]|CORESOURCE [131500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|85||||85|0|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|85||||85|20.71|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|GEHA [1415]|GEHA [141500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHNET [1495]|HEALTHNET [149500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85||||85|36.55|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|85||||85|79.05|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85||||85|51|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85||||85|42.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85||||85|15.33|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MULTIPLAN [1680]|HMA [168003]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MULTIPLAN [1680]|IHC HS [168011]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|85||||85|16.49|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|Self-pay|Self-pay|85||||85|25.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85||||85|17.85|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|TRUSTMARK [2030]|STARMARK [203000]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85||||85|40.76|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UMR [2035]|UMR OPTIONS [203501]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85||||85|14.6|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85||||85|76.5|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|85||||85|85|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|85||||85|20.71|85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|85||||85||85|14.6
43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|85||||85|42.5|85|14.6
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|203||||203|0|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203||||203|29.6|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203||||203|36.03|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203||||203|36.03|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|203||||203|101.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203||||203|71.25|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203||||203|87.29|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|203||||203|86.48|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|203||||203|101.5|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203||||203|131.95|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|203||||203|50.21|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|203||||203|51.23|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|GEHA [1415]|GEHA [141500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|203||||203|65.3|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203||||203|87.29|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|203||||203|188.79|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203||||203|121.8|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203||||203|31.92|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203||||203|101.5|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203||||203|34.8|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203||||203|39.18|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203||||203|29.6|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|203||||203|43.53|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|203||||203|37.45|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203||||203|31.92|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|Self-pay|Self-pay|203||||203|60.9|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203||||203|42.63|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|203||||203|28.44|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203||||203|42.37|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203||||203|97.34|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203||||203|33.15|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203||||203|182.7|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|203||||203|156|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|203||||203|51.23|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|203||||203|29.02|188.79|28.44
43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|203||||203|101.5|188.79|28.44
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|213||||213|0|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213||||213|34.25|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213||||213|37.37|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213||||213|37.37|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|213||||213|106.71|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213||||213|74.76|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213||||213|91.59|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|213||||213|90.74|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|213||||213|106.5|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213||||213|138.45|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|213||||213|53.65|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|213||||213|56.02|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|GEHA [1415]|GEHA [141500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|213||||213|75.56|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213||||213|91.59|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|213||||213|198.09|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213||||213|127.8|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213||||213|36.94|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213||||213|106.5|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213||||213|36.09|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213||||213|45.33|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213||||213|34.25|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|213||||213|50.37|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|213||||213|38.84|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213||||213|36.94|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|Self-pay|Self-pay|213||||213|63.9|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213||||213|44.73|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|213||||213|32.91|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213||||213|49.03|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213||||213|102.13|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213||||213|34.37|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213||||213|191.7|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|213||||213|156|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|213||||213|56.02|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|213||||213|33.58|198.09|32.91
43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|213||||213|106.5|198.09|32.91
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA [1015]|AETNA ACO WILCO [101532]|201||||201|0|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201||||201|37.05|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201||||201|40.48|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201||||201|40.48|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|201||||201|100.7|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201||||201|70.55|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201||||201|86.43|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|201||||201|85.63|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|201||||201|100.5|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201||||201|130.65|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CORESOURCE [1315]|CORESOURCE [131500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|201||||201|58.94|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|201||||201|60.14|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|GEHA [1415]|GEHA [141500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|201||||201|81.72|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHNET [1495]|HEALTHNET [149500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201||||201|86.43|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|201||||201|186.93|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201||||201|120.6|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201||||201|39.95|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201||||201|100.5|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201||||201|39.09|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201||||201|49.03|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201||||201|37.05|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MULTIPLAN [1680]|HMA [168003]|201||||201|54.48|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MULTIPLAN [1680]|IHC HS [168011]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|201||||201|42.07|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201||||201|39.95|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|Self-pay|Self-pay|201||||201|60.3|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201||||201|42.21|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|201||||201|35.59|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201||||201|53.03|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|TRUSTMARK [2030]|STARMARK [203000]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201||||201|96.38|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UMR [2035]|UMR OPTIONS [203501]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201||||201|37.23|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201||||201|180.9|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|201||||201|156|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|201||||201|60.14|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|201||||201|36.32|186.93|35.59
43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|201||||201|100.5|186.93|35.59
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|233||||233|0|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233||||233|29.6|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|233||||233|31.67|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|233||||233|31.67|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|233||||233|116.73|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|233||||233|81.78|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|233||||233|100.19|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|233||||233|99.26|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|233||||233|116.5|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233||||233|151.45|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|233||||233|43.58|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|233||||233|45.52|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|GEHA [1415]|GEHA [141500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|233||||233|65.3|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233||||233|100.19|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|233||||233|216.69|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|233||||233|139.8|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|233||||233|31.92|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|233||||233|116.5|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|233||||233|30.59|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|233||||233|39.18|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233||||233|29.6|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|233||||233|43.53|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|233||||233|32.92|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|233||||233|31.92|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|Self-pay|Self-pay|233||||233|69.9|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|233||||233|48.93|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|233||||233|28.44|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|233||||233|42.37|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233||||233|111.72|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|233||||233|29.13|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|233||||233|209.7|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|233||||233|156|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|233||||233|45.52|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|233||||233|29.02|216.69|28.44
43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|233||||233|116.5|216.69|28.44
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA [1015]|AETNA ACO WILCO [101532]|76||||76|0|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76||||76|23.41|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76||||76|28.47|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76||||76|28.47|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76||||76|38.08|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76||||76|26.68|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76||||76|32.68|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76||||76|32.38|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76||||76|38|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76||||76|49.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CORESOURCE [1315]|CORESOURCE [131500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76||||76|0|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76||||76|0|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|GEHA [1415]|GEHA [141500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76||||76|51.64|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHNET [1495]|HEALTHNET [149500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76||||76|32.68|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76||||76|70.68|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76||||76|45.6|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76||||76|25.25|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76||||76|0|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76||||76|27.49|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76||||76|30.98|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76||||76|23.41|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MULTIPLAN [1680]|HMA [168003]|76||||76|34.43|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MULTIPLAN [1680]|IHC HS [168011]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76||||76|29.59|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76||||76|25.25|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|Self-pay|Self-pay|76||||76|22.8|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76||||76|15.96|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76||||76|22.49|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76||||76|32.13|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TRUSTMARK [2030]|STARMARK [203000]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76||||76|36.44|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UMR [2035]|UMR OPTIONS [203501]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76||||76|0|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76||||76|68.4|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76||||76|76|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76||||76|0|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76||||76|22.95|76|15.96
43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76||||76|38|76|15.96
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA [1015]|AETNA ACO WILCO [101532]|72||||72|0|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72||||72|22.38|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72||||72|27.25|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72||||72|27.25|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72||||72|36.07|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72||||72|25.27|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72||||72|30.96|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72||||72|30.67|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72||||72|36|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72||||72|46.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CORESOURCE [1315]|CORESOURCE [131500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72||||72|0|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72||||72|0|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|GEHA [1415]|GEHA [141500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72||||72|49.37|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHNET [1495]|HEALTHNET [149500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72||||72|30.96|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72||||72|66.96|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72||||72|43.2|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72||||72|24.13|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72||||72|0|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72||||72|26.31|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72||||72|29.62|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72||||72|22.38|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MULTIPLAN [1680]|HMA [168003]|72||||72|32.91|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MULTIPLAN [1680]|IHC HS [168011]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72||||72|28.32|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72||||72|24.13|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|Self-pay|Self-pay|72||||72|21.6|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72||||72|15.12|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72||||72|21.5|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72||||72|30.72|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TRUSTMARK [2030]|STARMARK [203000]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72||||72|34.52|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UMR [2035]|UMR OPTIONS [203501]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72||||72|0|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72||||72|64.8|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72||||72|72|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72||||72|0|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72||||72|21.94|72|15.12
43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72||||72|36|72|15.12
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|102||||102|0|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102||||102|19.17|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102||||102|19.17|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102||||102|51.1|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102||||102|35.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102||||102|43.86|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102||||102|43.45|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102||||102|51|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102||||102|66.3|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CORESOURCE [1315]|CORESOURCE [131500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102||||102|0|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102||||102|26.24|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|GEHA [1415]|GEHA [141500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHNET [1495]|HEALTHNET [149500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102||||102|43.86|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102||||102|94.86|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102||||102|61.2|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102||||102|51|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102||||102|18.51|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MULTIPLAN [1680]|HMA [168003]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MULTIPLAN [1680]|IHC HS [168011]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102||||102|19.92|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|Self-pay|Self-pay|102||||102|30.6|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102||||102|21.42|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|TRUSTMARK [2030]|STARMARK [203000]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102||||102|48.91|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UMR [2035]|UMR OPTIONS [203501]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102||||102|17.63|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102||||102|91.8|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102||||102|102|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102||||102|26.24|102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102||||102||102|17.63
43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102||||102|51|102|17.63
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|260||||260|0|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260||||260|27.3|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260||||260|33.64|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260||||260|33.64|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|260||||260|130.26|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260||||260|91.26|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260||||260|111.8|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|260||||260|110.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|260||||260|130|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260||||260|169|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|260||||260|46.49|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|260||||260|47.44|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|GEHA [1415]|GEHA [141500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|260||||260|60.21|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260||||260|111.8|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|260||||260|241.8|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260||||260|156|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260||||260|29.44|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260||||260|130|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260||||260|32.49|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260||||260|36.13|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260||||260|27.3|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|260||||260|40.14|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|260||||260|34.96|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260||||260|29.44|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|Self-pay|Self-pay|260||||260|78|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260||||260|54.6|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|260||||260|26.22|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260||||260|39.07|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260||||260|124.67|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260||||260|30.94|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260||||260|234|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|260||||260|156|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|260||||260|47.44|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|260||||260|26.76|241.8|26.22
43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|260||||260|130|241.8|26.22
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA [1015]|AETNA ACO WILCO [101532]|479||||479|0|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|479||||479|17.75|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|479||||479|22.34|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|479||||479|22.34|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|479||||479|239.98|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|479||||479|168.13|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|479||||479|205.97|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|479||||479|204.05|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|479||||479|239.5|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|479||||479|311.35|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CORESOURCE [1315]|CORESOURCE [131500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|479||||479|30.74|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|479||||479|31.37|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|GEHA [1415]|GEHA [141500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|479||||479|39.15|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHNET [1495]|HEALTHNET [149500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|479||||479|205.97|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|479||||479|445.47|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|479||||479|287.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|479||||479|19.14|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|479||||479|239.5|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|479||||479|21.58|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|479||||479|23.49|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|479||||479|17.75|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MULTIPLAN [1680]|HMA [168003]|479||||479|26.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MULTIPLAN [1680]|IHC HS [168011]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|479||||479|23.22|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|479||||479|19.14|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|Self-pay|Self-pay|479||||479|143.7|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|479||||479|100.59|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|479||||479|17.05|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|479||||479|25.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|TRUSTMARK [2030]|STARMARK [203000]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|479||||479|229.68|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UMR [2035]|UMR OPTIONS [203501]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|479||||479|20.55|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|479||||479|431.1|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|479||||479|156|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|479||||479|31.37|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|479||||479|17.4|445.47|17.05
43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|479||||479|239.5|445.47|17.05
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|284||||284|0|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|284||||284|37.85|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|284||||284|37.32|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|284||||284|37.32|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|284||||284|142.28|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|284||||284|99.68|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|284||||284|122.12|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|284||||284|120.98|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|284||||284|142|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|284||||284|184.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|284||||284|56.07|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|284||||284|58.44|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|GEHA [1415]|GEHA [141500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|284||||284|83.5|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|284||||284|122.12|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|284||||284|264.12|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|284||||284|170.4|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|284||||284|40.82|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|284||||284|142|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|284||||284|36.05|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|284||||284|50.1|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|284||||284|37.85|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|284||||284|55.67|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|284||||284|38.79|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|284||||284|40.82|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|Self-pay|Self-pay|284||||284|85.2|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|284||||284|59.64|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|284||||284|36.37|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|284||||284|54.18|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|284||||284|136.18|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|284||||284|34.33|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|284||||284|255.6|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|284||||284|156|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|284||||284|58.44|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|284||||284|37.11|264.12|34.33
43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|284||||284|142|264.12|34.33
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|208||||208|0|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208||||208|57.46|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208||||208|33.69|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208||||208|33.69|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|208||||208|104.21|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208||||208|73.01|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208||||208|89.44|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|208||||208|88.61|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|208||||208|104|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208||||208|135.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|208||||208|51.57|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|208||||208|62.87|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|GEHA [1415]|GEHA [141500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|208||||208|126.74|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208||||208|89.44|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|208||||208|193.44|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208||||208|124.8|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208||||208|61.96|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208||||208|104|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208||||208|32.53|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208||||208|76.05|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208||||208|57.46|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MULTIPLAN [1680]|HMA [168003]|208||||208|84.5|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MULTIPLAN [1680]|IHC HS [168011]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|208||||208|35.02|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208||||208|61.96|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|Self-pay|Self-pay|208||||208|62.4|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208||||208|43.68|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|208||||208|55.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208||||208|82.24|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|TRUSTMARK [2030]|STARMARK [203000]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208||||208|99.74|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UMR [2035]|UMR OPTIONS [203501]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208||||208|30.98|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208||||208|187.2|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|208||||208|156|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|208||||208|62.87|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|208||||208|56.33|193.44|30.98
43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|208||||208|104|193.44|30.98
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|299||||299|0|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|299||||299|32.79|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|299||||299|38.27|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|299||||299|38.27|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|299||||299|149.8|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|299||||299|104.95|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|299||||299|128.57|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|299||||299|127.37|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|299||||299|149.5|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|299||||299|194.35|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|299||||299|54.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|299||||299|55.77|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|GEHA [1415]|GEHA [141500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|299||||299|72.34|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|299||||299|128.57|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|299||||299|278.07|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|299||||299|179.4|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|299||||299|35.37|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|299||||299|149.5|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|299||||299|36.95|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|299||||299|43.4|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|299||||299|32.79|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|299||||299|48.23|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|299||||299|39.78|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|299||||299|35.37|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|Self-pay|Self-pay|299||||299|89.7|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|299||||299|62.79|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|299||||299|31.51|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|299||||299|46.94|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|299||||299|143.37|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|299||||299|35.19|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|299||||299|269.1|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|299||||299|156|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|299||||299|55.77|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|299||||299|32.15|278.07|31.51
43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|299||||299|149.5|278.07|31.51
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|142||||142|0|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142||||142|31.63|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142||||142|35.12|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142||||142|35.12|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142||||142|71.14|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142||||142|49.84|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142||||142|61.06|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142||||142|60.49|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142||||142|71|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142||||142|92.3|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142||||142|51.99|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142||||142|53.51|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|GEHA [1415]|GEHA [141500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142||||142|69.77|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142||||142|61.06|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142||||142|132.06|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142||||142|85.2|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142||||142|34.11|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142||||142|71|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142||||142|33.92|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142||||142|41.86|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142||||142|31.63|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|142||||142|46.52|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142||||142|36.5|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142||||142|34.11|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|Self-pay|Self-pay|142||||142|42.6|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142||||142|29.82|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142||||142|30.39|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142||||142|45.27|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142||||142|68.09|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142||||142|32.3|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142||||142|127.8|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142||||142|142|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142||||142|53.51|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142||||142|31.01|142|29.82
43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142||||142|71|142|29.82
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|276||||276|0|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|276||||276|31.95|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|276||||276|36.03|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|276||||276|36.03|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|276||||276|138.28|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|276||||276|96.88|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|276||||276|118.68|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|276||||276|117.58|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|276||||276|138|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|276||||276|179.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|276||||276|52.54|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|276||||276|54.08|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|GEHA [1415]|GEHA [141500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|276||||276|70.47|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|276||||276|118.68|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|276||||276|256.68|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|276||||276|165.6|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|276||||276|34.45|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|276||||276|138|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|276||||276|34.8|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|276||||276|42.28|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|276||||276|31.95|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|276||||276|46.98|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|276||||276|37.45|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|276||||276|34.45|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|Self-pay|Self-pay|276||||276|82.8|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|276||||276|57.96|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|276||||276|30.69|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|276||||276|45.73|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|276||||276|132.34|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|276||||276|33.15|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|276||||276|248.4|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|276||||276|156|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|276||||276|54.08|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|276||||276|31.32|256.68|30.69
43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|276||||276|138|256.68|30.69
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|4749||||4749|0|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4749||||4749|170.44|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4749||||4749|137.06|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4749||||4749|137.06|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4749||||4749|165.53|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4749||||4749|2379.25|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4749||||4749|1666.9|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4749||||4749|2042.07|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4749||||4749|2023.07|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4749||||4749|2374.5|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4749||||4749|3086.85|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|CORESOURCE [1315]|CORESOURCE [131500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4749||||4749|120.78|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4749||||4749|130.21|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|GEHA [1415]|GEHA [141500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4749||||4749|375.98|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HEALTHNET [1495]|HEALTHNET [149500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4749||||4749|2042.07|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4749||||4749|4416.57|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4749||||4749|2849.4|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4749||||4749|182.08|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4749||||4749|421.76|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4749||||4749|132.37|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4749||||4749|225.59|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4749||||4749|170.44|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MULTIPLAN [1680]|HMA [168003]|4749||||4749|250.65|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MULTIPLAN [1680]|IHC HS [168011]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4749||||4749|142.46|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4749||||4749|182.08|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|Self-pay|Self-pay|4749||||4749|1424.7|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4749||||4749|997.29|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4749||||4749|163.76|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4749||||4749|243.97|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|TRUSTMARK [2030]|STARMARK [203000]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4749||||4749|2277.15|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|UMR [2035]|UMR OPTIONS [203501]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4749||||4749|126.07|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4749||||4749|4274.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4749||||4749|156|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4749||||4749|130.21|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4749||||4749|167.1|4416.57|120.78
43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4749||||4749|2374.5|4416.57|120.78
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|4806||||4806|0|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4806||||4806|137.06|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4806||||4806|137.06|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4806||||4806|2407.81|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4806||||4806|1686.91|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4806||||4806|2066.58|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4806||||4806|2047.36|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4806||||4806|2403|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4806||||4806|3123.9|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CORESOURCE [1315]|CORESOURCE [131500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4806||||4806|84.37|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4806||||4806|86.09|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|GEHA [1415]|GEHA [141500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHNET [1495]|HEALTHNET [149500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4806||||4806|2066.58|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4806||||4806|4469.58|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4806||||4806|2883.6|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4806||||4806|2403|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MULTIPLAN [1680]|HMA [168003]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MULTIPLAN [1680]|IHC HS [168011]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|Self-pay|Self-pay|4806||||4806|1441.8|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4806||||4806|1009.26|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|TRUSTMARK [2030]|STARMARK [203000]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4806||||4806|2304.48|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UMR [2035]|UMR OPTIONS [203501]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4806||||4806|4325.4|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4806||||4806|156|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4806||||4806|86.09|4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4806||||4806||4469.58|84.37
43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4806||||4806|2403|4469.58|84.37
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA [1015]|AETNA ACO WILCO [101532]|618||||618|0|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|618||||618|170.44|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|618||||618|78.16|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|618||||618|78.16|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|618||||618|165.53|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|618||||618|309.62|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|618||||618|216.92|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|618||||618|265.74|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|618||||618|263.27|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|618||||618|309|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|618||||618|401.7|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CORESOURCE [1315]|CORESOURCE [131500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|618||||618|62.89|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|618||||618|67.51|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|GEHA [1415]|GEHA [141500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|618||||618|375.98|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHNET [1495]|HEALTHNET [149500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|618||||618|265.74|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|618||||618|574.74|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|618||||618|370.8|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|618||||618|182.08|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|618||||618|421.76|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|618||||618|75.48|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|618||||618|225.59|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|618||||618|170.44|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MULTIPLAN [1680]|HMA [168003]|618||||618|250.65|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MULTIPLAN [1680]|IHC HS [168011]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|618||||618|81.24|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|618||||618|182.08|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|Self-pay|Self-pay|618||||618|185.4|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|618||||618|129.78|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|618||||618|163.76|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|618||||618|243.97|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|TRUSTMARK [2030]|STARMARK [203000]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|618||||618|296.33|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UMR [2035]|UMR OPTIONS [203501]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|618||||618|71.89|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|618||||618|556.2|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|618||||618|156|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|618||||618|67.51|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|618||||618|167.1|574.74|62.89
43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|618||||618|309|574.74|62.89
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|713||||713|0|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713||||713|170.44|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713||||713|129.9|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713||||713|129.9|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713||||713|165.53|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|713||||713|357.21|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713||||713|250.26|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713||||713|306.59|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|713||||713|303.74|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|713||||713|356.5|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713||||713|463.45|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CORESOURCE [1315]|CORESOURCE [131500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|713||||713|59.99|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|713||||713|63.44|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|GEHA [1415]|GEHA [141500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|713||||713|375.98|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHNET [1495]|HEALTHNET [149500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713||||713|306.59|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|713||||713|663.09|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713||||713|427.8|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713||||713|182.08|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713||||713|421.76|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713||||713|125.46|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713||||713|225.59|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713||||713|170.44|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MULTIPLAN [1680]|HMA [168003]|713||||713|250.65|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MULTIPLAN [1680]|IHC HS [168011]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|713||||713|135.01|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713||||713|182.08|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|Self-pay|Self-pay|713||||713|213.9|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713||||713|149.73|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|713||||713|163.76|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713||||713|243.97|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|TRUSTMARK [2030]|STARMARK [203000]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713||||713|341.88|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UMR [2035]|UMR OPTIONS [203501]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713||||713|119.48|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713||||713|641.7|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|713||||713|156|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|713||||713|63.44|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|713||||713|167.1|663.09|59.99
43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME <=50 SQ CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|713||||713|356.5|663.09|59.99
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA [1015]|AETNA ACO WILCO [101532]|1228||||1228|0|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1228||||1228|328.31|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1228||||1228|137.06|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1228||||1228|137.06|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1228||||1228|318.85|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1228||||1228|615.23|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1228||||1228|431.03|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1228||||1228|528.04|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1228||||1228|523.13|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1228||||1228|614|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1228||||1228|798.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CORESOURCE [1315]|CORESOURCE [131500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1228||||1228|70.38|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1228||||1228|74.78|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|GEHA [1415]|GEHA [141500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1228||||1228|724.22|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHNET [1495]|HEALTHNET [149500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1228||||1228|528.04|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1228||||1228|1142.04|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1228||||1228|736.8|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1228||||1228|350.73|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1228||||1228|750.73|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1228||||1228|132.37|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1228||||1228|434.53|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1228||||1228|328.31|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MULTIPLAN [1680]|HMA [168003]|1228||||1228|482.81|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MULTIPLAN [1680]|IHC HS [168011]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1228||||1228|142.46|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1228||||1228|350.73|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|Self-pay|Self-pay|1228||||1228|368.4|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1228||||1228|257.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1228||||1228|315.44|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1228||||1228|469.94|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|TRUSTMARK [2030]|STARMARK [203000]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1228||||1228|588.83|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UMR [2035]|UMR OPTIONS [203501]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1228||||1228|126.07|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1228||||1228|1105.2|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1228||||1228|156|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1228||||1228|74.78|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1228||||1228|321.88|1142.04|70.38
43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX DME >50 SQ CM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1228||||1228|614|1142.04|70.38
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|146||||146|0|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146||||146|33.43|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146||||146|38.27|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146||||146|38.27|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|146||||146|73.15|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146||||146|51.25|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146||||146|62.78|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|146||||146|62.2|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|146||||146|73|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146||||146|94.9|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|146||||146|57.61|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|146||||146|58.79|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|GEHA [1415]|GEHA [141500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|146||||146|73.73|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146||||146|62.78|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|146||||146|135.78|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146||||146|87.6|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146||||146|36.05|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146||||146|73|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146||||146|36.95|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146||||146|44.24|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146||||146|33.43|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|146||||146|49.16|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|146||||146|39.78|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146||||146|36.05|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|Self-pay|Self-pay|146||||146|43.8|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146||||146|30.66|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|146||||146|32.11|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146||||146|47.84|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146||||146|70.01|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146||||146|35.19|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146||||146|131.4|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|146||||146|146|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|146||||146|58.79|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|146||||146|32.77|146|30.66
43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|146||||146|73|146|30.66
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|0|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254|47.96|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|39.65|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|39.65|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|109.22|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|67.76|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|77.55|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254|105.8|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|109.22|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254|51.72|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|127|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|38.3|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254|63.48|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254|47.96|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|254||||254|70.53|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|41.21|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254|51.72|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|Self-pay|Self-pay|254||||254|76.2|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254|46.08|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254|68.65|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|36.47|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|156|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|77.55|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254|47.02|236.22|36.47
43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|36.47
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|254||||254|0|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254||||254|40.95|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254||||254|36.48|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254||||254|36.48|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|254||||254|127.25|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254||||254|89.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254||||254|109.22|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|254||||254|108.2|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|254||||254|127|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254||||254|165.1|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|254||||254|55.62|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|254||||254|59.23|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|GEHA [1415]|GEHA [141500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|254||||254|90.34|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254||||254|109.22|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|254||||254|236.22|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254||||254|152.4|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254||||254|44.17|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254||||254|127|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254||||254|35.23|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254||||254|54.2|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254||||254|40.95|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MULTIPLAN [1680]|HMA [168003]|254||||254|60.23|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|254||||254|37.92|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254||||254|44.17|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|Self-pay|Self-pay|254||||254|76.2|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254||||254|53.34|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|254||||254|39.35|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254||||254|58.62|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254||||254|121.79|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UMR [2035]|UMR OPTIONS [203501]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254||||254|33.55|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254||||254|228.6|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|254||||254|156|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|254||||254|59.23|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|254||||254|40.15|236.22|33.55
43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|254||||254|127|236.22|33.55
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|AETNA [1015]|AETNA ACO WILCO [101532]|89||||89|0|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89||||89|52.36|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89||||89|57.93|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89||||89|57.93|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89||||89|44.59|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89||||89|31.24|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89||||89|38.27|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89||||89|37.91|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89||||89|44.5|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89||||89|57.85|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|CORESOURCE [1315]|CORESOURCE [131500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89||||89|0|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89||||89|84.94|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|GEHA [1415]|GEHA [141500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89||||89|89|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HEALTHNET [1495]|HEALTHNET [149500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89||||89|38.27|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89||||89|82.77|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89||||89|53.4|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89||||89|56.46|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89||||89|44.5|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89||||89|55.96|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89||||89|69.3|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89||||89|52.36|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MULTIPLAN [1680]|HMA [168003]|89||||89|77|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MULTIPLAN [1680]|IHC HS [168011]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89||||89|60.21|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89||||89|56.46|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|Self-pay|Self-pay|89||||89|26.7|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89||||89|18.69|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89||||89|50.3|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89||||89|74.94|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|TRUSTMARK [2030]|STARMARK [203000]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89||||89|42.68|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|UMR [2035]|UMR OPTIONS [203501]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89||||89|0|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89||||89|80.1|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89||||89|89|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89||||89|84.94|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89||||89|51.33|89|18.69
43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89||||89|44.5|89|18.69
4310001|EAP||HH OT ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|Self-pay|Self-pay|||||140.68|42.2|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||140.68|0|70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||140.68||70.34|29.54
4310001|EAP||HH OT ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|GEHA [1415]|GEHA [141500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|Self-pay|Self-pay|||||140.68|42.2|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||140.68|0|70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||140.68||70.34|29.54
4310002|EAP||HH OT INITIAL VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|Self-pay|Self-pay|||||140.68|42.2|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||140.68|0|70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||140.68||70.34|29.54
4310003|EAP||HH OTA ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||140.68|0|70.34|29.54
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|2.4|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.48|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|2.4|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|Self-pay|Self-pay|90||||90|27|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.48|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|2.4
4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|500 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|2.4
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|932||||932|0|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|932||||932|96.43|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|932||||932|32.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|932||||932|32.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|932||||932|466.93|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|932||||932|327.13|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|932||||932|400.76|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|932||||932|397.03|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|932||||932|466|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|932||||932|605.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|CORESOURCE [1315]|CORESOURCE [131500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|932||||932|134.36|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|932||||932|137.71|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|GEHA [1415]|GEHA [141500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|932||||932|212.72|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HEALTHNET [1495]|HEALTHNET [149500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|932||||932|400.76|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|932||||932|866.76|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|932||||932|559.2|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|932||||932|103.99|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|932||||932|466|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|932||||932|31.42|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|932||||932|127.63|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|932||||932|96.43|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MULTIPLAN [1680]|HMA [168003]|932||||932|141.81|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MULTIPLAN [1680]|IHC HS [168011]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|932||||932|33.82|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|932||||932|103.99|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|Self-pay|Self-pay|932||||932|279.6|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|932||||932|195.72|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|932||||932|92.65|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|932||||932|138.03|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|TRUSTMARK [2030]|STARMARK [203000]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|932||||932|446.89|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|UMR [2035]|UMR OPTIONS [203501]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|932||||932|29.92|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|932||||932|838.8|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|932||||932|156|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|932||||932|137.71|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|932||||932|94.54|866.76|29.92
43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|932||||932|466|866.76|29.92
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1026||||1026|0|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1026||||1026|96.43|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1026||||1026|49.29|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1026||||1026|49.29|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1026||||1026|514.03|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1026||||1026|360.13|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1026||||1026|441.18|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1026||||1026|437.08|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1026||||1026|513|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1026||||1026|666.9|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|CORESOURCE [1315]|CORESOURCE [131500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1026||||1026|134.36|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1026||||1026|137.71|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|GEHA [1415]|GEHA [141500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1026||||1026|212.72|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HEALTHNET [1495]|HEALTHNET [149500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1026||||1026|441.18|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1026||||1026|954.18|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1026||||1026|615.6|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1026||||1026|103.99|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1026||||1026|513|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1026||||1026|47.61|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1026||||1026|127.63|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1026||||1026|96.43|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MULTIPLAN [1680]|HMA [168003]|1026||||1026|141.81|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MULTIPLAN [1680]|IHC HS [168011]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1026||||1026|51.23|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1026||||1026|103.99|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|Self-pay|Self-pay|1026||||1026|307.8|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1026||||1026|215.46|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1026||||1026|92.65|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1026||||1026|138.03|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|TRUSTMARK [2030]|STARMARK [203000]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1026||||1026|491.97|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|UMR [2035]|UMR OPTIONS [203501]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1026||||1026|45.34|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1026||||1026|923.4|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1026||||1026|156|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1026||||1026|137.71|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1026||||1026|94.54|954.18|45.34
43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1026||||1026|513|954.18|45.34
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1128||||1128|0|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1128||||1128|96.43|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1128||||1128|99.43|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1128||||1128|99.43|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1128||||1128|565.13|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1128||||1128|395.93|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1128||||1128|485.04|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1128||||1128|480.53|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1128||||1128|564|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1128||||1128|733.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|CORESOURCE [1315]|CORESOURCE [131500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1128||||1128|143.65|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1128||||1128|154.75|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|GEHA [1415]|GEHA [141500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1128||||1128|212.72|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HEALTHNET [1495]|HEALTHNET [149500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1128||||1128|485.04|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1128||||1128|1049.04|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1128||||1128|676.8|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1128||||1128|103.99|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1128||||1128|564|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1128||||1128|96.04|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1128||||1128|127.63|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1128||||1128|96.43|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MULTIPLAN [1680]|HMA [168003]|1128||||1128|141.81|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MULTIPLAN [1680]|IHC HS [168011]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1128||||1128|103.35|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1128||||1128|103.99|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|Self-pay|Self-pay|1128||||1128|338.4|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1128||||1128|236.88|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1128||||1128|92.65|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1128||||1128|138.03|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|TRUSTMARK [2030]|STARMARK [203000]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1128||||1128|540.88|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|UMR [2035]|UMR OPTIONS [203501]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1128||||1128|91.47|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1128||||1128|1015.2|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1128||||1128|156|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1128||||1128|154.75|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1128||||1128|94.54|1049.04|91.47
43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1128||||1128|564|1049.04|91.47
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|AETNA [1015]|AETNA ACO WILCO [101532]|466||||466|0|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|466||||466|64.85|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|466||||466|59.27|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|466||||466|59.27|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|466||||466|233.47|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|466||||466|163.57|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|466||||466|200.38|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|466||||466|198.52|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|466||||466|233|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|466||||466|302.9|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|CORESOURCE [1315]|CORESOURCE [131500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|466||||466|89.79|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|466||||466|94.46|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|GEHA [1415]|GEHA [141500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|466||||466|143.06|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HEALTHNET [1495]|HEALTHNET [149500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|466||||466|200.38|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|466||||466|433.38|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|466||||466|279.6|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|466||||466|69.94|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|466||||466|233|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|466||||466|57.24|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|466||||466|85.83|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|466||||466|64.85|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MULTIPLAN [1680]|HMA [168003]|466||||466|95.37|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MULTIPLAN [1680]|IHC HS [168011]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|466||||466|61.6|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|466||||466|69.94|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|Self-pay|Self-pay|466||||466|139.8|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|466||||466|97.86|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|466||||466|62.31|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|466||||466|92.83|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|TRUSTMARK [2030]|STARMARK [203000]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|466||||466|223.45|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|UMR [2035]|UMR OPTIONS [203501]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|466||||466|54.52|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|466||||466|419.4|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|466||||466|156|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|466||||466|94.46|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|466||||466|63.58|433.38|54.52
43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|466||||466|233|433.38|54.52
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|AETNA [1015]|AETNA ACO WILCO [101532]|541||||541|0|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|541||||541|76.72|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|541||||541|77.54|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|541||||541|77.54|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|541||||541|271.04|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|541||||541|189.89|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|541||||541|232.63|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|541||||541|230.47|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|541||||541|270.5|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|541||||541|351.65|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|CORESOURCE [1315]|CORESOURCE [131500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|541||||541|129|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|541||||541|200.17|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|GEHA [1415]|GEHA [141500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|541||||541|169.25|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HEALTHNET [1495]|HEALTHNET [149500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|541||||541|232.63|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|541||||541|503.13|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|541||||541|324.6|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|541||||541|82.74|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|541||||541|270.5|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|541||||541|74.89|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|541||||541|101.55|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|541||||541|76.72|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MULTIPLAN [1680]|HMA [168003]|541||||541|112.83|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MULTIPLAN [1680]|IHC HS [168011]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|541||||541|80.59|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|541||||541|82.74|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|Self-pay|Self-pay|541||||541|162.3|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|541||||541|113.61|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|541||||541|73.72|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|541||||541|109.82|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|TRUSTMARK [2030]|STARMARK [203000]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|541||||541|259.41|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|UMR [2035]|UMR OPTIONS [203501]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|541||||541|71.32|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|541||||541|486.9|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|541||||541|156|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|541||||541|200.17|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|541||||541|75.22|503.13|71.32
44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|541||||541|270.5|503.13|71.32
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|AETNA [1015]|AETNA ACO WILCO [101532]|403||||403|0|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|403||||403|69.06|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|403||||403|69.06|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|403||||403|201.9|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|403||||403|141.45|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|403||||403|173.29|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|403||||403|171.68|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|403||||403|201.5|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|403||||403|261.95|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|CORESOURCE [1315]|CORESOURCE [131500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|403||||403|0|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|403||||403|149.11|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|GEHA [1415]|GEHA [141500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HEALTHNET [1495]|HEALTHNET [149500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|403||||403|173.29|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|403||||403|374.79|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|403||||403|241.8|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|403||||403|254.52|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|403||||403|66.71|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MULTIPLAN [1680]|HMA [168003]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MULTIPLAN [1680]|IHC HS [168011]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|403||||403|71.78|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|Self-pay|Self-pay|403||||403|120.9|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|403||||403|84.63|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|TRUSTMARK [2030]|STARMARK [203000]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|403||||403|193.24|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|UMR [2035]|UMR OPTIONS [203501]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|403||||403|63.53|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|403||||403|362.7|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|403||||403|156|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|403||||403|149.11|374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|403||||403||374.79|63.53
44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|403||||403|201.5|374.79|63.53
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|AETNA [1015]|AETNA ACO WILCO [101532]|919||||919|0|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|919||||919|84.53|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|919||||919|103|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|919||||919|103|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|919||||919|460.42|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|919||||919|322.57|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|919||||919|395.17|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|919||||919|391.49|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|919||||919|459.5|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|919||||919|597.35|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|CORESOURCE [1315]|CORESOURCE [131500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|919||||919|0|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|919||||919|340.03|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|GEHA [1415]|GEHA [141500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|919||||919|186.46|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HEALTHNET [1495]|HEALTHNET [149500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|919||||919|395.17|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|919||||919|854.67|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|919||||919|551.4|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|919||||919|91.16|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|919||||919|459.5|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|919||||919|99.48|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|919||||919|111.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|919||||919|84.53|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MULTIPLAN [1680]|HMA [168003]|919||||919|124.31|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MULTIPLAN [1680]|IHC HS [168011]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|919||||919|107.06|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|919||||919|91.16|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|Self-pay|Self-pay|919||||919|275.7|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|919||||919|192.99|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|919||||919|81.21|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|919||||919|120.99|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|TRUSTMARK [2030]|STARMARK [203000]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|919||||919|440.66|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|UMR [2035]|UMR OPTIONS [203501]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|919||||919|94.74|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|919||||919|827.1|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|919||||919|156|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|919||||919|340.03|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|919||||919|82.87|854.67|81.21
44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|919||||919|459.5|854.67|81.21
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|AETNA [1015]|AETNA ACO WILCO [101532]|7||||7|0|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7||||7|41.79|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7||||7|41.79|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|7||||7|3.51|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7||||7|2.46|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7||||7|3.01|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|7||||7|2.98|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|7||||7|3.5|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7||||7|4.55|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|CORESOURCE [1315]|CORESOURCE [131500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7||||7|0|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7||||7|2.59|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|GEHA [1415]|GEHA [141500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HEALTHNET [1495]|HEALTHNET [149500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7||||7|3.01|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|7||||7|6.51|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7||||7|4.2|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7||||7|3.5|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7||||7|7|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MULTIPLAN [1680]|HMA [168003]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MULTIPLAN [1680]|IHC HS [168011]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7||||7|7|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|Self-pay|Self-pay|7||||7|2.1|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7||||7|1.47|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|TRUSTMARK [2030]|STARMARK [203000]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7||||7|3.36|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|UMR [2035]|UMR OPTIONS [203501]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7||||7|7|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7||||7|6.3|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7||||7|0|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|7||||7|2.59|41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|7||||7||41.79|1.47
44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|7||||7|3.5|41.79|1.47
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|AETNA [1015]|AETNA ACO WILCO [101532]|440||||440|0|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|440||||440|103.61|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|440||||440|41.79|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|440||||440|41.79|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|440||||440|220.44|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|440||||440|154.44|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|440||||440|189.2|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|440||||440|187.44|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|440||||440|220|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|440||||440|286|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|CORESOURCE [1315]|CORESOURCE [131500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|440||||440|0|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|440||||440|162.8|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|GEHA [1415]|GEHA [141500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|440||||440|228.56|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HEALTHNET [1495]|HEALTHNET [149500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|440||||440|189.2|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|440||||440|409.2|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|440||||440|264|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|440||||440|111.74|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|440||||440|220|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|440||||440|40.37|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|440||||440|137.13|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|440||||440|103.61|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MULTIPLAN [1680]|HMA [168003]|440||||440|152.37|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MULTIPLAN [1680]|IHC HS [168011]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|440||||440|43.44|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|440||||440|111.74|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|Self-pay|Self-pay|440||||440|132|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|440||||440|92.4|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|440||||440|99.55|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|440||||440|148.31|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|TRUSTMARK [2030]|STARMARK [203000]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|440||||440|210.98|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|UMR [2035]|UMR OPTIONS [203501]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|440||||440|38.45|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|440||||440|396|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|440||||440|156|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|440||||440|162.8|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|440||||440|101.58|409.2|38.45
44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|440||||440|220|409.2|38.45
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|999||||999|0|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|999||||999|66.5|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|999||||999|112.71|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|999||||999|112.71|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|999||||999|500.5|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|999||||999|350.65|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|999||||999|429.57|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|999||||999|425.57|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|999||||999|499.5|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|999||||999|649.35|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|CORESOURCE [1315]|CORESOURCE [131500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|999||||999|0|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|999||||999|369.63|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|GEHA [1415]|GEHA [141500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|999||||999|146.7|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HEALTHNET [1495]|HEALTHNET [149500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|999||||999|429.57|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|999||||999|929.07|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|999||||999|599.4|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|999||||999|71.72|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|999||||999|499.5|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|999||||999|108.87|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|999||||999|88.02|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|999||||999|66.5|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MULTIPLAN [1680]|HMA [168003]|999||||999|97.8|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MULTIPLAN [1680]|IHC HS [168011]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|999||||999|117.15|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|999||||999|71.72|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|Self-pay|Self-pay|999||||999|299.7|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|999||||999|209.79|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|999||||999|63.9|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|999||||999|91.28|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|TRUSTMARK [2030]|STARMARK [203000]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|999||||999|479.02|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|UMR [2035]|UMR OPTIONS [203501]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|999||||999|103.68|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|999||||999|899.1|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|999||||999|156|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|999||||999|369.63|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|999||||999|65.2|929.07|63.9
44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|999||||999|499.5|929.07|63.9
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|AETNA [1015]|AETNA ACO WILCO [101532]|736||||736|0|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|736||||736|100.24|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|736||||736|77.63|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|736||||736|77.63|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|736||||736|368.74|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|736||||736|258.34|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|736||||736|316.48|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|736||||736|313.54|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|736||||736|368|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|736||||736|478.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|CORESOURCE [1315]|CORESOURCE [131500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|736||||736|0|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|736||||736|272.32|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|GEHA [1415]|GEHA [141500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|736||||736|221.11|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HEALTHNET [1495]|HEALTHNET [149500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|736||||736|316.48|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|736||||736|684.48|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|736||||736|441.6|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|736||||736|108.1|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|736||||736|368|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|736||||736|74.98|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|736||||736|132.66|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|736||||736|100.24|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MULTIPLAN [1680]|HMA [168003]|736||||736|147.41|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MULTIPLAN [1680]|IHC HS [168011]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|736||||736|80.69|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|736||||736|108.1|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|Self-pay|Self-pay|736||||736|220.8|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|736||||736|154.56|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|736||||736|96.3|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|736||||736|137.58|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|TRUSTMARK [2030]|STARMARK [203000]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|736||||736|352.91|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|UMR [2035]|UMR OPTIONS [203501]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|736||||736|71.41|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|736||||736|662.4|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|736||||736|156|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|736||||736|272.32|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|736||||736|98.27|684.48|71.41
44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|736||||736|368|684.48|71.41
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA [1015]|AETNA ACO WILCO [101532]|76||||76|0|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76||||76|23.41|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76||||76|28.47|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76||||76|28.47|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76||||76|38.08|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76||||76|26.68|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76||||76|32.68|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76||||76|32.38|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76||||76|38|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76||||76|49.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CORESOURCE [1315]|CORESOURCE [131500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76||||76|0|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76||||76|28.12|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|GEHA [1415]|GEHA [141500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76||||76|51.64|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHNET [1495]|HEALTHNET [149500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76||||76|32.68|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76||||76|70.68|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76||||76|45.6|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76||||76|25.25|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76||||76|0|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76||||76|27.49|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76||||76|30.98|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76||||76|23.41|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MULTIPLAN [1680]|HMA [168003]|76||||76|34.43|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MULTIPLAN [1680]|IHC HS [168011]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76||||76|29.59|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76||||76|25.25|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|Self-pay|Self-pay|76||||76|22.8|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76||||76|15.96|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76||||76|22.49|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76||||76|32.13|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|TRUSTMARK [2030]|STARMARK [203000]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76||||76|36.44|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UMR [2035]|UMR OPTIONS [203501]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76||||76|0|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76||||76|68.4|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76||||76|76|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76||||76|28.12|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76||||76|22.95|76|15.96
44097129|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76||||76|38|76|15.96
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA [1015]|AETNA ACO WILCO [101532]|72||||72|0|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72||||72|22.38|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72||||72|27.25|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72||||72|27.25|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72||||72|36.07|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72||||72|25.27|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72||||72|30.96|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72||||72|30.67|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72||||72|36|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72||||72|46.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CORESOURCE [1315]|CORESOURCE [131500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72||||72|0|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72||||72|26.64|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|GEHA [1415]|GEHA [141500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72||||72|49.37|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHNET [1495]|HEALTHNET [149500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72||||72|30.96|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72||||72|66.96|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72||||72|43.2|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72||||72|24.13|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72||||72|0|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72||||72|26.31|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72||||72|29.62|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72||||72|22.38|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MULTIPLAN [1680]|HMA [168003]|72||||72|32.91|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MULTIPLAN [1680]|IHC HS [168011]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72||||72|28.32|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72||||72|24.13|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|Self-pay|Self-pay|72||||72|21.6|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72||||72|15.12|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72||||72|21.5|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72||||72|30.72|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|TRUSTMARK [2030]|STARMARK [203000]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72||||72|34.52|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UMR [2035]|UMR OPTIONS [203501]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72||||72|0|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72||||72|64.8|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72||||72|72|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72||||72|26.64|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72||||72|21.94|72|15.12
44097130|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72||||72|36|72|15.12
4410001|EAP||HH SLP ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||151.85|75.93|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|Self-pay|Self-pay|||||151.85|45.55|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||151.85|31.89|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||151.85|0|75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||151.85||75.93|31.89
4410001|EAP||HH SLP ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|GEHA [1415]|GEHA [141500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||151.85|75.93|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|Self-pay|Self-pay|||||151.85|45.55|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||151.85|31.89|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||151.85|0|75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||151.85||75.93|31.89
4410002|EAP||HH SLP INITIAL VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|CORESOURCE [1315]|CORESOURCE [131500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|GEHA [1415]|GEHA [141500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HEALTHNET [1495]|HEALTHNET [149500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||151.85|75.93|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MULTIPLAN [1680]|HMA [168003]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MULTIPLAN [1680]|IHC HS [168011]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|Self-pay|Self-pay|||||151.85|45.55|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||151.85|31.89|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|TRUSTMARK [2030]|STARMARK [203000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|UMR [2035]|UMR OPTIONS [203501]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||151.85|0|75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||151.85||75.93|31.89
4410003|EAP||HH SLP MAINTENANCE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||151.85|0|75.93|31.89
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|AETNA [1015]|AETNA ACO WILCO [101532]|534||||534|0|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|534||||534|105.06|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|534||||534|81.12|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|534||||534|81.12|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|534||||534|267.53|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|534||||534|187.43|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|534||||534|229.62|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|534||||534|227.48|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|534||||534|267|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|534||||534|347.1|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|CORESOURCE [1315]|CORESOURCE [131500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|534||||534|0|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|534||||534|197.58|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|GEHA [1415]|GEHA [141500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|534||||534|231.75|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HEALTHNET [1495]|HEALTHNET [149500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|534||||534|229.62|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|534||||534|496.62|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|534||||534|320.4|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|534||||534|113.3|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|534||||534|267|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|534||||534|78.35|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|534||||534|139.05|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|534||||534|105.06|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MULTIPLAN [1680]|HMA [168003]|534||||534|154.5|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MULTIPLAN [1680]|IHC HS [168011]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|534||||534|84.31|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|534||||534|113.3|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|Self-pay|Self-pay|534||||534|160.2|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|534||||534|112.14|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|534||||534|100.94|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|534||||534|150.38|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|TRUSTMARK [2030]|STARMARK [203000]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|534||||534|256.05|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|UMR [2035]|UMR OPTIONS [203501]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|534||||534|74.62|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|534||||534|480.6|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|534||||534|156|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|534||||534|197.58|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|534||||534|103|496.62|74.62
44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|534||||534|267|496.62|74.62
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|AETNA [1015]|AETNA ACO WILCO [101532]|154||||154|0|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154||||154|36.74|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154||||154|36.74|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|154||||154|77.15|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154||||154|54.05|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154||||154|66.22|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|154||||154|65.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|154||||154|77|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154||||154|100.1|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|CORESOURCE [1315]|CORESOURCE [131500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|154||||154|41.82|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|154||||154|56.98|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|GEHA [1415]|GEHA [141500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HEALTHNET [1495]|HEALTHNET [149500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154||||154|66.22|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|154||||154|143.22|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154||||154|92.4|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154||||154|77|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154||||154|35.49|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MULTIPLAN [1680]|HMA [168003]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MULTIPLAN [1680]|IHC HS [168011]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|154||||154|38.19|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|Self-pay|Self-pay|154||||154|46.2|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154||||154|32.34|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|TRUSTMARK [2030]|STARMARK [203000]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154||||154|73.84|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|UMR [2035]|UMR OPTIONS [203501]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154||||154|33.8|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154||||154|138.6|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|154||||154|154|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|154||||154|56.98|154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|154||||154||154|32.34
44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|154||||154|77|154|32.34
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|AETNA [1015]|AETNA ACO WILCO [101532]|784||||784|0|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784||||784|134.16|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784||||784|155.54|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784||||784|155.54|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|784||||784|392.78|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784||||784|275.18|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784||||784|337.12|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|784||||784|333.98|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|784||||784|392|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784||||784|509.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|CORESOURCE [1315]|CORESOURCE [131500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|784||||784|0|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|784||||784|290.08|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|GEHA [1415]|GEHA [141500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|784||||784|295.94|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HEALTHNET [1495]|HEALTHNET [149500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784||||784|337.12|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|784||||784|729.12|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784||||784|470.4|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784||||784|144.68|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784||||784|392|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784||||784|150.23|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784||||784|177.57|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784||||784|134.16|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MULTIPLAN [1680]|HMA [168003]|784||||784|197.3|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MULTIPLAN [1680]|IHC HS [168011]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|784||||784|161.66|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784||||784|144.68|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|Self-pay|Self-pay|784||||784|235.2|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784||||784|164.64|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|784||||784|128.9|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784||||784|192.03|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|TRUSTMARK [2030]|STARMARK [203000]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784||||784|375.93|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|UMR [2035]|UMR OPTIONS [203501]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784||||784|143.07|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784||||784|705.6|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|784||||784|156|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|784||||784|290.08|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|784||||784|131.53|729.12|128.9
44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|784||||784|392|729.12|128.9
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|784||||784|0|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784||||784|112.67|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784||||784|155.54|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784||||784|155.54|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|784||||784|392.78|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784||||784|275.18|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784||||784|337.12|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|784||||784|333.98|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|784||||784|392|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784||||784|509.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|CORESOURCE [1315]|CORESOURCE [131500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|784||||784|0|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|784||||784|290.08|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|GEHA [1415]|GEHA [141500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|784||||784|248.54|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HEALTHNET [1495]|HEALTHNET [149500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784||||784|337.12|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|784||||784|729.12|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784||||784|470.4|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784||||784|121.51|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784||||784|392|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784||||784|150.23|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784||||784|149.12|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784||||784|112.67|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MULTIPLAN [1680]|HMA [168003]|784||||784|165.69|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MULTIPLAN [1680]|IHC HS [168011]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|784||||784|161.66|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784||||784|121.51|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|Self-pay|Self-pay|784||||784|235.2|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784||||784|164.64|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|784||||784|108.25|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784||||784|161.27|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|TRUSTMARK [2030]|STARMARK [203000]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784||||784|375.93|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|UMR [2035]|UMR OPTIONS [203501]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784||||784|143.07|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784||||784|705.6|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|784||||784|156|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|784||||784|290.08|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|784||||784|110.46|729.12|108.25
44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|784||||784|392|729.12|108.25
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|784||||784|0|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784||||784|230.59|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784||||784|155.54|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784||||784|155.54|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|784||||784|392.78|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784||||784|275.18|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784||||784|337.12|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|784||||784|333.98|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|784||||784|392|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784||||784|509.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|CORESOURCE [1315]|CORESOURCE [131500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|784||||784|0|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|784||||784|290.08|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|GEHA [1415]|GEHA [141500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|784||||784|508.66|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HEALTHNET [1495]|HEALTHNET [149500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784||||784|337.12|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|784||||784|729.12|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784||||784|470.4|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784||||784|248.68|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784||||784|392|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784||||784|150.23|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784||||784|305.19|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784||||784|230.59|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MULTIPLAN [1680]|HMA [168003]|784||||784|339.11|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MULTIPLAN [1680]|IHC HS [168011]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|784||||784|161.66|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784||||784|248.68|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|Self-pay|Self-pay|784||||784|235.2|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784||||784|164.64|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|784||||784|221.55|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784||||784|330.06|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|TRUSTMARK [2030]|STARMARK [203000]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784||||784|375.93|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|UMR [2035]|UMR OPTIONS [203501]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784||||784|143.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784||||784|705.6|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|784||||784|156|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|784||||784|290.08|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|784||||784|226.07|729.12|143.07
44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|784||||784|392|729.12|143.07
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|AETNA [1015]|AETNA ACO WILCO [101532]|784||||784|0|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784||||784|110.33|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784||||784|155.54|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784||||784|155.54|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|784||||784|392.78|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784||||784|275.18|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784||||784|337.12|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|784||||784|333.98|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|784||||784|392|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784||||784|509.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|CORESOURCE [1315]|CORESOURCE [131500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|784||||784|0|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|784||||784|290.08|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|GEHA [1415]|GEHA [141500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|784||||784|243.38|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HEALTHNET [1495]|HEALTHNET [149500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784||||784|337.12|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|784||||784|729.12|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784||||784|470.4|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784||||784|118.99|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784||||784|392|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784||||784|150.23|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784||||784|146.03|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784||||784|110.33|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MULTIPLAN [1680]|HMA [168003]|784||||784|162.26|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MULTIPLAN [1680]|IHC HS [168011]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|784||||784|161.66|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784||||784|118.99|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|Self-pay|Self-pay|784||||784|235.2|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784||||784|164.64|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|784||||784|106.01|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784||||784|157.93|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|TRUSTMARK [2030]|STARMARK [203000]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784||||784|375.93|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|UMR [2035]|UMR OPTIONS [203501]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784||||784|143.07|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784||||784|705.6|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|784||||784|156|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|784||||784|290.08|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|784||||784|108.17|729.12|106.01
44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|784||||784|392|729.12|106.01
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|AETNA [1015]|AETNA ACO WILCO [101532]|1384||||1384|0|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1384||||1384|70.02|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1384||||1384|112.71|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1384||||1384|112.71|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1384||||1384|693.38|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1384||||1384|485.78|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1384||||1384|595.12|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1384||||1384|589.58|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1384||||1384|692|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1384||||1384|899.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|CORESOURCE [1315]|CORESOURCE [131500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1384||||1384|0|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1384||||1384|512.08|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|GEHA [1415]|GEHA [141500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1384||||1384|154.46|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HEALTHNET [1495]|HEALTHNET [149500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1384||||1384|595.12|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1384||||1384|1287.12|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1384||||1384|830.4|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1384||||1384|75.52|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1384||||1384|692|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1384||||1384|108.87|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1384||||1384|92.68|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1384||||1384|70.02|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MULTIPLAN [1680]|HMA [168003]|1384||||1384|102.98|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MULTIPLAN [1680]|IHC HS [168011]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1384||||1384|117.15|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1384||||1384|75.52|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|Self-pay|Self-pay|1384||||1384|415.2|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1384||||1384|290.64|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1384||||1384|67.28|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1384||||1384|96.11|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|TRUSTMARK [2030]|STARMARK [203000]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1384||||1384|663.63|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|UMR [2035]|UMR OPTIONS [203501]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1384||||1384|103.68|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1384||||1384|1245.6|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1384||||1384|156|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1384||||1384|512.08|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1384||||1384|68.65|1287.12|67.28
44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1384||||1384|692|1287.12|67.28
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|904||||904|0|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|904||||904|91.61|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|904||||904|112.71|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|904||||904|112.71|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|904||||904|452.9|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|904||||904|317.3|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|904||||904|388.72|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|904||||904|385.1|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|904||||904|452|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|904||||904|587.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|CORESOURCE [1315]|CORESOURCE [131500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|904||||904|0|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|904||||904|334.48|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|GEHA [1415]|GEHA [141500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|904||||904|202.07|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HEALTHNET [1495]|HEALTHNET [149500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|904||||904|388.72|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|904||||904|840.72|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|904||||904|542.4|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|904||||904|98.79|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|904||||904|452|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|904||||904|108.87|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|904||||904|121.24|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|904||||904|91.61|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MULTIPLAN [1680]|HMA [168003]|904||||904|134.72|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MULTIPLAN [1680]|IHC HS [168011]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|904||||904|117.15|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|904||||904|98.79|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|Self-pay|Self-pay|904||||904|271.2|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|904||||904|189.84|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|904||||904|88.01|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|904||||904|125.73|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|TRUSTMARK [2030]|STARMARK [203000]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|904||||904|433.47|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|UMR [2035]|UMR OPTIONS [203501]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|904||||904|103.68|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|904||||904|813.6|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|904||||904|156|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|904||||904|334.48|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|904||||904|89.81|840.72|88.01
44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|904||||904|452|840.72|88.01
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|AETNA [1015]|AETNA ACO WILCO [101532]|317||||317|0|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|317||||317|112.71|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|317||||317|112.71|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|317||||317|158.82|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|317||||317|111.27|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|317||||317|136.31|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|317||||317|135.04|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|317||||317|158.5|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|317||||317|206.05|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|CORESOURCE [1315]|CORESOURCE [131500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|317||||317|0|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|317||||317|117.29|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|GEHA [1415]|GEHA [141500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HEALTHNET [1495]|HEALTHNET [149500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|317||||317|136.31|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|317||||317|294.81|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|317||||317|190.2|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|317||||317|158.5|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|317||||317|108.87|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MULTIPLAN [1680]|HMA [168003]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MULTIPLAN [1680]|IHC HS [168011]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|317||||317|117.15|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|Self-pay|Self-pay|317||||317|95.1|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|317||||317|66.57|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|TRUSTMARK [2030]|STARMARK [203000]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|317||||317|152|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|UMR [2035]|UMR OPTIONS [203501]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|317||||317|103.68|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|317||||317|285.3|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|317||||317|156|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|317||||317|117.29|294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|317||||317||294.81|66.57
44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|317||||317|158.5|294.81|66.57
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|GEHA [1415]|GEHA [141500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|Self-pay|Self-pay|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|AETNA [1015]|AETNA ACO WILCO [101532]|1359||||1359|0|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1359||||1359|219.86|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1359||||1359|184.93|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1359||||1359|184.93|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1359||||1359|213.52|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1359||||1359|680.86|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1359||||1359|477.01|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1359||||1359|584.37|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1359||||1359|578.93|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1359||||1359|679.5|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1359||||1359|883.35|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|CORESOURCE [1315]|CORESOURCE [131500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1359||||1359|892.32|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1359||||1359|502.83|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|GEHA [1415]|GEHA [141500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1359||||1359|484.99|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HEALTHNET [1495]|HEALTHNET [149500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1359||||1359|584.37|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1359||||1359|1263.87|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1359||||1359|815.4|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1359||||1359|234.87|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1359||||1359|533.01|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1359||||1359|178.62|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1359||||1359|290.99|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1359||||1359|219.86|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MULTIPLAN [1680]|HMA [168003]|1359||||1359|323.32|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MULTIPLAN [1680]|IHC HS [168011]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1359||||1359|192.21|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1359||||1359|234.87|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|Self-pay|Self-pay|1359||||1359|407.7|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1359||||1359|285.39|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1359||||1359|211.24|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1359||||1359|314.7|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|TRUSTMARK [2030]|STARMARK [203000]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1359||||1359|651.64|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|UMR [2035]|UMR OPTIONS [203501]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1359||||1359|170.11|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1359||||1359|1223.1|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1359||||1359|0|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1359||||1359|502.83|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1359||||1359|215.55|1263.87|170.11
45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1359||||1359|679.5|1263.87|170.11
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|AETNA [1015]|AETNA ACO WILCO [101532]|2175||||2175|0|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2175||||2175|345.3|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2175||||2175|294.42|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2175||||2175|294.42|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2175||||2175|335.34|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2175||||2175|1089.68|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2175||||2175|763.43|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2175||||2175|935.25|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2175||||2175|926.55|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2175||||2175|1087.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2175||||2175|1413.75|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|CORESOURCE [1315]|CORESOURCE [131500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2175||||2175|1428.11|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2175||||2175|804.75|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|GEHA [1415]|GEHA [141500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2175||||2175|761.69|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HEALTHNET [1495]|HEALTHNET [149500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2175||||2175|935.25|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2175||||2175|2022.75|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2175||||2175|1305|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2175||||2175|368.88|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2175||||2175|861.37|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2175||||2175|284.36|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2175||||2175|457.01|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2175||||2175|341.4|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MULTIPLAN [1680]|HMA [168003]|2175||||2175|507.79|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MULTIPLAN [1680]|IHC HS [168011]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2175||||2175|306.01|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2175||||2175|368.88|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|Self-pay|Self-pay|2175||||2175|652.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2175||||2175|456.75|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2175||||2175|331.76|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2175||||2175|494.25|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|TRUSTMARK [2030]|STARMARK [203000]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2175||||2175|1042.91|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|UMR [2035]|UMR OPTIONS [203501]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2175||||2175|270.82|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2175||||2175|1957.5|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2175||||2175|0|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2175||||2175|804.75|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2175||||2175|338.53|2022.75|270.82
45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2175||||2175|1087.5|2022.75|270.82
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|AETNA [1015]|AETNA ACO WILCO [101532]|3419||||3419|0|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3419||||3419|495.65|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3419||||3419|435|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3419||||3419|435|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3419||||3419|481.36|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3419||||3419|1712.92|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3419||||3419|1200.07|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3419||||3419|1470.17|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3419||||3419|1456.49|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3419||||3419|1709.5|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3419||||3419|2222.35|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|CORESOURCE [1315]|CORESOURCE [131500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3419||||3419|2244.92|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3419||||3419|1265.03|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|GEHA [1415]|GEHA [141500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3419||||3419|1093.35|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HEALTHNET [1495]|HEALTHNET [149500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3419||||3419|1470.17|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3419||||3419|3179.67|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3419||||3419|2051.4|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3419||||3419|529.5|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3419||||3419|1255.6|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3419||||3419|420.15|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3419||||3419|656.01|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3419||||3419|490.06|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MULTIPLAN [1680]|HMA [168003]|3419||||3419|728.9|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MULTIPLAN [1680]|IHC HS [168011]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3419||||3419|452.13|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3419||||3419|529.5|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|Self-pay|Self-pay|3419||||3419|1025.7|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3419||||3419|717.99|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3419||||3419|476.22|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3419||||3419|709.47|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|TRUSTMARK [2030]|STARMARK [203000]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3419||||3419|1639.41|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|UMR [2035]|UMR OPTIONS [203501]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3419||||3419|400.13|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3419||||3419|3077.1|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3419||||3419|0|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3419||||3419|1265.03|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3419||||3419|485.94|3179.67|400.13
45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3419||||3419|1709.5|3179.67|400.13
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|GEHA [1415]|GEHA [141500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|Self-pay|Self-pay|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|452||||452|0|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|452||||452|212.69|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|452||||452|212.69|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|452||||452|226.45|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|452||||452|158.65|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|452||||452|194.36|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|452||||452|192.55|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|452||||452|226|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|452||||452|293.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|CORESOURCE [1315]|CORESOURCE [131500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|452||||452|0|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|452||||452|167.24|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|GEHA [1415]|GEHA [141500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HEALTHNET [1495]|HEALTHNET [149500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|452||||452|194.36|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|452||||452|420.36|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|452||||452|271.2|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|452||||452|324.96|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|452||||452|205.42|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MULTIPLAN [1680]|HMA [168003]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MULTIPLAN [1680]|IHC HS [168011]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|452||||452|221.06|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|Self-pay|Self-pay|452||||452|135.6|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|452||||452|94.92|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|TRUSTMARK [2030]|STARMARK [203000]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|452||||452|216.73|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|UMR [2035]|UMR OPTIONS [203501]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|452||||452|195.64|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|452||||452|406.8|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|452||||452|0|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|452||||452|167.24|420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|452||||452||420.36|94.92
46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|452||||452|226|420.36|94.92
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|AETNA [1015]|AETNA ACO WILCO [101532]|603||||603|0|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|603||||603|125.76|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|603||||603|125.76|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|603||||603|302.1|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|603||||603|211.65|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|603||||603|259.29|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|603||||603|256.88|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|603||||603|301.5|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|603||||603|391.95|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|CORESOURCE [1315]|CORESOURCE [131500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|603||||603|0|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|603||||603|223.11|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|GEHA [1415]|GEHA [141500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HEALTHNET [1495]|HEALTHNET [149500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|603||||603|259.29|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|603||||603|560.79|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|603||||603|361.8|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|603||||603|603|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|603||||603|121.46|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MULTIPLAN [1680]|HMA [168003]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MULTIPLAN [1680]|IHC HS [168011]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|603||||603|130.71|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|Self-pay|Self-pay|603||||603|180.9|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|603||||603|126.63|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|TRUSTMARK [2030]|STARMARK [203000]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|603||||603|289.14|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|UMR [2035]|UMR OPTIONS [203501]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|603||||603|115.67|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|603||||603|542.7|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|603||||603|0|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|603||||603|223.11|603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|603||||603||603|115.67
46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|603||||603|301.5|603|115.67
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|604||||604|0|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|604||||604|212.69|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|604||||604|212.69|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|604||||604|302.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|604||||604|212|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|604||||604|259.72|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|604||||604|257.3|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|604||||604|302|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|604||||604|392.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|CORESOURCE [1315]|CORESOURCE [131500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|604||||604|0|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|604||||604|223.48|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|GEHA [1415]|GEHA [141500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HEALTHNET [1495]|HEALTHNET [149500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|604||||604|259.72|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|604||||604|561.72|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|604||||604|362.4|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|604||||604|324.96|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|604||||604|205.42|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MULTIPLAN [1680]|HMA [168003]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MULTIPLAN [1680]|IHC HS [168011]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|604||||604|221.06|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|Self-pay|Self-pay|604||||604|181.2|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|604||||604|126.84|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|TRUSTMARK [2030]|STARMARK [203000]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|604||||604|289.62|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|UMR [2035]|UMR OPTIONS [203501]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|604||||604|195.64|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|604||||604|543.6|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|604||||604|0|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|604||||604|223.48|561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|604||||604||561.72|126.84
46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|604||||604|302|561.72|126.84
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|255||||255|0|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|255||||255|217.1|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|255||||255|217.1|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|255||||255|127.76|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|255||||255|89.51|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|255||||255|109.65|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|255||||255|108.63|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|255||||255|127.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|255||||255|165.75|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|255||||255|0|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|255||||255|94.35|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|GEHA [1415]|GEHA [141500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|255||||255|109.65|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|255||||255|237.15|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|255||||255|153|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|255||||255|255|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|255||||255|209.69|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MULTIPLAN [1680]|HMA [168003]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|255||||255|225.65|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|Self-pay|Self-pay|255||||255|76.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|255||||255|53.55|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|255||||255|122.27|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|UMR [2035]|UMR OPTIONS [203501]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|255||||255|199.7|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|255||||255|229.5|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|255||||255|0|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|255||||255|94.35|255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|255||||255||255|53.55
46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|255||||255|127.5|255|53.55
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|AETNA [1015]|AETNA ACO WILCO [101532]|891||||891|0|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|891||||891|212.69|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|891||||891|212.69|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|891||||891|446.39|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|891||||891|312.74|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|891||||891|383.13|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|891||||891|379.57|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|891||||891|445.5|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|891||||891|579.15|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|CORESOURCE [1315]|CORESOURCE [131500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|891||||891|0|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|891||||891|329.67|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|GEHA [1415]|GEHA [141500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HEALTHNET [1495]|HEALTHNET [149500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|891||||891|383.13|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|891||||891|828.63|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|891||||891|534.6|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|891||||891|603.08|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|891||||891|205.42|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MULTIPLAN [1680]|HMA [168003]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MULTIPLAN [1680]|IHC HS [168011]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|891||||891|221.06|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|Self-pay|Self-pay|891||||891|267.3|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|891||||891|187.11|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|TRUSTMARK [2030]|STARMARK [203000]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|891||||891|427.23|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|UMR [2035]|UMR OPTIONS [203501]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|891||||891|195.64|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|891||||891|801.9|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|891||||891|0|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|891||||891|329.67|828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|891||||891||828.63|187.11
46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|891||||891|445.5|828.63|187.11
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|AETNA [1015]|AETNA ACO WILCO [101532]|627||||627|0|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|627||||627|212.69|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|627||||627|212.69|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|627||||627|314.13|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|627||||627|220.08|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|627||||627|269.61|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|627||||627|267.1|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|627||||627|313.5|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|627||||627|407.55|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|CORESOURCE [1315]|CORESOURCE [131500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|627||||627|0|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|627||||627|231.99|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|GEHA [1415]|GEHA [141500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HEALTHNET [1495]|HEALTHNET [149500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|627||||627|269.61|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|627||||627|583.11|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|627||||627|376.2|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|627||||627|324.96|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|627||||627|205.42|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MULTIPLAN [1680]|HMA [168003]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MULTIPLAN [1680]|IHC HS [168011]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|627||||627|221.06|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|Self-pay|Self-pay|627||||627|188.1|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|627||||627|131.67|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|TRUSTMARK [2030]|STARMARK [203000]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|627||||627|300.65|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|UMR [2035]|UMR OPTIONS [203501]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|627||||627|195.64|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|627||||627|564.3|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|627||||627|0|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|627||||627|231.99|583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|627||||627||583.11|131.67
46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|627||||627|313.5|583.11|131.67
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|AETNA [1015]|AETNA ACO WILCO [101532]|704||||704|0|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|704||||704|79.2|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|704||||704|79.2|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|704||||704|352.7|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|704||||704|247.1|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|704||||704|302.72|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|704||||704|299.9|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|704||||704|352|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|704||||704|457.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|CORESOURCE [1315]|CORESOURCE [131500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|704||||704|0|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|704||||704|260.48|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|GEHA [1415]|GEHA [141500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HEALTHNET [1495]|HEALTHNET [149500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|704||||704|302.72|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|704||||704|654.72|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|704||||704|422.4|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|704||||704|352|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|704||||704|76.49|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MULTIPLAN [1680]|HMA [168003]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MULTIPLAN [1680]|IHC HS [168011]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|704||||704|82.32|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|Self-pay|Self-pay|704||||704|211.2|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|704||||704|147.84|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|TRUSTMARK [2030]|STARMARK [203000]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|704||||704|337.57|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|UMR [2035]|UMR OPTIONS [203501]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|704||||704|72.84|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|704||||704|633.6|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|704||||704|0|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|704||||704|260.48|654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|704||||704||654.72|72.84
46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|704||||704|352|654.72|72.84
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|242||||242|121.24|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242||||242|84.94|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242||||242|104.06|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|242||||242|103.09|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|242||||242|121|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242||||242|157.3|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|CORESOURCE [1315]|CORESOURCE [131500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|242||||242|89.54|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|GEHA [1415]|GEHA [141500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HEALTHNET [1495]|HEALTHNET [149500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242||||242|104.06|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|242||||242|225.06|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242||||242|145.2|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242||||242|121|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MULTIPLAN [1680]|HMA [168003]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MULTIPLAN [1680]|IHC HS [168011]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|Self-pay|Self-pay|242||||242|72.6|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242||||242|50.82|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|TRUSTMARK [2030]|STARMARK [203000]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242||||242|116.04|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|UMR [2035]|UMR OPTIONS [203501]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242||||242|217.8|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|242||||242|0|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|242||||242|89.54|225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|242||||242||225.06|50.82
46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|242||||242|121|225.06|50.82
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|AETNA [1015]|AETNA ACO WILCO [101532]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|357||||357|178.86|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|357||||357|125.31|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|357||||357|153.51|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|357||||357|152.08|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|357||||357|178.5|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|357||||357|232.05|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|CORESOURCE [1315]|CORESOURCE [131500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|357||||357|132.09|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|GEHA [1415]|GEHA [141500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HEALTHNET [1495]|HEALTHNET [149500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|357||||357|153.51|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|357||||357|332.01|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|357||||357|214.2|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|357||||357|178.5|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MULTIPLAN [1680]|HMA [168003]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MULTIPLAN [1680]|IHC HS [168011]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|Self-pay|Self-pay|357||||357|107.1|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|357||||357|74.97|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|TRUSTMARK [2030]|STARMARK [203000]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|357||||357|171.18|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|UMR [2035]|UMR OPTIONS [203501]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|357||||357|321.3|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|357||||357|0|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|357||||357|132.09|332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|357||||357||332.01|74.97
46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|357||||357|178.5|332.01|74.97
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|AETNA [1015]|AETNA ACO WILCO [101532]|286||||286|0|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|286||||286|85.55|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|286||||286|85.55|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|286||||286|143.29|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|286||||286|100.39|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|286||||286|122.98|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|286||||286|121.84|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|286||||286|143|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|286||||286|185.9|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|CORESOURCE [1315]|CORESOURCE [131500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|286||||286|0|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|286||||286|105.82|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|GEHA [1415]|GEHA [141500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HEALTHNET [1495]|HEALTHNET [149500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|286||||286|122.98|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|286||||286|265.98|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|286||||286|171.6|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|286||||286|286|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|286||||286|82.62|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MULTIPLAN [1680]|HMA [168003]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MULTIPLAN [1680]|IHC HS [168011]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|286||||286|88.92|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|Self-pay|Self-pay|286||||286|85.8|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|286||||286|60.06|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|TRUSTMARK [2030]|STARMARK [203000]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|286||||286|137.14|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|UMR [2035]|UMR OPTIONS [203501]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|286||||286|78.68|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|286||||286|257.4|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|286||||286|0|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|286||||286|105.82|286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|286||||286||286|60.06
46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|286||||286|143|286|60.06
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|AETNA [1015]|AETNA ACO WILCO [101532]|351||||351|0|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351||||351|212.69|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351||||351|212.69|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|351||||351|175.85|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351||||351|123.2|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351||||351|150.93|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|351||||351|149.53|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|351||||351|175.5|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351||||351|228.15|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|CORESOURCE [1315]|CORESOURCE [131500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|351||||351|0|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|351||||351|129.87|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|GEHA [1415]|GEHA [141500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HEALTHNET [1495]|HEALTHNET [149500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351||||351|150.93|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|351||||351|326.43|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351||||351|210.6|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351||||351|324.96|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351||||351|205.42|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MULTIPLAN [1680]|HMA [168003]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MULTIPLAN [1680]|IHC HS [168011]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|351||||351|221.06|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|Self-pay|Self-pay|351||||351|105.3|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351||||351|73.71|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|TRUSTMARK [2030]|STARMARK [203000]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351||||351|168.3|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|UMR [2035]|UMR OPTIONS [203501]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351||||351|195.64|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351||||351|315.9|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|351||||351|0|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|351||||351|129.87|326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|351||||351||326.43|73.71
46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|351||||351|175.5|326.43|73.71
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|296 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA ACO WILCO [101532]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40.97||||40.97|20.53|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40.97||||40.97|14.38|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40.97||||40.97|17.62|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40.97||||40.97|17.45|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40.97||||40.97|20.49|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40.97||||40.97|26.63|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|CORESOURCE [1315]|CORESOURCE [131500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|CORVEL CORP [2235]|CORVEL CORP [223500]|40.97||||40.97|3.93|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40.97||||40.97|15.16|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|GEHA [1415]|GEHA [141500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHNET [1495]|HEALTHNET [149500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40.97||||40.97|17.62|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART [150501]|40.97||||40.97|38.1|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40.97||||40.97|24.58|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|HMA [168003]|40.97||||40.97|14.34|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|IHC HS [168011]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|Self-pay|Self-pay|40.97||||40.97|12.29|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40.97||||40.97|8.6|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40.97||||40.97|3.9|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|TRUSTMARK [2030]|STARMARK [203000]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40.97||||40.97|19.65|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|UMR [2035]|UMR OPTIONS [203501]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40.97||||40.97|36.87|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40.97||||40.97|0|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40.97||||40.97|15.16|38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40.97||||40.97||38.1|3.9
472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|2 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40.97||||40.97|20.49|38.1|3.9
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|AETNA [1015]|AETNA ACO WILCO [101532]|1448||||1448|0|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1448||||1448|349.46|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1448||||1448|859.07|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1448||||1448|859.07|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1448||||1448|339.38|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1448||||1448|725.45|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1448||||1448|508.25|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1448||||1448|622.64|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1448||||1448|616.85|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1448||||1448|724|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1448||||1448|941.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|CORESOURCE [1315]|CORESOURCE [131500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1448||||1448|0|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1448||||1448|535.76|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|GEHA [1415]|GEHA [141500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1448||||1448|770.86|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HEALTHNET [1495]|HEALTHNET [149500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1448||||1448|622.64|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1448||||1448|1346.64|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1448||||1448|868.8|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1448||||1448|373.32|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1448||||1448|922.36|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1448||||1448|829.73|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1448||||1448|462.52|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1448||||1448|349.46|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MULTIPLAN [1680]|HMA [168003]|1448||||1448|513.91|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MULTIPLAN [1680]|IHC HS [168011]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1448||||1448|892.9|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1448||||1448|373.32|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|Self-pay|Self-pay|1448||||1448|434.4|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1448||||1448|304.08|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1448||||1448|335.75|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1448||||1448|500.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|TRUSTMARK [2030]|STARMARK [203000]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1448||||1448|694.32|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|UMR [2035]|UMR OPTIONS [203501]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1448||||1448|790.19|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1448||||1448|1303.2|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1448||||1448|0|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1448||||1448|535.76|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1448||||1448|342.61|1346.64|304.08
48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1448||||1448|724|1346.64|304.08
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|1133||||1133|0|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1133||||1133|859.07|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1133||||1133|859.07|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1133||||1133|567.63|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1133||||1133|397.68|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1133||||1133|487.19|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1133||||1133|482.66|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1133||||1133|566.5|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1133||||1133|736.45|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1133||||1133|0|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1133||||1133|419.21|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|GEHA [1415]|GEHA [141500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1133||||1133|487.19|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1133||||1133|1053.69|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1133||||1133|679.8|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1133||||1133|1133|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1133||||1133|829.73|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1133||||1133|892.9|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|Self-pay|Self-pay|1133||||1133|339.9|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1133||||1133|237.93|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1133||||1133|543.27|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1133||||1133|790.19|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1133||||1133|1019.7|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1133||||1133|0|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1133||||1133|419.21|1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1133||||1133||1133|237.93
48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1133||||1133|566.5|1133|237.93
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1349||||1349|0|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1349||||1349|458.41|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1349||||1349|786.34|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1349||||1349|786.34|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1349||||1349|445.19|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1349||||1349|675.85|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1349||||1349|473.5|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1349||||1349|580.07|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1349||||1349|574.67|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1349||||1349|674.5|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1349||||1349|876.85|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|CORESOURCE [1315]|CORESOURCE [131500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1349||||1349|0|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1349||||1349|499.13|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|GEHA [1415]|GEHA [141500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1349||||1349|1349|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HEALTHNET [1495]|HEALTHNET [149500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1349||||1349|580.07|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1349||||1349|1254.57|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1349||||1349|809.4|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1349||||1349|489.71|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1349||||1349|1189.12|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1349||||1349|759.47|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1349||||1349|606.72|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1349||||1349|458.41|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MULTIPLAN [1680]|HMA [168003]|1349||||1349|674.14|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MULTIPLAN [1680]|IHC HS [168011]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1349||||1349|817.3|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1349||||1349|489.71|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|Self-pay|Self-pay|1349||||1349|404.7|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1349||||1349|283.29|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1349||||1349|440.44|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1349||||1349|656.16|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|TRUSTMARK [2030]|STARMARK [203000]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1349||||1349|646.85|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|UMR [2035]|UMR OPTIONS [203501]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1349||||1349|723.29|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1349||||1349|1214.1|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1349||||1349|0|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1349||||1349|499.13|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1349||||1349|449.42|1349|283.29
48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1349||||1349|674.5|1349|283.29
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|AETNA [1015]|AETNA ACO WILCO [101532]|1662||||1662|0|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1662||||1662|458.41|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1662||||1662|786.34|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1662||||1662|786.34|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1662||||1662|445.19|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1662||||1662|832.66|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1662||||1662|583.36|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1662||||1662|714.66|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1662||||1662|708.01|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1662||||1662|831|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1662||||1662|1080.3|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|CORESOURCE [1315]|CORESOURCE [131500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1662||||1662|0|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1662||||1662|614.94|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|GEHA [1415]|GEHA [141500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1662||||1662|1011.21|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HEALTHNET [1495]|HEALTHNET [149500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1662||||1662|714.66|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1662||||1662|1545.66|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1662||||1662|997.2|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1662||||1662|489.71|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1662||||1662|1189.12|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1662||||1662|759.47|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1662||||1662|606.72|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1662||||1662|458.41|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MULTIPLAN [1680]|HMA [168003]|1662||||1662|674.14|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MULTIPLAN [1680]|IHC HS [168011]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1662||||1662|817.3|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1662||||1662|489.71|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|Self-pay|Self-pay|1662||||1662|498.6|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1662||||1662|349.02|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1662||||1662|440.44|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1662||||1662|656.16|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|TRUSTMARK [2030]|STARMARK [203000]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1662||||1662|796.93|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|UMR [2035]|UMR OPTIONS [203501]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1662||||1662|723.29|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1662||||1662|1495.8|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1662||||1662|0|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1662||||1662|614.94|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1662||||1662|449.42|1545.66|349.02
48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1662||||1662|831|1545.66|349.02
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|1473||||1473|0|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1473||||1473|251.04|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1473||||1473|313.92|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1473||||1473|313.92|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1473||||1473|243.8|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1473||||1473|737.97|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1473||||1473|517.02|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1473||||1473|633.39|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1473||||1473|627.5|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1473||||1473|736.5|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1473||||1473|957.45|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1473||||1473|0|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1473||||1473|545.01|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|GEHA [1415]|GEHA [141500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1473||||1473|1473|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1473||||1473|633.39|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1473||||1473|1369.89|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1473||||1473|883.8|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1473||||1473|268.18|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1473||||1473|603.08|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1473||||1473|303.2|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1473||||1473|332.26|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1473||||1473|251.04|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MULTIPLAN [1680]|HMA [168003]|1473||||1473|369.18|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1473||||1473|326.28|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1473||||1473|268.18|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|Self-pay|Self-pay|1473||||1473|441.9|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1473||||1473|309.33|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1473||||1473|241.2|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1473||||1473|359.33|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1473||||1473|706.3|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|UMR [2035]|UMR OPTIONS [203501]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1473||||1473|288.76|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1473||||1473|1325.7|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1473||||1473|0|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1473||||1473|545.01|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1473||||1473|246.12|1473|241.2
48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1473||||1473|736.5|1473|241.2
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1799||||1799|0|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1799||||1799|859.07|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1799||||1799|859.07|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1799||||1799|901.3|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1799||||1799|631.45|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1799||||1799|773.57|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1799||||1799|766.37|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1799||||1799|899.5|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1799||||1799|1169.35|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1799||||1799|0|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1799||||1799|665.63|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|GEHA [1415]|GEHA [141500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1799||||1799|773.57|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1799||||1799|1673.07|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1799||||1799|1079.4|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1799||||1799|1653.46|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1799||||1799|829.73|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1799||||1799|892.9|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|Self-pay|Self-pay|1799||||1799|539.7|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1799||||1799|377.79|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1799||||1799|862.62|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1799||||1799|790.19|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1799||||1799|1619.1|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1799||||1799|0|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1799||||1799|665.63|1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1799||||1799||1673.07|377.79
48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1799||||1799|899.5|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|AETNA [1015]|AETNA ACO WILCO [101532]|1799||||1799|0|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1799||||1799|859.07|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1799||||1799|859.07|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1799||||1799|901.3|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1799||||1799|631.45|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1799||||1799|773.57|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1799||||1799|766.37|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1799||||1799|899.5|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1799||||1799|1169.35|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|CORESOURCE [1315]|CORESOURCE [131500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1799||||1799|0|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1799||||1799|665.63|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|GEHA [1415]|GEHA [141500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HEALTHNET [1495]|HEALTHNET [149500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1799||||1799|773.57|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1799||||1799|1673.07|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1799||||1799|1079.4|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1799||||1799|1653.46|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1799||||1799|829.73|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MULTIPLAN [1680]|HMA [168003]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MULTIPLAN [1680]|IHC HS [168011]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1799||||1799|892.9|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|Self-pay|Self-pay|1799||||1799|539.7|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1799||||1799|377.79|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|TRUSTMARK [2030]|STARMARK [203000]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1799||||1799|862.62|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|UMR [2035]|UMR OPTIONS [203501]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1799||||1799|790.19|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1799||||1799|1619.1|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1799||||1799|0|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1799||||1799|665.63|1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1799||||1799||1673.07|377.79
48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1799||||1799|899.5|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|AETNA [1015]|AETNA ACO WILCO [101532]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1799||||1799|901.3|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1799||||1799|631.45|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1799||||1799|773.57|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1799||||1799|766.37|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1799||||1799|899.5|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1799||||1799|1169.35|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|CORESOURCE [1315]|CORESOURCE [131500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1799||||1799|665.63|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|GEHA [1415]|GEHA [141500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HEALTHNET [1495]|HEALTHNET [149500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1799||||1799|773.57|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1799||||1799|1673.07|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1799||||1799|1079.4|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1799||||1799|899.5|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MULTIPLAN [1680]|HMA [168003]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MULTIPLAN [1680]|IHC HS [168011]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|Self-pay|Self-pay|1799||||1799|539.7|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1799||||1799|377.79|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|TRUSTMARK [2030]|STARMARK [203000]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1799||||1799|862.62|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|UMR [2035]|UMR OPTIONS [203501]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1799||||1799|1619.1|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1799||||1799|0|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1799||||1799|665.63|1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1799||||1799||1673.07|377.79
48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1799||||1799|899.5|1673.07|377.79
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|AETNA [1015]|AETNA ACO WILCO [101532]|1133||||1133|0|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1133||||1133|859.07|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1133||||1133|859.07|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1133||||1133|567.63|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1133||||1133|397.68|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1133||||1133|487.19|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1133||||1133|482.66|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1133||||1133|566.5|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1133||||1133|736.45|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|CORESOURCE [1315]|CORESOURCE [131500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1133||||1133|0|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1133||||1133|419.21|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|GEHA [1415]|GEHA [141500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HEALTHNET [1495]|HEALTHNET [149500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1133||||1133|487.19|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1133||||1133|1053.69|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1133||||1133|679.8|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1133||||1133|1133|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1133||||1133|829.73|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MULTIPLAN [1680]|HMA [168003]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MULTIPLAN [1680]|IHC HS [168011]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1133||||1133|892.9|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|Self-pay|Self-pay|1133||||1133|339.9|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1133||||1133|237.93|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|TRUSTMARK [2030]|STARMARK [203000]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1133||||1133|543.27|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|UMR [2035]|UMR OPTIONS [203501]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1133||||1133|790.19|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1133||||1133|1019.7|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1133||||1133|0|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1133||||1133|419.21|1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1133||||1133||1133|237.93
48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1133||||1133|566.5|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|AETNA [1015]|AETNA ACO WILCO [101532]|1133||||1133|0|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1133||||1133|678.93|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1133||||1133|859.07|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1133||||1133|859.07|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1133||||1133|659.35|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1133||||1133|567.63|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1133||||1133|397.68|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1133||||1133|487.19|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1133||||1133|482.66|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1133||||1133|566.5|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1133||||1133|736.45|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|CORESOURCE [1315]|CORESOURCE [131500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1133||||1133|0|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1133||||1133|419.21|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|GEHA [1415]|GEHA [141500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1133||||1133|1133|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HEALTHNET [1495]|HEALTHNET [149500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1133||||1133|487.19|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1133||||1133|1053.69|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1133||||1133|679.8|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1133||||1133|725.28|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1133||||1133|1133|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1133||||1133|829.73|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1133||||1133|898.58|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1133||||1133|678.93|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MULTIPLAN [1680]|HMA [168003]|1133||||1133|998.42|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MULTIPLAN [1680]|IHC HS [168011]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1133||||1133|892.9|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1133||||1133|725.28|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|Self-pay|Self-pay|1133||||1133|339.9|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1133||||1133|237.93|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1133||||1133|652.3|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1133||||1133|971.8|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|TRUSTMARK [2030]|STARMARK [203000]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1133||||1133|543.27|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|UMR [2035]|UMR OPTIONS [203501]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1133||||1133|790.19|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1133||||1133|1019.7|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1133||||1133|0|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1133||||1133|419.21|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1133||||1133|665.61|1133|237.93
48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1133||||1133|566.5|1133|237.93
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1842||||1842|0|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1842||||1842|458.41|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1842||||1842|594.95|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1842||||1842|594.95|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1842||||1842|445.19|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1842||||1842|922.84|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1842||||1842|646.54|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1842||||1842|792.06|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1842||||1842|784.69|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1842||||1842|921|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1842||||1842|1197.3|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1842||||1842|0|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1842||||1842|681.54|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|GEHA [1415]|GEHA [141500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1842||||1842|1011.21|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1842||||1842|792.06|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1842||||1842|1713.06|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1842||||1842|1105.2|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1842||||1842|489.71|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1842||||1842|1189.12|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1842||||1842|574.62|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1842||||1842|606.72|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1842||||1842|458.41|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|1842||||1842|674.14|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1842||||1842|618.38|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1842||||1842|489.71|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|Self-pay|Self-pay|1842||||1842|552.6|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1842||||1842|386.82|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1842||||1842|440.44|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1842||||1842|656.16|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1842||||1842|883.24|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1842||||1842|547.24|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1842||||1842|1657.8|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1842||||1842|0|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1842||||1842|681.54|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1842||||1842|449.42|1713.06|386.82
48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1842||||1842|921|1713.06|386.82
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|725||||725|0|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|725||||725|218.46|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|725||||725|348.8|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|725||||725|348.8|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|725||||725|212.16|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|725||||725|363.23|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|725||||725|254.48|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|725||||725|311.75|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|725||||725|308.85|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|725||||725|362.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|725||||725|471.25|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|725||||725|0|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|725||||725|268.25|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|GEHA [1415]|GEHA [141500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|725||||725|481.9|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|725||||725|311.75|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|725||||725|674.25|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|725||||725|435|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|725||||725|233.38|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|725||||725|551.1|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|725||||725|336.88|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|725||||725|289.14|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|725||||725|218.46|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MULTIPLAN [1680]|HMA [168003]|725||||725|321.27|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|725||||725|362.53|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|725||||725|233.38|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|Self-pay|Self-pay|725||||725|217.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|725||||725|152.25|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|725||||725|209.89|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|725||||725|312.7|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|725||||725|347.64|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|725||||725|320.83|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|725||||725|652.5|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|725||||725|0|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|725||||725|268.25|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|725||||725|214.18|674.25|152.25
48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|725||||725|362.5|674.25|152.25
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|AETNA [1015]|AETNA ACO WILCO [101532]|2527||||2527|0|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2527||||2527|458.41|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2527||||2527|786.34|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2527||||2527|786.34|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2527||||2527|445.19|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2527||||2527|1266.03|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2527||||2527|886.98|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2527||||2527|1086.61|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2527||||2527|1076.5|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2527||||2527|1263.5|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2527||||2527|1642.55|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|CORESOURCE [1315]|CORESOURCE [131500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2527||||2527|0|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2527||||2527|934.99|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|GEHA [1415]|GEHA [141500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2527||||2527|1011.21|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HEALTHNET [1495]|HEALTHNET [149500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2527||||2527|1086.61|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2527||||2527|2350.11|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2527||||2527|1516.2|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2527||||2527|489.71|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2527||||2527|1189.12|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2527||||2527|759.47|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2527||||2527|606.72|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2527||||2527|453.24|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MULTIPLAN [1680]|HMA [168003]|2527||||2527|674.14|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MULTIPLAN [1680]|IHC HS [168011]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2527||||2527|817.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2527||||2527|489.71|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|Self-pay|Self-pay|2527||||2527|758.1|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2527||||2527|530.67|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2527||||2527|440.44|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2527||||2527|656.16|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|TRUSTMARK [2030]|STARMARK [203000]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2527||||2527|1211.7|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|UMR [2035]|UMR OPTIONS [203501]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2527||||2527|723.29|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2527||||2527|2274.3|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2527||||2527|0|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2527||||2527|934.99|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2527||||2527|449.42|2350.11|440.44
48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2527||||2527|1263.5|2350.11|440.44
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|762||||762|0|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|762||||762|594.95|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|762||||762|594.95|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|762||||762|381.76|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|762||||762|267.46|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|762||||762|327.66|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|762||||762|324.61|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|762||||762|381|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|762||||762|495.3|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|762||||762|0|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|762||||762|281.94|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|GEHA [1415]|GEHA [141500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|762||||762|327.66|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|762||||762|708.66|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|762||||762|457.2|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|762||||762|762|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|762||||762|574.62|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MULTIPLAN [1680]|HMA [168003]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|762||||762|618.38|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|Self-pay|Self-pay|762||||762|228.6|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|762||||762|160.02|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|762||||762|365.38|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|UMR [2035]|UMR OPTIONS [203501]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|762||||762|547.24|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|762||||762|685.8|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|762||||762|0|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|762||||762|281.94|762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|762||||762||762|160.02
48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|762||||762|381|762|160.02
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|AETNA [1015]|AETNA ACO WILCO [101532]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|784||||784|392.78|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784||||784|275.18|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784||||784|337.12|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|784||||784|333.98|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|784||||784|392|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784||||784|509.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|CORESOURCE [1315]|CORESOURCE [131500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|784||||784|290.08|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|GEHA [1415]|GEHA [141500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HEALTHNET [1495]|HEALTHNET [149500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784||||784|337.12|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|784||||784|729.12|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784||||784|470.4|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784||||784|392|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MULTIPLAN [1680]|HMA [168003]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MULTIPLAN [1680]|IHC HS [168011]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|Self-pay|Self-pay|784||||784|235.2|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784||||784|164.64|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|TRUSTMARK [2030]|STARMARK [203000]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784||||784|375.93|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|UMR [2035]|UMR OPTIONS [203501]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784||||784|705.6|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|784||||784|0|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|784||||784|290.08|729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|784||||784||729.12|164.64
48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|784||||784|392|729.12|164.64
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|167||||167|83.67|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167||||167|58.62|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167||||167|71.81|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|167||||167|71.14|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|167||||167|83.5|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167||||167|108.55|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|167||||167|61.79|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|GEHA [1415]|GEHA [141500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167||||167|71.81|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|167||||167|155.31|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167||||167|100.2|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167||||167|83.5|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MULTIPLAN [1680]|HMA [168003]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|Self-pay|Self-pay|167||||167|50.1|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167||||167|35.07|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167||||167|80.08|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167||||167|150.3|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|167||||167|0|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|167||||167|61.79|155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|167||||167||155.31|35.07
48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|167||||167|83.5|155.31|35.07
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|AETNA [1015]|AETNA ACO WILCO [101532]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|686||||686|343.69|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|686||||686|240.79|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|686||||686|294.98|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|686||||686|292.24|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|686||||686|343|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|686||||686|445.9|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|CORESOURCE [1315]|CORESOURCE [131500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|686||||686|253.82|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|GEHA [1415]|GEHA [141500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HEALTHNET [1495]|HEALTHNET [149500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|686||||686|294.98|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|686||||686|637.98|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|686||||686|411.6|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|686||||686|343|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MULTIPLAN [1680]|HMA [168003]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MULTIPLAN [1680]|IHC HS [168011]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|Self-pay|Self-pay|686||||686|205.8|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|686||||686|144.06|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|TRUSTMARK [2030]|STARMARK [203000]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|686||||686|328.94|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|UMR [2035]|UMR OPTIONS [203501]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|686||||686|617.4|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|686||||686|0|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|686||||686|253.82|637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|686||||686||637.98|144.06
48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|686||||686|343|637.98|144.06
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|AETNA [1015]|AETNA ACO WILCO [101532]|1988||||1988|0|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1988||||1988|458.41|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1988||||1988|594.95|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1988||||1988|594.95|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1988||||1988|445.19|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1988||||1988|995.99|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1988||||1988|697.79|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1988||||1988|854.84|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1988||||1988|846.89|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1988||||1988|994|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1988||||1988|1292.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|CORESOURCE [1315]|CORESOURCE [131500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1988||||1988|0|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1988||||1988|735.56|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|GEHA [1415]|GEHA [141500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1988||||1988|1011.21|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HEALTHNET [1495]|HEALTHNET [149500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1988||||1988|854.84|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1988||||1988|1848.84|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1988||||1988|1192.8|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1988||||1988|489.71|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1988||||1988|1189.12|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1988||||1988|574.62|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1988||||1988|606.72|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1988||||1988|458.41|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MULTIPLAN [1680]|HMA [168003]|1988||||1988|674.14|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MULTIPLAN [1680]|IHC HS [168011]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1988||||1988|618.38|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1988||||1988|489.71|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|Self-pay|Self-pay|1988||||1988|596.4|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1988||||1988|417.48|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1988||||1988|440.44|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1988||||1988|656.16|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|TRUSTMARK [2030]|STARMARK [203000]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1988||||1988|953.25|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|UMR [2035]|UMR OPTIONS [203501]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1988||||1988|547.24|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1988||||1988|1789.2|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1988||||1988|0|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1988||||1988|735.56|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1988||||1988|449.42|1848.84|417.48
48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1988||||1988|994|1848.84|417.48
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|AETNA [1015]|AETNA ACO WILCO [101532]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.93||||106.93|53.57|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.93||||106.93|37.53|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.93||||106.93|45.98|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.93||||106.93|45.55|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.93||||106.93|53.47|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.93||||106.93|69.5|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|CORESOURCE [1315]|CORESOURCE [131500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.93||||106.93|39.56|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|GEHA [1415]|GEHA [141500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HEALTHNET [1495]|HEALTHNET [149500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.93||||106.93|45.98|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|106.93||||106.93|99.44|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106.93||||106.93|64.16|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MULTIPLAN [1680]|HMA [168003]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MULTIPLAN [1680]|IHC HS [168011]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|Self-pay|Self-pay|106.93||||106.93|32.08|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.93||||106.93|22.46|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|TRUSTMARK [2030]|STARMARK [203000]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.93||||106.93|51.27|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|UMR [2035]|UMR OPTIONS [203501]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.93||||106.93|96.24|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.93||||106.93|0|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.93||||106.93|39.56|99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.93||||106.93||99.44|22.46
4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|500 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.93||||106.93|53.47|99.44|22.46
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12.17||||12.17|6.1|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.17||||12.17|4.27|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.17||||12.17|5.23|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12.17||||12.17|5.18|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12.17||||12.17|6.09|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.17||||12.17|7.91|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|12.17||||12.17|0.38|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12.17||||12.17|4.5|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.17||||12.17|5.23|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|12.17||||12.17|11.32|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.17||||12.17|7.3|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|12.17||||12.17|3.65|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.17||||12.17|2.56|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.17||||12.17|5.84|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.17||||12.17|10.95|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12.17||||12.17|0|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12.17||||12.17|4.5|11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12.17||||12.17||11.32|0.38
4973|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHOTREXATE SODIUM 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12.17||||12.17|6.09|11.32|0.38
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.36|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.27|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.27
4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.27
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67.73||||67.73|33.93|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67.73||||67.73|23.77|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67.73||||67.73|29.12|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67.73||||67.73|28.85|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67.73||||67.73|33.87|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67.73||||67.73|44.02|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|67.73||||67.73|12.61|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67.73||||67.73|25.06|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|GEHA [1415]|GEHA [141500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67.73||||67.73|29.12|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|67.73||||67.73|62.99|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67.73||||67.73|40.64|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MULTIPLAN [1680]|HMA [168003]|67.73||||67.73|23.71|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|Self-pay|Self-pay|67.73||||67.73|20.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67.73||||67.73|14.22|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67.73||||67.73|11.86|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67.73||||67.73|32.48|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67.73||||67.73|60.96|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67.73||||67.73|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67.73||||67.73|25.06|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67.73||||67.73||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67.73||||67.73|33.87|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|323.69||||323.69|162.17|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|323.69||||323.69|113.62|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|323.69||||323.69|139.19|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|323.69||||323.69|137.89|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|323.69||||323.69|161.85|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|323.69||||323.69|210.4|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|323.69||||323.69|63.03|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|323.69||||323.69|119.77|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|GEHA [1415]|GEHA [141500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|323.69||||323.69|139.19|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|323.69||||323.69|301.03|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|323.69||||323.69|194.21|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MULTIPLAN [1680]|HMA [168003]|323.69||||323.69|113.29|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|Self-pay|Self-pay|323.69||||323.69|97.11|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|323.69||||323.69|67.97|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|323.69||||323.69|59.31|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|323.69||||323.69|155.21|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|323.69||||323.69|291.32|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|323.69||||323.69|0|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|323.69||||323.69|119.77|301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|323.69||||323.69||301.03|11.86
4996|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|323.69||||323.69|161.85|301.03|11.86
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|90||||90|27|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|AETNA [1015]|AETNA ACO WILCO [101532]|431||||431|0|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|431||||431|8.88|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|431||||431|111.66|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|431||||431|113.22|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|431||||431|113.22|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|431||||431|215.93|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|431||||431|151.28|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|431||||431|185.33|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|431||||431|183.61|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|431||||431|215.5|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|431||||431|280.15|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|CORESOURCE [1315]|CORESOURCE [131500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|431||||431|0|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|431||||431|159.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|GEHA [1415]|GEHA [141500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|431||||431|19.98|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HEALTHNET [1495]|HEALTHNET [149500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|431||||431|185.33|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|431||||431|400.83|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|431||||431|258.6|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|431||||431|120.42|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|431||||431|215.5|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|431||||431|109.35|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|431||||431||400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|431||||431|111.66|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MULTIPLAN [1680]|HMA [168003]|431||||431|164.21|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MULTIPLAN [1680]|IHC HS [168011]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|431||||431|8.88|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|431||||431|117.68|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|431||||431|120.42|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|Self-pay|Self-pay|431||||431|129.3|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|431||||431|90.51|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|431||||431|107.28|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|431||||431||400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|TRUSTMARK [2030]|STARMARK [203000]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|431||||431|206.66|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|UMR [2035]|UMR OPTIONS [203501]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|431||||431|104.14|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|431||||431|387.9|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|431||||431|0|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|431||||431|109.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|431||||431|159.47|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|431||||431|8.88|400.83|8.88
51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|431||||431|215.5|400.83|8.88
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|4118||||4118|0|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4118||||4118|842.56|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4118||||4118|842.56|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4118||||4118|2063.12|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4118||||4118|1445.42|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4118||||4118|1770.74|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4118||||4118|1754.27|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4118||||4118|2059|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4118||||4118|2676.7|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|CORESOURCE [1315]|CORESOURCE [131500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4118||||4118|0|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4118||||4118|1523.66|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|GEHA [1415]|GEHA [141500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HEALTHNET [1495]|HEALTHNET [149500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4118||||4118|1770.74|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4118||||4118|3829.74|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4118||||4118|2470.8|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4118||||4118|1828.14|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MULTIPLAN [1680]|HMA [168003]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MULTIPLAN [1680]|IHC HS [168011]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|Self-pay|Self-pay|4118||||4118|1235.4|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4118||||4118|864.78|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|TRUSTMARK [2030]|STARMARK [203000]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4118||||4118|1974.58|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|UMR [2035]|UMR OPTIONS [203501]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4118||||4118|3706.2|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4118||||4118|0|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4118||||4118|1523.66|3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4118||||4118||3829.74|842.56
51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4118||||4118|2059|3829.74|842.56
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39.97||||39.97|20.02|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.97||||39.97|14.03|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.97||||39.97|17.19|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39.97||||39.97|17.03|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39.97||||39.97|19.99|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.97||||39.97|25.98|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39.97||||39.97|14.79|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|GEHA [1415]|GEHA [141500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.97||||39.97|17.19|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|39.97||||39.97|37.17|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.97||||39.97|23.98|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MULTIPLAN [1680]|HMA [168003]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|Self-pay|Self-pay|39.97||||39.97|11.99|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.97||||39.97|8.39|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.97||||39.97|19.17|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.97||||39.97|35.97|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39.97||||39.97|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39.97||||39.97|14.79|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39.97||||39.97||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39.97||||39.97|19.99|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|Self-pay|Self-pay|10||||10|3|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||37.17|2.1
5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|37.17|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA [1015]|AETNA ACO WILCO [101532]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63.92||||63.92|32.02|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.92||||63.92|22.44|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.92||||63.92|27.49|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63.92||||63.92|27.23|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63.92||||63.92|31.96|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.92||||63.92|41.55|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CORESOURCE [1315]|CORESOURCE [131500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63.92||||63.92|23.65|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|GEHA [1415]|GEHA [141500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHNET [1495]|HEALTHNET [149500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.92||||63.92|27.49|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|63.92||||63.92|59.45|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.92||||63.92|38.35|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MULTIPLAN [1680]|HMA [168003]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MULTIPLAN [1680]|IHC HS [168011]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|Self-pay|Self-pay|63.92||||63.92|19.18|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.92||||63.92|13.42|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|TRUSTMARK [2030]|STARMARK [203000]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.92||||63.92|30.65|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UMR [2035]|UMR OPTIONS [203501]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.92||||63.92|57.53|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63.92||||63.92|0|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63.92||||63.92|23.65|59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63.92||||63.92||59.45|13.42
5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|1,000 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63.92||||63.92|31.96|59.45|13.42
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|AETNA [1015]|AETNA ACO WILCO [101532]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|508.88||||508.88|254.95|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|508.88||||508.88|178.62|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|508.88||||508.88|218.82|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|508.88||||508.88|216.78|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|508.88||||508.88|254.44|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|508.88||||508.88|330.77|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|CORESOURCE [1315]|CORESOURCE [131500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|508.88||||508.88|188.29|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|GEHA [1415]|GEHA [141500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HEALTHNET [1495]|HEALTHNET [149500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|508.88||||508.88|218.82|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|508.88||||508.88|473.26|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|508.88||||508.88|305.33|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MULTIPLAN [1680]|HMA [168003]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MULTIPLAN [1680]|IHC HS [168011]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|Self-pay|Self-pay|508.88||||508.88|152.66|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|508.88||||508.88|106.86|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|TRUSTMARK [2030]|STARMARK [203000]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|508.88||||508.88|244.01|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|UMR [2035]|UMR OPTIONS [203501]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|508.88||||508.88|457.99|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|508.88||||508.88|0|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|508.88||||508.88|188.29|473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|508.88||||508.88||473.26|106.86
5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|10,000 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|508.88||||508.88|254.44|473.26|106.86
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|AETNA [1015]|AETNA ACO WILCO [101532]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94.21||||94.21|47.2|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94.21||||94.21|33.07|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94.21||||94.21|40.51|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94.21||||94.21|40.13|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94.21||||94.21|47.11|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94.21||||94.21|61.24|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|CORESOURCE [1315]|CORESOURCE [131500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94.21||||94.21|34.86|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|GEHA [1415]|GEHA [141500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HEALTHNET [1495]|HEALTHNET [149500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94.21||||94.21|40.51|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|94.21||||94.21|87.62|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94.21||||94.21|56.53|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MULTIPLAN [1680]|HMA [168003]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MULTIPLAN [1680]|IHC HS [168011]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|Self-pay|Self-pay|94.21||||94.21|28.26|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94.21||||94.21|19.78|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|TRUSTMARK [2030]|STARMARK [203000]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94.21||||94.21|45.17|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|UMR [2035]|UMR OPTIONS [203501]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94.21||||94.21|84.79|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94.21||||94.21|0|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94.21||||94.21|34.86|87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94.21||||94.21||87.62|19.78
5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|2,000 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94.21||||94.21|47.11|87.62|19.78
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65.7||||65.7|32.92|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65.7||||65.7|23.06|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65.7||||65.7|28.25|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65.7||||65.7|27.99|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65.7||||65.7|32.85|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65.7||||65.7|42.71|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|65.7||||65.7|17.37|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65.7||||65.7|24.31|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65.7||||65.7|28.25|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|65.7||||65.7|61.1|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65.7||||65.7|39.42|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|65.7||||65.7|23|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|65.7||||65.7|19.71|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65.7||||65.7|13.8|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65.7||||65.7|11.69|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65.7||||65.7|31.5|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65.7||||65.7|59.13|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65.7||||65.7|0|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65.7||||65.7|24.31|61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65.7||||65.7||61.1|11.69
5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65.7||||65.7|32.85|61.1|11.69
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5510001|EAP||HH RN INITIAL VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|GEHA [1415]|GEHA [141500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|Self-pay|Self-pay|||||127.81|38.34|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||127.81|0|38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||127.81||38.34|26.84
5510001|EAP||HH RN INITIAL VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|Self-pay|Self-pay|||||127.81|38.34|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||127.81|0|38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||127.81||38.34|26.84
5510002|EAP||HH RN ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||127.81|0|38.34|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|GEHA [1415]|GEHA [141500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|63.91|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MULTIPLAN [1680]|HMA [168003]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MULTIPLAN [1680]|IHC HS [168011]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|Self-pay|Self-pay|||||127.81|38.34|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|TRUSTMARK [2030]|STARMARK [203000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|UMR [2035]|UMR OPTIONS [203501]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||127.81|0|63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||127.81||63.91|26.84
5510003|EAP||HH RN MANAGEMENT AND EVALUATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||127.81|0|63.91|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|GEHA [1415]|GEHA [141500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MULTIPLAN [1680]|HMA [168003]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MULTIPLAN [1680]|IHC HS [168011]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|Self-pay|Self-pay|||||127.81|38.34|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|TRUSTMARK [2030]|STARMARK [203000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|UMR [2035]|UMR OPTIONS [203501]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||127.81|0|38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||127.81||38.34|26.84
5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|GEHA [1415]|GEHA [141500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MULTIPLAN [1680]|HMA [168003]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MULTIPLAN [1680]|IHC HS [168011]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|Self-pay|Self-pay|||||127.81|38.34|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|TRUSTMARK [2030]|STARMARK [203000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|UMR [2035]|UMR OPTIONS [203501]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||127.81|0|38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||127.81||38.34|26.84
5510005|EAP||HH RN TRAINING AND EDUCATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||127.81|0|38.34|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|GEHA [1415]|GEHA [141500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|63.91|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MULTIPLAN [1680]|HMA [168003]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MULTIPLAN [1680]|IHC HS [168011]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|Self-pay|Self-pay|||||127.81|38.34|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|TRUSTMARK [2030]|STARMARK [203000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|UMR [2035]|UMR OPTIONS [203501]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||127.81|0|63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||127.81||63.91|26.84
5510006|EAP||Hh/hspc Lpn Routine Visit|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||127.81|0|63.91|26.84
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5600001|EAP||HH MSW INITIAL VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|GEHA [1415]|GEHA [141500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||204.87|102.44|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|Self-pay|Self-pay|||||204.87|61.46|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||204.87|43.02|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||204.87|0|102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||204.87||102.44|43.02
5600001|EAP||HH MSW INITIAL VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||204.87|0|102.44|43.02
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|Self-pay|Self-pay|10||||10|3|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5610001|EAP||HH MSW ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||204.87|102.44|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|Self-pay|Self-pay|||||204.87|61.46|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||204.87|43.02|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||204.87|0|102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||204.87||102.44|43.02
5610001|EAP||HH MSW ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||204.87|0|102.44|43.02
5710001|EAP||HH HHA VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|GEHA [1415]|GEHA [141500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||57.88|28.94|28.94|12.15
5710001|EAP||HH HHA VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|Self-pay|Self-pay|||||57.88|17.36|28.94|12.15
5710001|EAP||HH HHA VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||57.88|12.15|28.94|12.15
5710001|EAP||HH HHA VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||57.88|0|28.94|12.15
5710001|EAP||HH HHA VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||57.88||28.94|12.15
5710001|EAP||HH HHA VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||57.88|0|28.94|12.15
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|AETNA [1015]|AETNA ACO WILCO [101532]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61.46||||61.46|30.79|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.46||||61.46|21.57|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.46||||61.46|26.43|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61.46||||61.46|26.18|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61.46||||61.46|30.73|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.46||||61.46|39.95|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|CORESOURCE [1315]|CORESOURCE [131500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|CORVEL CORP [2235]|CORVEL CORP [223500]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61.46||||61.46|22.74|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|GEHA [1415]|GEHA [141500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HEALTHNET [1495]|HEALTHNET [149500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.46||||61.46|26.43|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART [150501]|61.46||||61.46|57.16|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.46||||61.46|36.88|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MULTIPLAN [1680]|HMA [168003]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MULTIPLAN [1680]|IHC HS [168011]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|Self-pay|Self-pay|61.46||||61.46|18.44|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.46||||61.46|12.91|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|TRUSTMARK [2030]|STARMARK [203000]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.46||||61.46|29.47|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|UMR [2035]|UMR OPTIONS [203501]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.46||||61.46|55.31|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61.46||||61.46|0|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61.46||||61.46|22.74|57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61.46||||61.46||57.16|12.91
5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|15 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61.46||||61.46|30.73|57.16|12.91
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|Self-pay|Self-pay|10||||10|3|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|AETNA [1015]|AETNA ACO WILCO [101532]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55.34||||55.34|27.73|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.34||||55.34|19.42|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.34||||55.34|23.8|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55.34||||55.34|23.57|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55.34||||55.34|27.67|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.34||||55.34|35.97|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|CORESOURCE [1315]|CORESOURCE [131500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55.34||||55.34|20.48|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|GEHA [1415]|GEHA [141500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HEALTHNET [1495]|HEALTHNET [149500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.34||||55.34|23.8|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|55.34||||55.34|51.47|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.34||||55.34|33.2|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MULTIPLAN [1680]|HMA [168003]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MULTIPLAN [1680]|IHC HS [168011]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|Self-pay|Self-pay|55.34||||55.34|16.6|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.34||||55.34|11.62|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|TRUSTMARK [2030]|STARMARK [203000]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.34||||55.34|26.54|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|UMR [2035]|UMR OPTIONS [203501]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.34||||55.34|49.81|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55.34||||55.34|0|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55.34||||55.34|20.48|51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55.34||||55.34||51.47|2.1
5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|60 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55.34||||55.34|27.67|51.47|2.1
5800001|EAP||HH INITIAL RT VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|GEHA [1415]|GEHA [141500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|Self-pay|Self-pay|||||150|45|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||150|31.5|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||150|0|45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||150||45|31.5
5800001|EAP||HH INITIAL RT VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|AETNA [1015]|AETNA ACO WILCO [101532]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|CORESOURCE [1315]|CORESOURCE [131500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|GEHA [1415]|GEHA [141500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HEALTHNET [1495]|HEALTHNET [149500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MULTIPLAN [1680]|HMA [168003]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MULTIPLAN [1680]|IHC HS [168011]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|Self-pay|Self-pay|||||150|45|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||150|31.5|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|TRUSTMARK [2030]|STARMARK [203000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|UMR [2035]|UMR OPTIONS [203501]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|||||150|0|45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|||||150||45|31.5
5810001|EAP||HH RT ROUTINE VISIT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|||||150|0|45|31.5
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|30 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|AETNA [1015]|AETNA ACO WILCO [101532]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|211.16||||211.16|105.79|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211.16||||211.16|74.12|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211.16||||211.16|90.8|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|211.16||||211.16|89.95|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|211.16||||211.16|105.58|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211.16||||211.16|137.25|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|CORESOURCE [1315]|CORESOURCE [131500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|CORVEL CORP [2235]|CORVEL CORP [223500]|211.16||||211.16|34.29|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|211.16||||211.16|78.13|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|FIRST HEALTH [1375]|QUALCHOICE [137513]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|FMH BENEFIT SERVICES [1390]|FMH [139000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|GEHA [1415]|GEHA [141500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HEALTHNET [1495]|HEALTHNET [149500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.16||||211.16|90.8|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HEALTHSMART [1505]|HEALTHSMART [150501]|211.16||||211.16|196.38|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211.16||||211.16|126.7|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MULTIPLAN [1680]|HMA [168003]|211.16||||211.16|73.91|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MULTIPLAN [1680]|IHC HS [168011]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|PENDING SSI [1616]|PENDING SSI RCA [161601]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|Self-pay|Self-pay|211.16||||211.16|63.35|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211.16||||211.16|44.34|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|TRIWEST [3750]|TRIWEST TWVACCN [375000]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211.16||||211.16|39.64|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|TRUSTMARK [2030]|STARMARK [203000]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211.16||||211.16|101.25|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|UMR [2035]|UMR OPTIONS [203501]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211.16||||211.16|190.04|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|211.16||||211.16|0|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|211.16||||211.16|78.13|196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|211.16||||211.16||196.38|34.29
6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|20 Million Units|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|211.16||||211.16|105.58|196.38|34.29
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|AETNA [1015]|AETNA ACO WILCO [101532]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|69.49||||69.49|34.81|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69.49||||69.49|24.39|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69.49||||69.49|29.88|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|69.49||||69.49|29.6|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|69.49||||69.49|34.75|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69.49||||69.49|45.17|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|CORESOURCE [1315]|CORESOURCE [131500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|CORVEL CORP [2235]|CORVEL CORP [223500]|69.49||||69.49|9.08|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|69.49||||69.49|25.71|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|FIRST HEALTH [1375]|QUALCHOICE [137513]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|FMH BENEFIT SERVICES [1390]|FMH [139000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|GEHA [1415]|GEHA [141500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HEALTHNET [1495]|HEALTHNET [149500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69.49||||69.49|29.88|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HEALTHSMART [1505]|HEALTHSMART [150501]|69.49||||69.49|64.63|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69.49||||69.49|41.69|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MULTIPLAN [1680]|HMA [168003]|69.49||||69.49|24.32|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MULTIPLAN [1680]|IHC HS [168011]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|PENDING SSI [1616]|PENDING SSI RCA [161601]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|Self-pay|Self-pay|69.49||||69.49|20.85|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69.49||||69.49|14.59|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|TRIWEST [3750]|TRIWEST TWVACCN [375000]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69.49||||69.49|10.49|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|TRUSTMARK [2030]|STARMARK [203000]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69.49||||69.49|33.32|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|UMR [2035]|UMR OPTIONS [203501]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69.49||||69.49|62.54|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|69.49||||69.49|0|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|69.49||||69.49|25.71|64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|69.49||||69.49||64.63|9.08
6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|5 Million Units|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|69.49||||69.49|34.75|64.63|9.08
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001001|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001002|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001003|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001004|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001007|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001008|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001009|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001010|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001011|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001012|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001013|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001014|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001015|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001016|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001017|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001018|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001019|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001020|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001021|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001022|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61001023|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3803||||3803|807.65|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3803||||3803|268.31|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3803||||3803|349.46|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3803||||3803|706.36|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3803||||3803|339.38|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3803||||3803|1905.3|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3803||||3803|1334.85|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3803||||3803|1635.29|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3803||||3803|1620.08|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3803||||3803|1901.5|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3803||||3803|2471.95|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3803||||3803|603.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3803||||3803|1635.29|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3803||||3803|3536.79|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3803||||3803|2281.8|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3803||||3803|373.32|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3803||||3803|1901.5|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3803||||3803|362.22|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3803||||3803|349.46|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3803||||3803|402.47|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3803||||3803|268.31|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3803||||3803|373.32|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|Self-pay|Self-pay|3803||||3803|1140.9|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3803||||3803|798.63|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3803||||3803|335.75|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3803||||3803|500.2|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3803||||3803|1823.54|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3803||||3803|3422.7|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3803||||3803|0|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3803||||3803|342.61|3536.79|268.31
61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3803||||3803|1901.5|3536.79|268.31
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3480||||3480|807.65|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3480||||3480|706.36|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3480||||3480|1743.48|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3480||||3480|1221.48|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3480||||3480|1496.4|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3480||||3480|1482.48|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3480||||3480|1740|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3480||||3480|2262|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3480||||3480|1496.4|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3480||||3480|3236.4|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3480||||3480|2088|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3480||||3480|1740|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|Self-pay|Self-pay|3480||||3480|1044|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3480||||3480|730.8|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3480||||3480|1668.66|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3480||||3480|3132|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3480||||3480|0|3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3480||||3480||3236.4|706.36
61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3480||||3480|1740|3236.4|706.36
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2587||||2587|807.65|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2587||||2587|268|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2587||||2587|349.46|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2587||||2587|706.36|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2587||||2587|339.38|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2587||||2587|1296.09|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2587||||2587|908.04|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2587||||2587|1112.41|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2587||||2587|1102.06|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2587||||2587|1293.5|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2587||||2587|1681.55|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2587||||2587|603|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2587||||2587|1112.41|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2587||||2587|2405.91|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2587||||2587|1552.2|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2587||||2587|373.32|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2587||||2587|1293.5|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2587||||2587|361.8|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2587||||2587|349.46|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2587||||2587|402|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2587||||2587|268|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2587||||2587|373.32|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|Self-pay|Self-pay|2587||||2587|776.1|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2587||||2587|543.27|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2587||||2587|335.75|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2587||||2587|500.2|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2587||||2587|1240.47|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2587||||2587|2328.3|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2587||||2587|0|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2587||||2587|342.61|2405.91|268
61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2587||||2587|1293.5|2405.91|268
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|AETNA [1015]|AETNA ACO WILCO [101532]|2693||||2693|807.65|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2693||||2693|218.46|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2693||||2693|461.12|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2693||||2693|461.12|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2693||||2693|212.16|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2693||||2693|1349.19|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2693||||2693|945.24|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2693||||2693|1157.99|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2693||||2693|1147.22|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2693||||2693|1346.5|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2693||||2693|1750.45|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|CORESOURCE [1315]|CORESOURCE [131500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2693||||2693|546.6|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2693||||2693|334.66|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|GEHA [1415]|GEHA [141500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2693||||2693|481.9|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HEALTHNET [1495]|HEALTHNET [149500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2693||||2693|1157.99|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2693||||2693|2504.49|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2693||||2693|1615.8|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2693||||2693|233.38|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2693||||2693|551.1|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2693||||2693|445.37|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2693||||2693|289.14|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2693||||2693|218.46|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MULTIPLAN [1680]|HMA [168003]|2693||||2693|321.27|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MULTIPLAN [1680]|IHC HS [168011]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2693||||2693|479.28|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2693||||2693|233.38|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|Self-pay|Self-pay|2693||||2693|807.9|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2693||||2693|565.53|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2693||||2693|209.89|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2693||||2693|312.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|TRUSTMARK [2030]|STARMARK [203000]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2693||||2693|1291.29|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|UMR [2035]|UMR OPTIONS [203501]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2693||||2693|424.15|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2693||||2693|2423.7|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2693||||2693|0|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2693||||2693|334.66|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2693||||2693|214.18|2504.49|209.89
61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2693||||2693|1346.5|2504.49|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3218||||3218|807.65|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3218||||3218|218.46|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3218||||3218|461.12|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3218||||3218|461.12|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3218||||3218|212.16|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3218||||3218|1612.22|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3218||||3218|1129.52|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3218||||3218|1383.74|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3218||||3218|1370.87|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3218||||3218|1609|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3218||||3218|2091.7|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3218||||3218|569.55|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3218||||3218|348.7|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3218||||3218|481.9|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3218||||3218|1383.74|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3218||||3218|2992.74|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3218||||3218|1930.8|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3218||||3218|233.38|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3218||||3218|551.1|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3218||||3218|445.37|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3218||||3218|289.14|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3218||||3218|218.46|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3218||||3218|321.27|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3218||||3218|479.28|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3218||||3218|233.38|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|Self-pay|Self-pay|3218||||3218|965.4|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3218||||3218|675.78|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3218||||3218|209.89|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3218||||3218|312.7|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3218||||3218|1543.03|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3218||||3218|424.15|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3218||||3218|2896.2|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3218||||3218|0|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3218||||3218|348.7|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3218||||3218|214.18|2992.74|209.89
61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3218||||3218|1609|2992.74|209.89
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3659||||3659|807.65|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3659||||3659|349.46|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3659||||3659|706.36|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3659||||3659|706.36|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3659||||3659|339.38|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3659||||3659|1833.16|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3659||||3659|1284.31|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3659||||3659|1573.37|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3659||||3659|1558.73|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3659||||3659|1829.5|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3659||||3659|2378.35|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3659||||3659|868.88|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3659||||3659|531.97|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|GEHA [1415]|GEHA [141500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3659||||3659|770.86|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3659||||3659|1573.37|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3659||||3659|3402.87|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3659||||3659|2195.4|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3659||||3659|373.32|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3659||||3659|922.36|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3659||||3659|682.23|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3659||||3659|462.52|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3659||||3659|349.46|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3659||||3659|513.91|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3659||||3659|734.17|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3659||||3659|373.32|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|Self-pay|Self-pay|3659||||3659|1097.7|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3659||||3659|768.39|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3659||||3659|335.75|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3659||||3659|500.2|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3659||||3659|1754.49|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3659||||3659|649.73|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3659||||3659|3293.1|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3659||||3659|0|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3659||||3659|531.97|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3659||||3659|342.61|3402.87|335.75
61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3659||||3659|1829.5|3402.87|335.75
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3350||||3350|807.65|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3350||||3350|218.46|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3350||||3350|461.12|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3350||||3350|461.12|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3350||||3350|212.16|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3350||||3350|1678.35|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3350||||3350|1175.85|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3350||||3350|1440.5|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3350||||3350|1427.1|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3350||||3350|1675|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3350||||3350|2177.5|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3350||||3350|602.81|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3350||||3350|369.06|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3350||||3350|481.9|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3350||||3350|1440.5|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3350||||3350|3115.5|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3350||||3350|2010|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3350||||3350|233.38|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3350||||3350|551.1|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3350||||3350|445.37|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3350||||3350|289.14|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3350||||3350|218.46|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3350||||3350|321.27|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3350||||3350|479.28|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3350||||3350|233.38|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|Self-pay|Self-pay|3350||||3350|1005|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3350||||3350|703.5|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3350||||3350|209.89|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3350||||3350|312.7|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3350||||3350|1606.33|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3350||||3350|424.15|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3350||||3350|3015|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3350||||3350|0|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3350||||3350|369.06|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3350||||3350|214.18|3115.5|209.89
61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3350||||3350|1675|3115.5|209.89
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3769||||3769|807.65|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3769||||3769|349.46|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3769||||3769|706.36|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3769||||3769|706.36|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3769||||3769|339.38|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3769||||3769|1888.27|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3769||||3769|1322.92|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3769||||3769|1620.67|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3769||||3769|1605.59|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3769||||3769|1884.5|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3769||||3769|2449.85|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3769||||3769|902.81|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3769||||3769|552.74|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3769||||3769|770.86|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3769||||3769|1620.67|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3769||||3769|3505.17|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3769||||3769|2261.4|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3769||||3769|373.32|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3769||||3769|922.36|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3769||||3769|682.23|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3769||||3769|462.52|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3769||||3769|349.46|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3769||||3769|513.91|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3769||||3769|734.17|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3769||||3769|373.32|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|Self-pay|Self-pay|3769||||3769|1130.7|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3769||||3769|791.49|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3769||||3769|335.75|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3769||||3769|500.2|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3769||||3769|1807.24|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3769||||3769|649.73|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3769||||3769|3392.1|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3769||||3769|0|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3769||||3769|552.74|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3769||||3769|342.61|3505.17|335.75
61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3769||||3769|1884.5|3505.17|335.75
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3386||||3386|807.65|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3386||||3386|349.46|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3386||||3386|706.36|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3386||||3386|706.36|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3386||||3386|339.38|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3386||||3386|1696.39|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3386||||3386|1188.49|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3386||||3386|1455.98|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3386||||3386|1442.44|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3386||||3386|1693|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3386||||3386|2200.9|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3386||||3386|868.81|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3386||||3386|531.92|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3386||||3386|770.86|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3386||||3386|1455.98|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3386||||3386|3148.98|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3386||||3386|2031.6|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3386||||3386|373.32|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3386||||3386|922.36|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3386||||3386|682.23|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3386||||3386|462.52|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3386||||3386|349.46|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3386||||3386|513.91|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3386||||3386|734.17|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3386||||3386|373.32|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|Self-pay|Self-pay|3386||||3386|1015.8|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3386||||3386|711.06|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3386||||3386|331.97|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3386||||3386|500.2|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3386||||3386|1623.59|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3386||||3386|649.73|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3386||||3386|3047.4|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3386||||3386|0|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3386||||3386|531.92|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3386||||3386|342.61|3148.98|331.97
61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3386||||3386|1693|3148.98|331.97
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2776||||2776|807.65|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2776||||2776|218.46|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2776||||2776|461.12|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2776||||2776|461.12|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2776||||2776|212.16|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2776||||2776|1390.78|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2776||||2776|974.38|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2776||||2776|1193.68|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2776||||2776|1182.58|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2776||||2776|1388|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2776||||2776|1804.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2776||||2776|568.37|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2776||||2776|347.98|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2776||||2776|481.9|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2776||||2776|1193.68|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2776||||2776|2581.68|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2776||||2776|1665.6|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2776||||2776|233.38|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2776||||2776|551.1|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2776||||2776|445.37|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2776||||2776|289.14|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2776||||2776|218.46|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2776||||2776|321.27|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2776||||2776|479.28|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2776||||2776|233.38|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|Self-pay|Self-pay|2776||||2776|832.8|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2776||||2776|582.96|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2776||||2776|209.89|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2776||||2776|312.7|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2776||||2776|1331.09|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2776||||2776|424.15|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2776||||2776|2498.4|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2776||||2776|0|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2776||||2776|347.98|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2776||||2776|214.18|2581.68|209.89
61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2776||||2776|1388|2581.68|209.89
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|AETNA [1015]|AETNA ACO WILCO [101532]|3745||||3745|807.65|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3745||||3745|349.46|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3745||||3745|706.36|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3745||||3745|706.36|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3745||||3745|339.38|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3745||||3745|1876.25|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3745||||3745|1314.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3745||||3745|1610.35|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3745||||3745|1595.37|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3745||||3745|1872.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3745||||3745|2434.25|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|CORESOURCE [1315]|CORESOURCE [131500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3745||||3745|783.97|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3745||||3745|479.98|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|GEHA [1415]|GEHA [141500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3745||||3745|770.86|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HEALTHNET [1495]|HEALTHNET [149500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3745||||3745|1610.35|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3745||||3745|3482.85|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3745||||3745|2247|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3745||||3745|373.32|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3745||||3745|922.36|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3745||||3745|682.23|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3745||||3745|462.52|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3745||||3745|349.46|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MULTIPLAN [1680]|HMA [168003]|3745||||3745|513.91|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MULTIPLAN [1680]|IHC HS [168011]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3745||||3745|734.17|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3745||||3745|373.32|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|Self-pay|Self-pay|3745||||3745|1123.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3745||||3745|786.45|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3745||||3745|335.75|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3745||||3745|500.2|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|TRUSTMARK [2030]|STARMARK [203000]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3745||||3745|1795.73|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|UMR [2035]|UMR OPTIONS [203501]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3745||||3745|649.73|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3745||||3745|3370.5|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3745||||3745|0|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3745||||3745|479.98|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3745||||3745|342.61|3482.85|335.75
61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3745||||3745|1872.5|3482.85|335.75
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3076||||3076|807.65|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3076||||3076|216|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3076||||3076|461.12|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3076||||3076|461.12|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3076||||3076|212.16|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3076||||3076|1541.08|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3076||||3076|1079.68|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3076||||3076|1322.68|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3076||||3076|1310.38|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3076||||3076|1538|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3076||||3076|1999.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3076||||3076|569.81|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3076||||3076|348.87|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3076||||3076|476.46|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3076||||3076|1322.68|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3076||||3076|2860.68|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3076||||3076|1845.6|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3076||||3076|214.18|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3076||||3076|233.38|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3076||||3076|551.1|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3076||||3076|445.37|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3076||||3076|289.14|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3076||||3076|218.46|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3076||||3076|317.64|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3076||||3076|479.28|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3076||||3076|233.38|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|Self-pay|Self-pay|3076||||3076|922.8|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3076||||3076|645.96|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3076||||3076|214.18|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3076||||3076|209.89|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3076||||3076|312.7|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3076||||3076|1474.94|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3076||||3076|424.15|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3076||||3076|2768.4|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3076||||3076|0|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3076||||3076|348.87|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3076||||3076|211.76|2860.68|209.89
61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3076||||3076|1538|2860.68|209.89
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3409||||3409|807.65|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3409||||3409|678.93|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3409||||3409|559.36|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3409||||3409|559.36|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3409||||3409|659.35|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3409||||3409|1707.91|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3409||||3409|1196.56|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3409||||3409|1465.87|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3409||||3409|1452.23|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3409||||3409|1704.5|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3409||||3409|2215.85|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3409||||3409|633.8|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3409||||3409|388.04|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3409||||3409|1497.63|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3409||||3409|1465.87|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3409||||3409|3170.37|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3409||||3409|2045.4|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3409||||3409|725.28|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3409||||3409|1653.46|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3409||||3409|540.25|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3409||||3409|898.58|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3409||||3409|678.93|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3409||||3409|998.42|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3409||||3409|581.38|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3409||||3409|725.28|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|Self-pay|Self-pay|3409||||3409|1022.7|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3409||||3409|715.89|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3409||||3409|652.3|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3409||||3409|971.8|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3409||||3409|1634.62|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3409||||3409|514.51|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3409||||3409|3068.1|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3409||||3409|0|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3409||||3409|388.04|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3409||||3409|665.61|3170.37|388.04
61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3409||||3409|1704.5|3170.37|388.04
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3647||||3647|807.65|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3647||||3647|349.46|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3647||||3647|706.36|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3647||||3647|706.36|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3647||||3647|339.38|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3647||||3647|1827.15|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3647||||3647|1280.1|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3647||||3647|1568.21|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3647||||3647|1553.62|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3647||||3647|1823.5|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3647||||3647|2370.55|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3647||||3647|853.37|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3647||||3647|522.47|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3647||||3647|770.86|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3647||||3647|1568.21|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3647||||3647|3391.71|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3647||||3647|2188.2|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3647||||3647|373.32|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3647||||3647|922.36|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3647||||3647|682.23|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3647||||3647|462.52|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3647||||3647|349.46|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3647||||3647|513.91|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3647||||3647|734.17|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3647||||3647|373.32|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|Self-pay|Self-pay|3647||||3647|1094.1|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3647||||3647|765.87|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3647||||3647|335.75|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3647||||3647|500.2|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3647||||3647|1748.74|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3647||||3647|649.73|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3647||||3647|3282.3|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3647||||3647|0|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3647||||3647|522.47|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3647||||3647|342.61|3391.71|335.75
61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3647||||3647|1823.5|3391.71|335.75
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3097||||3097|807.65|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3097||||3097|218.46|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3097||||3097|461.12|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3097||||3097|461.12|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3097||||3097|212.16|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3097||||3097|1551.6|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3097||||3097|1087.05|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3097||||3097|1331.71|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3097||||3097|1319.32|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3097||||3097|1548.5|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3097||||3097|2013.05|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3097||||3097|563.65|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3097||||3097|345.09|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3097||||3097|481.9|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3097||||3097|1331.71|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3097||||3097|2880.21|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3097||||3097|1858.2|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3097||||3097|233.38|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3097||||3097|551.1|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3097||||3097|445.37|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3097||||3097|289.14|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3097||||3097|216|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3097||||3097|321.27|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3097||||3097|479.28|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3097||||3097|233.38|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|Self-pay|Self-pay|3097||||3097|929.1|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3097||||3097|650.37|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3097||||3097|209.89|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3097||||3097|312.7|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3097||||3097|1485.01|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3097||||3097|424.15|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3097||||3097|2787.3|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3097||||3097|0|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3097||||3097|345.09|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3097||||3097|214.18|2880.21|209.89
61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3097||||3097|1548.5|2880.21|209.89
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3477||||3477|807.65|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3477||||3477|349.46|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3477||||3477|706.36|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3477||||3477|706.36|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3477||||3477|339.38|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3477||||3477|1741.98|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3477||||3477|1220.43|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3477||||3477|1495.11|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3477||||3477|1481.2|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3477||||3477|1738.5|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3477||||3477|2260.05|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3477||||3477|784.92|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3477||||3477|480.56|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3477||||3477|770.86|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3477||||3477|1495.11|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3477||||3477|3233.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3477||||3477|2086.2|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3477||||3477|373.32|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3477||||3477|922.36|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3477||||3477|682.23|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3477||||3477|462.52|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3477||||3477|349.46|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3477||||3477|513.91|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3477||||3477|734.17|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3477||||3477|373.32|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|Self-pay|Self-pay|3477||||3477|1043.1|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3477||||3477|730.17|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3477||||3477|335.75|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3477||||3477|500.2|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3477||||3477|1667.22|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3477||||3477|649.73|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3477||||3477|3129.3|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3477||||3477|0|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3477||||3477|480.56|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3477||||3477|342.61|3233.61|335.75
61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3477||||3477|1738.5|3233.61|335.75
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3198||||3198|807.65|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3198||||3198|218.46|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3198||||3198|461.12|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3198||||3198|461.12|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3198||||3198|212.16|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3198||||3198|1602.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3198||||3198|1122.5|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3198||||3198|1375.14|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3198||||3198|1362.35|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3198||||3198|1599|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3198||||3198|2078.7|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3198||||3198|559.13|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3198||||3198|342.32|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3198||||3198|476.46|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3198||||3198|1375.14|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3198||||3198|2974.14|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3198||||3198|1918.8|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3198||||3198|214.18|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3198||||3198|233.38|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3198||||3198|551.1|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3198||||3198|445.37|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3198||||3198|289.14|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3198||||3198|216|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3198||||3198|317.64|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3198||||3198|479.28|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3198||||3198|233.38|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|Self-pay|Self-pay|3198||||3198|959.4|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3198||||3198|671.58|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3198||||3198|209.89|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3198||||3198|312.7|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3198||||3198|1533.44|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3198||||3198|424.15|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3198||||3198|2878.2|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3198||||3198|0|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3198||||3198|342.32|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3198||||3198|211.76|2974.14|209.89
61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3198||||3198|1599|2974.14|209.89
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3546||||3546|807.65|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3546||||3546|671.27|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3546||||3546|559.36|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3546||||3546|559.36|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3546||||3546|659.35|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3546||||3546|1776.55|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3546||||3546|1244.65|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3546||||3546|1524.78|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3546||||3546|1510.6|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3546||||3546|1773|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3546||||3546|2304.9|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3546||||3546|634.92|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3546||||3546|388.73|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|GEHA [1415]|GEHA [141500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3546||||3546|1480.74|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3546||||3546|1524.78|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3546||||3546|3297.78|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3546||||3546|2127.6|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3546||||3546|725.28|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3546||||3546|1653.46|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3546||||3546|540.25|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3546||||3546|898.58|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3546||||3546|671.27|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3546||||3546|987.16|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3546||||3546|581.38|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3546||||3546|725.28|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|Self-pay|Self-pay|3546||||3546|1063.8|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3546||||3546|744.66|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3546||||3546|652.3|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3546||||3546|971.8|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3546||||3546|1700.31|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3546||||3546|514.51|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3546||||3546|3191.4|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3546||||3546|0|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3546||||3546|388.73|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3546||||3546|658.1|3297.78|388.73
61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3546||||3546|1773|3297.78|388.73
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3708||||3708|807.65|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3708||||3708|349.46|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3708||||3708|706.36|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3708||||3708|706.36|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3708||||3708|339.38|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3708||||3708|1857.71|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3708||||3708|1301.51|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3708||||3708|1594.44|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3708||||3708|1579.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3708||||3708|1854|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3708||||3708|2410.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3708||||3708|834.6|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3708||||3708|510.98|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3708||||3708|770.86|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3708||||3708|1594.44|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3708||||3708|3448.44|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3708||||3708|2224.8|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3708||||3708|373.32|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3708||||3708|922.36|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3708||||3708|682.23|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3708||||3708|462.52|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3708||||3708|349.46|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3708||||3708|513.91|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3708||||3708|734.17|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3708||||3708|373.32|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|Self-pay|Self-pay|3708||||3708|1112.4|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3708||||3708|778.68|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3708||||3708|331.97|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3708||||3708|500.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3708||||3708|1777.99|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3708||||3708|649.73|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3708||||3708|3337.2|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3708||||3708|0|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3708||||3708|510.98|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3708||||3708|342.61|3448.44|331.97
61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3708||||3708|1854|3448.44|331.97
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3165||||3165|807.65|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3165||||3165|218.46|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3165||||3165|461.12|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3165||||3165|461.12|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3165||||3165|212.16|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3165||||3165|1585.67|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3165||||3165|1110.92|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3165||||3165|1360.95|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3165||||3165|1348.29|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3165||||3165|1582.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3165||||3165|2057.25|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3165||||3165|550.28|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3165||||3165|336.91|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3165||||3165|481.9|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3165||||3165|1360.95|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3165||||3165|2943.45|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3165||||3165|1899|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3165||||3165|233.38|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3165||||3165|551.1|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3165||||3165|445.37|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3165||||3165|289.14|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3165||||3165|218.46|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3165||||3165|321.27|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3165||||3165|479.28|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3165||||3165|233.38|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|Self-pay|Self-pay|3165||||3165|949.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3165||||3165|664.65|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3165||||3165|209.89|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3165||||3165|312.7|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3165||||3165|1517.62|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3165||||3165|424.15|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3165||||3165|2848.5|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3165||||3165|0|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3165||||3165|336.91|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3165||||3165|214.18|2943.45|209.89
61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3165||||3165|1582.5|2943.45|209.89
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3386||||3386|807.65|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3386||||3386|349.46|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3386||||3386|706.36|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3386||||3386|706.36|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3386||||3386|339.38|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3386||||3386|1696.39|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3386||||3386|1188.49|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3386||||3386|1455.98|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3386||||3386|1442.44|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3386||||3386|1693|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3386||||3386|2200.9|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3386||||3386|869.28|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3386||||3386|532.21|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3386||||3386|762.16|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3386||||3386|1455.98|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3386||||3386|3148.98|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3386||||3386|2031.6|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3386||||3386|342.61|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3386||||3386|373.32|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3386||||3386|922.36|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3386||||3386|682.23|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3386||||3386|462.52|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3386||||3386|345.51|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3386||||3386|508.11|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3386||||3386|734.17|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3386||||3386|373.32|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|Self-pay|Self-pay|3386||||3386|1015.8|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3386||||3386|711.06|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3386||||3386|342.61|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3386||||3386|331.97|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3386||||3386|500.2|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3386||||3386|1623.59|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3386||||3386|649.73|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3386||||3386|3047.4|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3386||||3386|0|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3386||||3386|532.21|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3386||||3386|338.74|3148.98|331.97
61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3386||||3386|1693|3148.98|331.97
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101001|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101002|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101003|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101004|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101007|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101008|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101009|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101010|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101011|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101012|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101013|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101014|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101015|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101016|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101017|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101018|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101019|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101020|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101021|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101022|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61101023|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2646||||2646|214.18|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2646||||2646|807.65|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2646||||2646|216|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2646||||2646|461.12|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2646||||2646|461.12|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2646||||2646|212.16|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2646||||2646|1325.65|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2646||||2646|928.75|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2646||||2646|1137.78|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2646||||2646|1127.2|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2646||||2646|1323|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2646||||2646|1719.9|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2646||||2646|575.63|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2646||||2646|352.43|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2646||||2646|481.9|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2646||||2646|1137.78|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2646||||2646|2460.78|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2646||||2646|1587.6|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2646||||2646|214.18|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2646||||2646|233.38|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2646||||2646|551.1|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2646||||2646|445.37|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2646||||2646|289.14|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2646||||2646|218.46|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2646||||2646|321.27|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2646||||2646|479.28|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2646||||2646|233.38|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|Self-pay|Self-pay|2646||||2646|793.8|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2646||||2646|555.66|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2646||||2646|214.18|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2646||||2646|209.89|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2646||||2646|312.7|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2646||||2646|1268.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2646||||2646|424.15|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2646||||2646|2381.4|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2646||||2646|0|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2646||||2646|352.43|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2646||||2646|211.76|2460.78|209.89
61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2646||||2646|1323|2460.78|209.89
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4325||||4325|807.65|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4325||||4325|349.46|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4325||||4325|559.36|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4325||||4325|559.36|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4325||||4325|339.38|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4325||||4325|2166.83|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4325||||4325|1518.08|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4325||||4325|1859.75|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4325||||4325|1842.45|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4325||||4325|2162.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4325||||4325|2811.25|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4325||||4325|658.12|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4325||||4325|402.93|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|GEHA [1415]|GEHA [141500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4325||||4325|770.86|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4325||||4325|1859.75|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4325||||4325|4022.25|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4325||||4325|2595|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4325||||4325|373.32|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4325||||4325|922.36|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4325||||4325|540.25|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4325||||4325|462.52|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4325||||4325|349.46|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4325||||4325|513.91|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4325||||4325|581.38|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4325||||4325|373.32|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|Self-pay|Self-pay|4325||||4325|1297.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4325||||4325|908.25|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4325||||4325|335.75|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4325||||4325|500.2|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4325||||4325|2073.84|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4325||||4325|514.51|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4325||||4325|3892.5|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4325||||4325|0|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4325||||4325|402.93|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4325||||4325|342.61|4022.25|335.75
61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4325||||4325|2162.5|4022.25|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|5300||||5300|807.65|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5300||||5300|349.46|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5300||||5300|706.36|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5300||||5300|706.36|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5300||||5300|339.38|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5300||||5300|2655.3|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5300||||5300|1860.3|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5300||||5300|2279|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5300||||5300|2257.8|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5300||||5300|2650|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5300||||5300|3445|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5300||||5300|816|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5300||||5300|499.59|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5300||||5300|770.86|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5300||||5300|2279|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5300||||5300|4929|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5300||||5300|3180|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5300||||5300|373.32|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5300||||5300|922.36|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5300||||5300|682.23|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5300||||5300|462.52|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5300||||5300|349.46|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|5300||||5300|513.91|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5300||||5300|734.17|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5300||||5300|373.32|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|Self-pay|Self-pay|5300||||5300|1590|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5300||||5300|1113|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5300||||5300|335.75|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5300||||5300|500.2|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5300||||5300|2541.35|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5300||||5300|649.73|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5300||||5300|4770|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5300||||5300|0|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5300||||5300|499.59|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5300||||5300|342.61|4929|335.75
61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5300||||5300|2650|4929|335.75
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201001|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201002|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201003|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201004|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201007|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201008|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201009|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201010|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201011|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201012|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201013|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201014|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201015|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201016|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201017|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201018|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201019|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201020|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201021|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201022|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61201023|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3200||||3200|807.65|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3200||||3200|218.46|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3200||||3200|461.12|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3200||||3200|461.12|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3200||||3200|212.16|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3200||||3200|1603.2|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3200||||3200|1123.2|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3200||||3200|1376|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3200||||3200|1363.2|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3200||||3200|1600|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3200||||3200|2080|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3200||||3200|572.49|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3200||||3200|350.51|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3200||||3200|481.9|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3200||||3200|1376|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3200||||3200|2976|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3200||||3200|1920|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3200||||3200|233.38|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3200||||3200|551.1|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3200||||3200|445.37|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3200||||3200|289.14|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3200||||3200|218.46|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3200||||3200|321.27|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3200||||3200|479.28|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3200||||3200|233.38|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|Self-pay|Self-pay|3200||||3200|960|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3200||||3200|672|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3200||||3200|209.89|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3200||||3200|312.7|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3200||||3200|1534.4|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3200||||3200|424.15|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3200||||3200|2880|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3200||||3200|0|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3200||||3200|350.51|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3200||||3200|214.18|2976|209.89
61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3200||||3200|1600|2976|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3358||||3358|807.65|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3358||||3358|218.46|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3358||||3358|461.12|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3358||||3358|461.12|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3358||||3358|212.16|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3358||||3358|1682.36|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3358||||3358|1178.66|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3358||||3358|1443.94|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3358||||3358|1430.51|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3358||||3358|1679|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3358||||3358|2182.7|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3358||||3358|572.24|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3358||||3358|350.35|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3358||||3358|481.9|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3358||||3358|1443.94|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3358||||3358|3122.94|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3358||||3358|2014.8|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3358||||3358|233.38|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3358||||3358|551.1|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3358||||3358|445.37|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3358||||3358|289.14|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3358||||3358|218.46|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3358||||3358|321.27|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3358||||3358|479.28|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3358||||3358|233.38|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|Self-pay|Self-pay|3358||||3358|1007.4|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3358||||3358|705.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3358||||3358|209.89|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3358||||3358|312.7|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3358||||3358|1610.16|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3358||||3358|424.15|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3358||||3358|3022.2|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3358||||3358|0|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3358||||3358|350.35|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3358||||3358|214.18|3122.94|209.89
61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3358||||3358|1679|3122.94|209.89
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|4514||||4514|807.65|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4514||||4514|349.46|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4514||||4514|559.36|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4514||||4514|559.36|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4514||||4514|339.38|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4514||||4514|2261.51|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4514||||4514|1584.41|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4514||||4514|1941.02|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4514||||4514|1922.96|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4514||||4514|2257|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4514||||4514|2934.1|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4514||||4514|654.93|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4514||||4514|400.98|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|GEHA [1415]|GEHA [141500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4514||||4514|770.86|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4514||||4514|1941.02|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4514||||4514|4198.02|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4514||||4514|2708.4|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4514||||4514|373.32|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4514||||4514|922.36|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4514||||4514|540.25|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4514||||4514|462.52|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4514||||4514|349.46|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|4514||||4514|513.91|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4514||||4514|581.38|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4514||||4514|373.32|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|Self-pay|Self-pay|4514||||4514|1354.2|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4514||||4514|947.94|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4514||||4514|335.75|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4514||||4514|500.2|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4514||||4514|2164.46|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4514||||4514|514.51|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4514||||4514|4062.6|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4514||||4514|0|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4514||||4514|400.98|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4514||||4514|342.61|4198.02|335.75
61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4514||||4514|2257|4198.02|335.75
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3481||||3481|807.65|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3481||||3481|218.46|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3481||||3481|461.12|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3481||||3481|461.12|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3481||||3481|212.16|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3481||||3481|1743.98|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3481||||3481|1221.83|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3481||||3481|1496.83|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3481||||3481|1482.91|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3481||||3481|1740.5|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3481||||3481|2262.65|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3481||||3481|568.04|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3481||||3481|347.78|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3481||||3481|481.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3481||||3481|1496.83|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3481||||3481|3237.33|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3481||||3481|2088.6|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3481||||3481|233.38|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3481||||3481|551.1|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3481||||3481|445.37|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3481||||3481|289.14|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3481||||3481|216|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3481||||3481|321.27|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3481||||3481|479.28|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3481||||3481|233.38|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|Self-pay|Self-pay|3481||||3481|1044.3|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3481||||3481|731.01|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3481||||3481|209.89|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3481||||3481|312.7|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3481||||3481|1669.14|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3481||||3481|424.15|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3481||||3481|3132.9|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3481||||3481|0|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3481||||3481|347.78|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3481||||3481|214.18|3237.33|209.89
61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3481||||3481|1740.5|3237.33|209.89
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3933||||3933|807.65|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3933||||3933|349.46|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3933||||3933|559.36|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3933||||3933|559.36|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3933||||3933|339.38|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3933||||3933|1970.43|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3933||||3933|1380.48|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3933||||3933|1691.19|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3933||||3933|1675.46|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3933||||3933|1966.5|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3933||||3933|2556.45|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3933||||3933|654.93|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3933||||3933|400.98|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|GEHA [1415]|GEHA [141500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3933||||3933|770.86|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3933||||3933|1691.19|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3933||||3933|3657.69|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3933||||3933|2359.8|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3933||||3933|373.32|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3933||||3933|922.36|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3933||||3933|540.25|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3933||||3933|462.52|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3933||||3933|349.46|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3933||||3933|513.91|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3933||||3933|581.38|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3933||||3933|373.32|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|Self-pay|Self-pay|3933||||3933|1179.9|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3933||||3933|825.93|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3933||||3933|335.75|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3933||||3933|500.2|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3933||||3933|1885.87|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3933||||3933|514.51|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3933||||3933|3539.7|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3933||||3933|0|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3933||||3933|400.98|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3933||||3933|342.61|3657.69|335.75
61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3933||||3933|1966.5|3657.69|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|5245||||5245|807.65|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5245||||5245|349.46|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5245||||5245|706.36|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5245||||5245|706.36|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5245||||5245|339.38|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5245||||5245|2627.75|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5245||||5245|1841|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5245||||5245|2255.35|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5245||||5245|2234.37|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5245||||5245|2622.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5245||||5245|3409.25|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5245||||5245|817.93|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5245||||5245|500.77|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5245||||5245|770.86|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5245||||5245|2255.35|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5245||||5245|4877.85|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5245||||5245|3147|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5245||||5245|373.32|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5245||||5245|922.36|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5245||||5245|682.23|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5245||||5245|462.52|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5245||||5245|345.51|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|5245||||5245|513.91|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5245||||5245|734.17|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5245||||5245|373.32|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|Self-pay|Self-pay|5245||||5245|1573.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5245||||5245|1101.45|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5245||||5245|335.75|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5245||||5245|500.2|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5245||||5245|2514.98|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5245||||5245|649.73|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5245||||5245|4720.5|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5245||||5245|0|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5245||||5245|500.77|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5245||||5245|342.61|4877.85|335.75
61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5245||||5245|2622.5|4877.85|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|5375||||5375|807.65|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5375||||5375|349.46|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5375||||5375|706.36|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5375||||5375|706.36|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5375||||5375|339.38|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5375||||5375|2692.88|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5375||||5375|1886.63|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5375||||5375|2311.25|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5375||||5375|2289.75|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5375||||5375|2687.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5375||||5375|3493.75|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5375||||5375|798.71|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5375||||5375|489.01|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5375||||5375|770.86|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5375||||5375|2311.25|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5375||||5375|4998.75|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5375||||5375|3225|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5375||||5375|373.32|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5375||||5375|922.36|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5375||||5375|682.23|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5375||||5375|462.52|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5375||||5375|349.46|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|5375||||5375|513.91|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5375||||5375|734.17|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5375||||5375|373.32|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|Self-pay|Self-pay|5375||||5375|1612.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5375||||5375|1128.75|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5375||||5375|335.75|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5375||||5375|500.2|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5375||||5375|2577.31|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5375||||5375|649.73|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5375||||5375|4837.5|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5375||||5375|0|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5375||||5375|489.01|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5375||||5375|342.61|4998.75|335.75
61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5375||||5375|2687.5|4998.75|335.75
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|5290||||5290|807.65|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5290||||5290|349.46|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5290||||5290|706.36|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5290||||5290|706.36|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5290||||5290|339.38|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5290||||5290|2650.29|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5290||||5290|1856.79|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5290||||5290|2274.7|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5290||||5290|2253.54|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5290||||5290|2645|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5290||||5290|3438.5|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5290||||5290|810.36|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5290||||5290|496.14|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5290||||5290|770.86|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5290||||5290|2274.7|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5290||||5290|4919.7|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5290||||5290|3174|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5290||||5290|373.32|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5290||||5290|922.36|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5290||||5290|682.23|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5290||||5290|462.52|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5290||||5290|345.51|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|5290||||5290|513.91|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5290||||5290|734.17|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5290||||5290|373.32|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|Self-pay|Self-pay|5290||||5290|1587|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5290||||5290|1110.9|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5290||||5290|331.97|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5290||||5290|500.2|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5290||||5290|2536.56|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5290||||5290|649.73|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5290||||5290|4761|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5290||||5290|0|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5290||||5290|496.14|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5290||||5290|342.61|4919.7|331.97
61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5290||||5290|2645|4919.7|331.97
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3140||||3140|807.65|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3140||||3140|218.46|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3140||||3140|461.12|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3140||||3140|461.12|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3140||||3140|212.16|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3140||||3140|1573.14|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3140||||3140|1102.14|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3140||||3140|1350.2|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3140||||3140|1337.64|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3140||||3140|1570|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3140||||3140|2041|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3140||||3140|569.75|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3140||||3140|348.83|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3140||||3140|481.9|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3140||||3140|1350.2|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3140||||3140|2920.2|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3140||||3140|1884|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3140||||3140|233.38|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3140||||3140|551.1|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3140||||3140|445.37|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3140||||3140|289.14|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3140||||3140|218.46|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3140||||3140|321.27|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3140||||3140|479.28|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3140||||3140|233.38|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|Self-pay|Self-pay|3140||||3140|942|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3140||||3140|659.4|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3140||||3140|209.89|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3140||||3140|312.7|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3140||||3140|1505.63|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3140||||3140|424.15|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3140||||3140|2826|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3140||||3140|0|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3140||||3140|348.83|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3140||||3140|214.18|2920.2|209.89
61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3140||||3140|1570|2920.2|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2380||||2380|807.65|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2380||||2380|218.46|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2380||||2380|461.12|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2380||||2380|461.12|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2380||||2380|212.16|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2380||||2380|1192.38|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2380||||2380|835.38|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2380||||2380|1023.4|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2380||||2380|1013.88|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2380||||2380|1190|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2380||||2380|1547|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2380||||2380|585.08|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2380||||2380|358.21|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2380||||2380|481.9|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2380||||2380|1023.4|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2380||||2380|2213.4|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2380||||2380|1428|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2380||||2380|233.38|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2380||||2380|551.1|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2380||||2380|445.37|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2380||||2380|289.14|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2380||||2380|218.46|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2380||||2380|321.27|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2380||||2380|479.28|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2380||||2380|233.38|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|Self-pay|Self-pay|2380||||2380|714|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2380||||2380|499.8|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2380||||2380|209.89|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2380||||2380|312.7|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2380||||2380|1141.21|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2380||||2380|424.15|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2380||||2380|2142|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2380||||2380|0|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2380||||2380|358.21|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2380||||2380|214.18|2213.4|209.89
61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2380||||2380|1190|2213.4|209.89
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3276||||3276|807.65|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3276||||3276|349.46|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3276||||3276|706.36|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3276||||3276|706.36|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3276||||3276|339.38|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3276||||3276|1641.28|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3276||||3276|1149.88|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3276||||3276|1408.68|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3276||||3276|1395.58|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3276||||3276|1638|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3276||||3276|2129.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3276||||3276|951.78|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3276||||3276|582.72|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3276||||3276|770.86|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3276||||3276|1408.68|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3276||||3276|3046.68|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3276||||3276|1965.6|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3276||||3276|373.32|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3276||||3276|922.36|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3276||||3276|682.23|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3276||||3276|462.52|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3276||||3276|349.46|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3276||||3276|513.91|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3276||||3276|734.17|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3276||||3276|373.32|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|Self-pay|Self-pay|3276||||3276|982.8|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3276||||3276|687.96|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3276||||3276|335.75|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3276||||3276|500.2|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3276||||3276|1570.84|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3276||||3276|649.73|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3276||||3276|2948.4|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3276||||3276|0|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3276||||3276|582.72|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3276||||3276|342.61|3046.68|335.75
61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3276||||3276|1638|3046.68|335.75
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2343||||2343|807.65|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2343||||2343|218.46|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2343||||2343|461.12|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2343||||2343|461.12|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2343||||2343|212.16|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2343||||2343|1173.84|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2343||||2343|822.39|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2343||||2343|1007.49|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2343||||2343|998.12|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2343||||2343|1171.5|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2343||||2343|1522.95|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2343||||2343|574.46|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2343||||2343|351.71|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2343||||2343|481.9|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2343||||2343|1007.49|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2343||||2343|2178.99|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2343||||2343|1405.8|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2343||||2343|233.38|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2343||||2343|551.1|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2343||||2343|445.37|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2343||||2343|289.14|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2343||||2343|218.46|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2343||||2343|321.27|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2343||||2343|479.28|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2343||||2343|233.38|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|Self-pay|Self-pay|2343||||2343|702.9|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2343||||2343|492.03|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2343||||2343|209.89|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2343||||2343|312.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2343||||2343|1123.47|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2343||||2343|424.15|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2343||||2343|2108.7|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2343||||2343|0|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2343||||2343|351.71|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2343||||2343|214.18|2178.99|209.89
61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2343||||2343|1171.5|2178.99|209.89
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|2836||||2836|807.65|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2836||||2836|349.46|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2836||||2836|559.36|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2836||||2836|559.36|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2836||||2836|339.38|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2836||||2836|1420.84|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2836||||2836|995.44|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2836||||2836|1219.48|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2836||||2836|1208.14|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2836||||2836|1418|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2836||||2836|1843.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2836||||2836|640.44|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2836||||2836|392.1|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|GEHA [1415]|GEHA [141500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2836||||2836|770.86|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2836||||2836|1219.48|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2836||||2836|2637.48|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2836||||2836|1701.6|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2836||||2836|373.32|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2836||||2836|922.36|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2836||||2836|540.25|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2836||||2836|462.52|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2836||||2836|349.46|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|2836||||2836|513.91|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2836||||2836|581.38|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2836||||2836|373.32|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|Self-pay|Self-pay|2836||||2836|850.8|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2836||||2836|595.56|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2836||||2836|335.75|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2836||||2836|500.2|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2836||||2836|1359.86|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2836||||2836|514.51|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2836||||2836|2552.4|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2836||||2836|0|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2836||||2836|392.1|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2836||||2836|342.61|2637.48|335.75
61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2836||||2836|1418|2637.48|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|AETNA [1015]|AETNA ACO WILCO [101532]|3599||||3599|807.65|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3599||||3599|349.46|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3599||||3599|706.36|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3599||||3599|706.36|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3599||||3599|339.38|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3599||||3599|1803.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3599||||3599|1263.25|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3599||||3599|1547.57|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3599||||3599|1533.17|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3599||||3599|1799.5|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3599||||3599|2339.35|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|CORESOURCE [1315]|CORESOURCE [131500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3599||||3599|888.39|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3599||||3599|543.91|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|GEHA [1415]|GEHA [141500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3599||||3599|770.86|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HEALTHNET [1495]|HEALTHNET [149500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3599||||3599|1547.57|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3599||||3599|3347.07|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3599||||3599|2159.4|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3599||||3599|373.32|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3599||||3599|922.36|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3599||||3599|682.23|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3599||||3599|462.52|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3599||||3599|349.46|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MULTIPLAN [1680]|HMA [168003]|3599||||3599|513.91|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MULTIPLAN [1680]|IHC HS [168011]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3599||||3599|734.17|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3599||||3599|373.32|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|Self-pay|Self-pay|3599||||3599|1079.7|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3599||||3599|755.79|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3599||||3599|335.75|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3599||||3599|500.2|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|TRUSTMARK [2030]|STARMARK [203000]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3599||||3599|1725.72|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|UMR [2035]|UMR OPTIONS [203501]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3599||||3599|649.73|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3599||||3599|3239.1|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3599||||3599|0|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3599||||3599|543.91|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3599||||3599|342.61|3347.07|335.75
61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3599||||3599|1799.5|3347.07|335.75
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01|0.01|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|Self-pay|Self-pay|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.01||||0.01|0|0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0.01||||0.01||0.01|0.01
61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0.01||||0.01|0.01|0.01|0.01
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|147.87||||147.87|74.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147.87||||147.87|51.9|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147.87||||147.87|63.58|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|147.87||||147.87|62.99|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|147.87||||147.87|73.94|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147.87||||147.87|96.12|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|147.87||||147.87|54.71|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147.87||||147.87|63.58|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|147.87||||147.87|137.52|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147.87||||147.87|88.72|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|Self-pay|Self-pay|147.87||||147.87|44.36|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147.87||||147.87|31.05|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147.87||||147.87|70.9|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147.87||||147.87|133.08|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|147.87||||147.87|0|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|147.87||||147.87|54.71|137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|147.87||||147.87||137.52|31.05
6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|147.87||||147.87|73.94|137.52|31.05
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.02|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.01|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.01
6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.01
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.35|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.21|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.21
6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.21
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.09|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.05|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.05
6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.05
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.88|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10|3.5|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10|0.53|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.53
6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.53
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|304.66||||304.66|152.63|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|304.66||||304.66|106.94|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|304.66||||304.66|131|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|304.66||||304.66|129.79|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|304.66||||304.66|152.33|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|304.66||||304.66|198.03|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|304.66||||304.66|75.76|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|304.66||||304.66|112.72|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|304.66||||304.66|131|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|304.66||||304.66|283.33|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|304.66||||304.66|182.8|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|304.66||||304.66|106.63|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|Self-pay|Self-pay|304.66||||304.66|91.4|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|304.66||||304.66|63.98|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|304.66||||304.66|76.03|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|304.66||||304.66|146.08|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|304.66||||304.66|274.19|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|304.66||||304.66|0|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|304.66||||304.66|112.72|283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|304.66||||304.66||283.33|63.98
6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|304.66||||304.66|152.33|283.33|63.98
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74.7||||74.7|37.42|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.7||||74.7|26.22|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.7||||74.7|32.12|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74.7||||74.7|31.82|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74.7||||74.7|37.35|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.7||||74.7|48.56|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|74.7||||74.7|9.86|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74.7||||74.7|27.64|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|GEHA [1415]|GEHA [141500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.7||||74.7|32.12|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|74.7||||74.7|69.47|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.7||||74.7|44.82|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|HMA [168003]|74.7||||74.7|26.15|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|Self-pay|Self-pay|74.7||||74.7|22.41|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.7||||74.7|15.69|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.7||||74.7|5.41|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.7||||74.7|35.82|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|UMR [2035]|UMR OPTIONS [203501]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.7||||74.7|67.23|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74.7||||74.7|0|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74.7||||74.7|27.64|69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74.7||||74.7||69.47|5.41
6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74.7||||74.7|37.35|69.47|5.41
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0.03|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|5|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|0.03
6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|0.03
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76.51||||76.51|38.33|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76.51||||76.51|26.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76.51||||76.51|32.9|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76.51||||76.51|32.59|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76.51||||76.51|38.26|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76.51||||76.51|49.73|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76.51||||76.51|28.31|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76.51||||76.51|32.9|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|76.51||||76.51|71.15|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.51||||76.51|45.91|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|Self-pay|Self-pay|76.51||||76.51|22.95|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76.51||||76.51|16.07|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76.51||||76.51|36.69|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76.51||||76.51|68.86|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76.51||||76.51|0|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76.51||||76.51|28.31|71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76.51||||76.51||71.15|16.07
70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76.51||||76.51|38.26|71.15|16.07
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30.1||||30.1|15.08|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.1||||30.1|10.57|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.1||||30.1|12.94|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30.1||||30.1|12.82|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30.1||||30.1|15.05|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.1||||30.1|19.57|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30.1||||30.1|11.14|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|GEHA [1415]|GEHA [141500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.1||||30.1|12.94|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|30.1||||30.1|27.99|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.1||||30.1|18.06|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|Self-pay|Self-pay|30.1||||30.1|9.03|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.1||||30.1|6.32|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.1||||30.1|14.43|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.1||||30.1|27.09|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30.1||||30.1|0|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30.1||||30.1|11.14|27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30.1||||30.1||27.99|6.32
70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30.1||||30.1|15.05|27.99|6.32
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|AETNA [1015]|AETNA ACO WILCO [101532]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48.35||||48.35|24.22|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.35||||48.35|16.97|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.35||||48.35|20.79|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48.35||||48.35|20.6|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48.35||||48.35|24.18|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.35||||48.35|31.43|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|CORESOURCE [1315]|CORESOURCE [131500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|CORVEL CORP [2235]|CORVEL CORP [223500]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48.35||||48.35|17.89|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|GEHA [1415]|GEHA [141500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HEALTHNET [1495]|HEALTHNET [149500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.35||||48.35|20.79|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HEALTHSMART [1505]|HEALTHSMART [150501]|48.35||||48.35|44.97|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.35||||48.35|29.01|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MULTIPLAN [1680]|HMA [168003]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MULTIPLAN [1680]|IHC HS [168011]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|Self-pay|Self-pay|48.35||||48.35|14.5|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.35||||48.35|10.15|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|TRUSTMARK [2030]|STARMARK [203000]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.35||||48.35|23.18|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|UMR [2035]|UMR OPTIONS [203501]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.35||||48.35|43.52|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48.35||||48.35|0|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48.35||||48.35|17.89|44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48.35||||48.35||44.97|10.15
70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|16 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48.35||||48.35|24.18|44.97|10.15
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|482||||482|0|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|482||||482|52.84|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|482||||482|103.48|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|482||||482|103.48|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|482||||482|51.31|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|482||||482|241.48|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|482||||482|169.18|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|482||||482|207.26|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|482||||482|205.33|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|482||||482|241|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|482||||482|313.3|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|482||||482|0|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|482||||482|178.34|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|GEHA [1415]|GEHA [141500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|482||||482|116.55|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|482||||482|207.26|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|482||||482|448.26|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|482||||482|289.2|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|482||||482|56.44|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|482||||482|133.61|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|482||||482|99.95|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|482||||482|69.93|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|482||||482|52.84|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MULTIPLAN [1680]|HMA [168003]|482||||482|77.7|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|482||||482|107.55|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|482||||482|56.44|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|Self-pay|Self-pay|482||||482|144.6|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|482||||482|101.22|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|482||||482|50.76|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|482||||482|75.63|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|482||||482|231.12|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|UMR [2035]|UMR OPTIONS [203501]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|482||||482|95.19|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|482||||482|433.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|482||||482|0|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|482||||482|178.34|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|482||||482|51.8|448.26|50.76
73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|482||||482|241|448.26|50.76
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|2.47|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.69|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|2.47
7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|2.47
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|127.95||||127.95|64.1|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.95||||127.95|44.91|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.95||||127.95|55.02|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|127.95||||127.95|54.51|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|127.95||||127.95|63.98|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.95||||127.95|83.17|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|127.95||||127.95|47.34|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|GEHA [1415]|GEHA [141500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.95||||127.95|55.02|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|127.95||||127.95|118.99|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.95||||127.95|76.77|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MULTIPLAN [1680]|HMA [168003]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MULTIPLAN [1680]|IHC HS [168011]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|Self-pay|Self-pay|127.95||||127.95|38.38|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.95||||127.95|26.87|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|TRUSTMARK [2030]|STARMARK [203000]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.95||||127.95|61.35|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|UMR [2035]|UMR OPTIONS [203501]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.95||||127.95|115.16|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|127.95||||127.95|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|127.95||||127.95|47.34|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|127.95||||127.95||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|127.95||||127.95|63.98|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|324.74||||324.74|162.69|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|324.74||||324.74|113.98|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|324.74||||324.74|139.64|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|324.74||||324.74|138.34|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|324.74||||324.74|162.37|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|324.74||||324.74|211.08|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|324.74||||324.74|120.15|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|324.74||||324.74|139.64|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|324.74||||324.74|302.01|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|324.74||||324.74|194.84|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|Self-pay|Self-pay|324.74||||324.74|97.42|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|324.74||||324.74|68.2|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|324.74||||324.74|155.71|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|324.74||||324.74|292.27|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|324.74||||324.74|0|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|324.74||||324.74|120.15|302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|324.74||||324.74||302.01|26.87
736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|324.74||||324.74|162.37|302.01|26.87
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|375.52||||375.52|188.14|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|375.52||||375.52|131.81|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|375.52||||375.52|161.47|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|375.52||||375.52|159.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|375.52||||375.52|187.76|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|375.52||||375.52|244.09|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|375.52||||375.52|138.94|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|375.52||||375.52|161.47|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|375.52||||375.52|349.23|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|375.52||||375.52|225.31|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|375.52||||375.52|112.66|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|375.52||||375.52|78.86|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|375.52||||375.52|180.06|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|375.52||||375.52|337.97|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|375.52||||375.52|0|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|375.52||||375.52|138.94|349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|375.52||||375.52||349.23|78.86
7364|ERX|0250 - PHARMACY-GENERAL|SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|375.52||||375.52|187.76|349.23|78.86
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1859||||1859|0|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1859||||1859|251.04|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1859||||1859|213.8|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1859||||1859|213.8|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1859||||1859|243.8|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1859||||1859|931.36|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1859||||1859|652.51|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1859||||1859|799.37|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1859||||1859|791.93|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1859||||1859|929.5|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1859||||1859|1208.35|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|CORESOURCE [1315]|CORESOURCE [131500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1859||||1859|0|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1859||||1859|687.83|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|GEHA [1415]|GEHA [141500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1859||||1859|553.77|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HEALTHNET [1495]|HEALTHNET [149500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1859||||1859|799.37|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1859||||1859|1728.87|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1859||||1859|1115.4|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1859||||1859|268.18|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1859||||1859|603.08|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1859||||1859|206.49|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1859||||1859|332.26|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1859||||1859|251.04|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MULTIPLAN [1680]|HMA [168003]|1859||||1859|369.18|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MULTIPLAN [1680]|IHC HS [168011]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1859||||1859|222.22|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1859||||1859|268.18|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|Self-pay|Self-pay|1859||||1859|557.7|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1859||||1859|390.39|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1859||||1859|241.2|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1859||||1859|359.33|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|TRUSTMARK [2030]|STARMARK [203000]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1859||||1859|891.39|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|UMR [2035]|UMR OPTIONS [203501]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1859||||1859|196.65|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1859||||1859|1673.1|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1859||||1859|0|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1859||||1859|687.83|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1859||||1859|246.12|1728.87|196.65
74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1859||||1859|929.5|1728.87|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|2046||||2046|0|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2046||||2046|251.04|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2046||||2046|213.8|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2046||||2046|213.8|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2046||||2046|243.8|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2046||||2046|1025.05|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2046||||2046|718.15|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2046||||2046|879.78|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2046||||2046|871.6|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2046||||2046|1023|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2046||||2046|1329.9|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2046||||2046|0|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2046||||2046|757.02|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|GEHA [1415]|GEHA [141500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2046||||2046|553.77|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2046||||2046|879.78|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2046||||2046|1902.78|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2046||||2046|1227.6|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2046||||2046|268.18|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2046||||2046|603.08|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2046||||2046|206.49|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2046||||2046|332.26|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2046||||2046|251.04|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MULTIPLAN [1680]|HMA [168003]|2046||||2046|369.18|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MULTIPLAN [1680]|IHC HS [168011]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2046||||2046|222.22|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2046||||2046|268.18|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|Self-pay|Self-pay|2046||||2046|613.8|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2046||||2046|429.66|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2046||||2046|241.2|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2046||||2046|359.33|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|TRUSTMARK [2030]|STARMARK [203000]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2046||||2046|981.06|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|UMR [2035]|UMR OPTIONS [203501]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2046||||2046|196.65|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2046||||2046|1841.4|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2046||||2046|0|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2046||||2046|757.02|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2046||||2046|246.12|1902.78|196.65
74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 61-119 MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2046||||2046|1023|1902.78|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|AETNA [1015]|AETNA ACO WILCO [101532]|2429||||2429|0|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2429||||2429|251.04|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2429||||2429|213.8|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2429||||2429|213.8|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2429||||2429|243.8|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2429||||2429|1216.93|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2429||||2429|852.58|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2429||||2429|1044.47|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2429||||2429|1034.75|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2429||||2429|1214.5|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2429||||2429|1578.85|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|CORESOURCE [1315]|CORESOURCE [131500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2429||||2429|0|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2429||||2429|898.73|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|GEHA [1415]|GEHA [141500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2429||||2429|553.77|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HEALTHNET [1495]|HEALTHNET [149500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2429||||2429|1044.47|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2429||||2429|2258.97|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2429||||2429|1457.4|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2429||||2429|268.18|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2429||||2429|603.08|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2429||||2429|206.49|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2429||||2429|332.26|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2429||||2429|251.04|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MULTIPLAN [1680]|HMA [168003]|2429||||2429|369.18|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MULTIPLAN [1680]|IHC HS [168011]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2429||||2429|222.22|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2429||||2429|268.18|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|Self-pay|Self-pay|2429||||2429|728.7|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2429||||2429|510.09|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2429||||2429|241.2|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2429||||2429|359.33|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|TRUSTMARK [2030]|STARMARK [203000]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2429||||2429|1164.71|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|UMR [2035]|UMR OPTIONS [203501]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2429||||2429|196.65|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2429||||2429|2186.1|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2429||||2429|0|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2429||||2429|898.73|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2429||||2429|246.12|2258.97|196.65
74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2429||||2429|1214.5|2258.97|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|AETNA [1015]|AETNA ACO WILCO [101532]|2788||||2788|0|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2788||||2788|251.04|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2788||||2788|213.8|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2788||||2788|213.8|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2788||||2788|243.8|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2788||||2788|1396.79|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2788||||2788|978.59|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2788||||2788|1198.84|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2788||||2788|1187.69|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2788||||2788|1394|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2788||||2788|1812.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|CORESOURCE [1315]|CORESOURCE [131500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2788||||2788|0|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2788||||2788|1031.56|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|GEHA [1415]|GEHA [141500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2788||||2788|553.77|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HEALTHNET [1495]|HEALTHNET [149500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2788||||2788|1198.84|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2788||||2788|2592.84|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2788||||2788|1672.8|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2788||||2788|268.18|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2788||||2788|603.08|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2788||||2788|206.49|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2788||||2788|332.26|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2788||||2788|251.04|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MULTIPLAN [1680]|HMA [168003]|2788||||2788|369.18|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MULTIPLAN [1680]|IHC HS [168011]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2788||||2788|222.22|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2788||||2788|268.18|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|Self-pay|Self-pay|2788||||2788|836.4|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2788||||2788|585.48|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2788||||2788|241.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2788||||2788|359.33|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|TRUSTMARK [2030]|STARMARK [203000]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2788||||2788|1336.85|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|UMR [2035]|UMR OPTIONS [203501]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2788||||2788|196.65|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2788||||2788|2509.2|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2788||||2788|0|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2788||||2788|1031.56|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2788||||2788|246.12|2592.84|196.65
74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2788||||2788|1394|2592.84|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|AETNA [1015]|AETNA ACO WILCO [101532]|2265||||2265|0|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2265||||2265|213.8|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2265||||2265|213.8|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2265||||2265|1134.77|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2265||||2265|795.02|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2265||||2265|973.95|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2265||||2265|964.89|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2265||||2265|1132.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2265||||2265|1472.25|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|CORESOURCE [1315]|CORESOURCE [131500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2265||||2265|0|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2265||||2265|838.05|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|GEHA [1415]|GEHA [141500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HEALTHNET [1495]|HEALTHNET [149500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2265||||2265|973.95|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2265||||2265|2106.45|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2265||||2265|1359|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2265||||2265|603.08|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2265||||2265|206.49|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MULTIPLAN [1680]|HMA [168003]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MULTIPLAN [1680]|IHC HS [168011]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2265||||2265|222.22|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|Self-pay|Self-pay|2265||||2265|679.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2265||||2265|475.65|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|TRUSTMARK [2030]|STARMARK [203000]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2265||||2265|1086.07|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|UMR [2035]|UMR OPTIONS [203501]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2265||||2265|196.65|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2265||||2265|2038.5|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2265||||2265|0|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2265||||2265|838.05|2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2265||||2265||2106.45|196.65
74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2265||||2265|1132.5|2106.45|196.65
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|1398||||1398|0|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1398||||1398|238.6|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1398||||1398|238.6|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1398||||1398|700.4|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1398||||1398|490.7|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1398||||1398|601.14|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1398||||1398|595.55|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1398||||1398|699|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1398||||1398|908.7|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|CORESOURCE [1315]|CORESOURCE [131500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1398||||1398|0|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1398||||1398|517.26|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|GEHA [1415]|GEHA [141500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HEALTHNET [1495]|HEALTHNET [149500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1398||||1398|601.14|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1398||||1398|1300.14|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1398||||1398|838.8|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1398||||1398|1088.21|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1398||||1398|230.45|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MULTIPLAN [1680]|HMA [168003]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MULTIPLAN [1680]|IHC HS [168011]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1398||||1398|247.99|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|Self-pay|Self-pay|1398||||1398|419.4|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1398||||1398|293.58|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|TRUSTMARK [2030]|STARMARK [203000]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1398||||1398|670.34|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|UMR [2035]|UMR OPTIONS [203501]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1398||||1398|219.47|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1398||||1398|1258.2|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1398||||1398|0|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1398||||1398|517.26|1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1398||||1398||1300.14|219.47
74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1398||||1398|699|1300.14|219.47
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25||||25|12.53|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25||||25|8.78|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25||||25|10.75|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25||||25|10.65|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25||||25|12.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25||||25|16.25|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25||||25|9.25|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25||||25|10.75|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|25||||25|23.25|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25||||25|15|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|Self-pay|Self-pay|25||||25|7.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25||||25|5.25|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25||||25|11.99|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25||||25|22.5|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25||||25|0|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25||||25|9.25|23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25||||25||23.25|5.25
7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25||||25|12.5|23.25|5.25
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|AETNA [1015]|AETNA ACO WILCO [101532]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60.24||||60.24|30.18|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.24||||60.24|21.14|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.24||||60.24|25.9|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60.24||||60.24|25.66|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60.24||||60.24|30.12|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.24||||60.24|39.16|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|CORESOURCE [1315]|CORESOURCE [131500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60.24||||60.24|22.29|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|GEHA [1415]|GEHA [141500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HEALTHNET [1495]|HEALTHNET [149500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.24||||60.24|25.9|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|60.24||||60.24|56.02|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.24||||60.24|36.14|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MULTIPLAN [1680]|HMA [168003]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MULTIPLAN [1680]|IHC HS [168011]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|Self-pay|Self-pay|60.24||||60.24|18.07|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.24||||60.24|12.65|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|TRUSTMARK [2030]|STARMARK [203000]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.24||||60.24|28.89|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|UMR [2035]|UMR OPTIONS [203501]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.24||||60.24|54.22|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60.24||||60.24|0|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60.24||||60.24|22.29|56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60.24||||60.24||56.02|12.65
76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|473 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60.24||||60.24|30.12|56.02|12.65
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|0|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|52.77|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|52.77|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|51.6|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|0|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|44.4|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|51.6|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|0|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|21.59|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MULTIPLAN [1680]|HMA [168003]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|54.85|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|Self-pay|Self-pay|120||||120|36|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|0|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|0|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|44.4|111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120||111.6|21.59
77100001|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 1ST DOSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|21.59
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|0|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|52.77|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|52.77|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|51.6|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|0|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|44.4|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|51.6|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|0|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|36.18|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MULTIPLAN [1680]|HMA [168003]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|54.85|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|Self-pay|Self-pay|120||||120|36|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|0|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|0|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|44.4|111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120||111.6|25.2
77100002|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 30MCG/0.3ML DIL RCON 2ND DOSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|25.2
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|52||||52|0|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52||||52|57.68|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52||||52|37.97|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52||||52|33.86|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52||||52|33.86|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52||||52|36.88|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52||||52|26.05|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52||||52|18.25|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52||||52|22.36|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52||||52|22.15|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52||||52|26|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52||||52|33.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|CORESOURCE [1315]|CORESOURCE [131500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52||||52|0|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52||||52|19.24|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|GEHA [1415]|GEHA [141500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52||||52|52|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HEALTHNET [1495]|HEALTHNET [149500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52||||52|22.36|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52||||52|48.36|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52||||52|31.2|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52||||52|40.56|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52||||52|52|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52||||52|32.71|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52||||52|52|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52||||52|37.54|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MULTIPLAN [1680]|HMA [168003]|52||||52|52|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MULTIPLAN [1680]|IHC HS [168011]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52||||52|57.68|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52||||52|35.19|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52||||52|40.56|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|Self-pay|Self-pay|52||||52|15.6|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52||||52|10.92|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52||||52|36.48|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52||||52|52|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|TRUSTMARK [2030]|STARMARK [203000]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52||||52|24.93|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|UMR [2035]|UMR OPTIONS [203501]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52||||52|31.15|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52||||52|46.8|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52||||52|0|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52||||52|19.24|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52||||52|37.23|57.68|10.92
77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52||||52|26|57.68|10.92
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|AETNA [1015]|AETNA ACO WILCO [101532]|174||||174|0|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|174||||174|57.68|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|174||||174|37.97|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|174||||174|33.86|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|174||||174|33.86|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|174||||174|36.88|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|174||||174|87.17|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|174||||174|61.07|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|174||||174|74.82|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|174||||174|74.12|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|174||||174|87|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|174||||174|113.1|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|CORESOURCE [1315]|CORESOURCE [131500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|174||||174|0|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|174||||174|64.38|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|GEHA [1415]|GEHA [141500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|174||||174|129.78|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HEALTHNET [1495]|HEALTHNET [149500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|174||||174|74.82|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|174||||174|161.82|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|174||||174|104.4|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|174||||174|40.56|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|174||||174|142.82|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|174||||174|32.71|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|174||||174|77.87|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|174||||174|37.97|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MULTIPLAN [1680]|HMA [168003]|174||||174|86.52|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MULTIPLAN [1680]|IHC HS [168011]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|174||||174|57.68|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|174||||174|35.19|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|174||||174|40.56|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|Self-pay|Self-pay|174||||174|52.2|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|174||||174|36.54|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|174||||174|36.48|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|174||||174|54.35|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|TRUSTMARK [2030]|STARMARK [203000]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|174||||174|83.43|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|UMR [2035]|UMR OPTIONS [203501]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|174||||174|31.15|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|174||||174|156.6|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|174||||174|0|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|174||||174|64.38|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|174||||174|37.23|161.82|31.15
77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|174||||174|87|161.82|31.15
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|52.77|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|0|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|51.6|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120|40.56|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|0|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|21.59|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|Self-pay|Self-pay|120||||120|36|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120|36.48|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120|54.35|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|0|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC  IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|0|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120|37.97|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|52.77|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120|36.88|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|51.6|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|44.4|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120|83.76|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120|50.26|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120|37.97|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MULTIPLAN [1680]|HMA [168003]|120||||120|55.84|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|54.85|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120|40.56|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120|37.23|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|0|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|44.4|111.6|21.59
77100011|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120|37.23|111.6|21.59
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|0|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120|37.97|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|52.77|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|52.77|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120|36.88|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|51.6|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|0|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|44.4|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120|83.76|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|51.6|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120|40.56|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|0|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|36.18|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120|50.26|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120|37.97|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MULTIPLAN [1680]|HMA [168003]|120||||120|55.84|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|54.85|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120|40.56|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|Self-pay|Self-pay|120||||120|36|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120|36.48|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120|54.35|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|0|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|0|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|44.4|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120|37.23|111.6|25.2
77100012|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|AETNA [1015]|AETNA ACO WILCO [101532]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120||||120|60.12|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120||||120|42.12|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120||||120|51.6|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120||||120|51.12|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120||||120|60|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120||||120|78|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|CORESOURCE [1315]|CORESOURCE [131500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120||||120|44.4|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|GEHA [1415]|GEHA [141500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HEALTHNET [1495]|HEALTHNET [149500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120||||120|51.6|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120||||120|111.6|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120||||120|72|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MULTIPLAN [1680]|HMA [168003]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MULTIPLAN [1680]|IHC HS [168011]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|Self-pay|Self-pay|120||||120|36|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120||||120|25.2|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|TRUSTMARK [2030]|STARMARK [203000]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120||||120|57.54|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|UMR [2035]|UMR OPTIONS [203501]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120||||120|108|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120||||120|0|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120||||120|44.4|111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120||||120||111.6|25.2
77100030|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC IMM ADMIN SARSCOV2 30MCG/0.3ML 3RD DOSE PFIZER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120||||120|60|111.6|25.2
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|AETNA [1015]|AETNA ACO WILCO [101532]|536.51||||536.51|0|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|536.51||||536.51|99.35|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|536.51||||536.51|131|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|536.51||||536.51|131|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|536.51||||536.51|268.79|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|536.51||||536.51|188.32|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|536.51||||536.51|230.7|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|536.51||||536.51|228.55|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|536.51||||536.51|268.26|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|536.51||||536.51|348.73|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|CORESOURCE [1315]|CORESOURCE [131500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|536.51||||536.51|101.43|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|536.51||||536.51|198.51|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|GEHA [1415]|GEHA [141500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|536.51||||536.51|219.15|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HEALTHNET [1495]|HEALTHNET [149500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|536.51||||536.51|230.7|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|536.51||||536.51|498.95|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|536.51||||536.51|321.91|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|536.51||||536.51|107.14|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|536.51||||536.51|0|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|536.51||||536.51|139.7|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|536.51||||536.51|131.49|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|536.51||||536.51|99.35|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MULTIPLAN [1680]|HMA [168003]|536.51||||536.51|187.78|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MULTIPLAN [1680]|IHC HS [168011]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|536.51||||536.51|136.16|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|536.51||||536.51|107.14|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|Self-pay|Self-pay|536.51||||536.51|160.95|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|536.51||||536.51|112.67|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|536.51||||536.51|95.45|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|536.51||||536.51|125.08|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|TRUSTMARK [2030]|STARMARK [203000]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|536.51||||536.51|257.26|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|UMR [2035]|UMR OPTIONS [203501]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|536.51||||536.51|133.04|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|536.51||||536.51|482.86|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|536.51||||536.51|0|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|536.51||||536.51|198.51|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|536.51||||536.51|97.4|498.95|95.45
77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|100 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|536.51||||536.51|268.26|498.95|95.45
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23.72||||23.72|11.88|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.72||||23.72|8.33|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.72||||23.72|10.2|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23.72||||23.72|10.1|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23.72||||23.72|11.86|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.72||||23.72|15.42|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23.72||||23.72|8.78|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.72||||23.72|10.2|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|23.72||||23.72|22.06|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.72||||23.72|14.23|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|Self-pay|Self-pay|23.72||||23.72|7.12|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.72||||23.72|4.98|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.72||||23.72|11.37|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.72||||23.72|21.35|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23.72||||23.72|0|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23.72||||23.72|8.78|22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23.72||||23.72||22.06|4.98
77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23.72||||23.72|11.86|22.06|4.98
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54.36||||54.36|27.23|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.36||||54.36|19.08|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.36||||54.36|23.37|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54.36||||54.36|23.16|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54.36||||54.36|27.18|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.36||||54.36|35.33|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|54.36||||54.36|5.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54.36||||54.36|20.11|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|GEHA [1415]|GEHA [141500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.36||||54.36|23.37|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|54.36||||54.36|50.55|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.36||||54.36|32.62|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|HMA [168003]|54.36||||54.36|19.03|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|Self-pay|Self-pay|54.36||||54.36|16.31|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.36||||54.36|11.42|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.36||||54.36|5.36|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.36||||54.36|26.07|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|UMR [2035]|UMR OPTIONS [203501]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.36||||54.36|48.92|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54.36||||54.36|0|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54.36||||54.36|20.11|50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54.36||||54.36||50.55|5.36
7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54.36||||54.36|27.18|50.55|5.36
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|AETNA [1015]|AETNA ACO WILCO [101532]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6282||||6282|3147.28|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6282||||6282|2204.98|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6282||||6282|2701.26|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6282||||6282|2676.13|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6282||||6282|3141|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6282||||6282|4083.3|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|CORESOURCE [1315]|CORESOURCE [131500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6282||||6282|2324.34|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|GEHA [1415]|GEHA [141500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HEALTHNET [1495]|HEALTHNET [149500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6282||||6282|2701.26|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6282||||6282|5842.26|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6282||||6282|3769.2|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MULTIPLAN [1680]|HMA [168003]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MULTIPLAN [1680]|IHC HS [168011]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|Self-pay|Self-pay|6282||||6282|1884.6|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6282||||6282|1319.22|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|TRUSTMARK [2030]|STARMARK [203000]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6282||||6282|3012.22|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|UMR [2035]|UMR OPTIONS [203501]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6282||||6282|5653.8|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6282||||6282|0|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6282||||6282|2324.34|5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6282||||6282||5842.26|1319.22
80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6282||||6282|3141|5842.26|1319.22
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2058||||2058|1031.06|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2058||||2058|722.36|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2058||||2058|884.94|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2058||||2058|876.71|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2058||||2058|1029|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2058||||2058|1337.7|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2058||||2058|761.46|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|GEHA [1415]|GEHA [141500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2058||||2058|884.94|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2058||||2058|1913.94|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2058||||2058|1234.8|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MULTIPLAN [1680]|HMA [168003]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MULTIPLAN [1680]|IHC HS [168011]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|Self-pay|Self-pay|2058||||2058|617.4|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2058||||2058|432.18|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|TRUSTMARK [2030]|STARMARK [203000]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2058||||2058|986.81|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|UMR [2035]|UMR OPTIONS [203501]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2058||||2058|1852.2|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2058||||2058|0|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2058||||2058|761.46|1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2058||||2058||1913.94|432.18
80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2058||||2058|1029|1913.94|432.18
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|AETNA [1015]|AETNA ACO WILCO [101532]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20.43||||20.43|10.24|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.43||||20.43|7.17|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.43||||20.43|8.78|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20.43||||20.43|8.7|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20.43||||20.43|10.22|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.43||||20.43|13.28|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|CORESOURCE [1315]|CORESOURCE [131500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|CORVEL CORP [2235]|CORVEL CORP [223500]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20.43||||20.43|7.56|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|GEHA [1415]|GEHA [141500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HEALTHNET [1495]|HEALTHNET [149500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.43||||20.43|8.78|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART [150501]|20.43||||20.43|19|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.43||||20.43|12.26|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MULTIPLAN [1680]|HMA [168003]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MULTIPLAN [1680]|IHC HS [168011]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|Self-pay|Self-pay|20.43||||20.43|6.13|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.43||||20.43|4.29|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|TRUSTMARK [2030]|STARMARK [203000]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.43||||20.43|9.8|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|UMR [2035]|UMR OPTIONS [203501]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.43||||20.43|18.39|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20.43||||20.43|0|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20.43||||20.43|7.56|19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20.43||||20.43||19|4.29
8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|15 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20.43||||20.43|10.22|19|4.29
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46.44||||46.44|23.27|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.44||||46.44|16.3|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.44||||46.44|19.97|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46.44||||46.44|19.78|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46.44||||46.44|23.22|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.44||||46.44|30.19|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|46.44||||46.44|6.66|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46.44||||46.44|17.18|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|GEHA [1415]|GEHA [141500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.44||||46.44|19.97|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|46.44||||46.44|43.19|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.44||||46.44|27.86|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MULTIPLAN [1680]|HMA [168003]|46.44||||46.44|16.25|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|Self-pay|Self-pay|46.44||||46.44|13.93|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.44||||46.44|9.75|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.44||||46.44|5.64|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.44||||46.44|22.27|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.44||||46.44|41.8|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46.44||||46.44|0|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46.44||||46.44|17.18|43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46.44||||46.44||43.19|5.64
8120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46.44||||46.44|23.22|43.19|5.64
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10.92||||10.92|5.47|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.92||||10.92|3.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.92||||10.92|4.7|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10.92||||10.92|4.65|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10.92||||10.92|5.46|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.92||||10.92|7.1|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10.92||||10.92|4.04|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.92||||10.92|4.7|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10.92||||10.92|10.16|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.92||||10.92|6.55|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10.92||||10.92|3.28|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.92||||10.92|2.29|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.92||||10.92|5.24|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.92||||10.92|9.83|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10.92||||10.92|0|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10.92||||10.92|4.04|10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10.92||||10.92||10.16|2.29
81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10.92||||10.92|5.46|10.16|2.29
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49.01||||49.01|24.55|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.01||||49.01|17.2|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.01||||49.01|21.07|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49.01||||49.01|20.88|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49.01||||49.01|24.51|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.01||||49.01|31.86|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|CORESOURCE [1315]|CORESOURCE [131500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49.01||||49.01|18.13|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|GEHA [1415]|GEHA [141500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HEALTHNET [1495]|HEALTHNET [149500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.01||||49.01|21.07|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|49.01||||49.01|45.58|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.01||||49.01|29.41|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MULTIPLAN [1680]|HMA [168003]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MULTIPLAN [1680]|IHC HS [168011]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|Self-pay|Self-pay|49.01||||49.01|14.7|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.01||||49.01|10.29|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|TRUSTMARK [2030]|STARMARK [203000]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.01||||49.01|23.5|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|UMR [2035]|UMR OPTIONS [203501]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.01||||49.01|44.11|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49.01||||49.01|0|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49.01||||49.01|18.13|45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49.01||||49.01||45.58|10.29
8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|0.1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49.01||||49.01|24.51|45.58|10.29
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|AETNA [1015]|AETNA ACO WILCO [101532]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65.99||||65.99|33.06|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65.99||||65.99|23.16|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65.99||||65.99|28.38|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65.99||||65.99|28.11|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65.99||||65.99|33|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65.99||||65.99|42.89|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|CORESOURCE [1315]|CORESOURCE [131500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|65.99||||65.99|8.3|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65.99||||65.99|24.42|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|GEHA [1415]|GEHA [141500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HEALTHNET [1495]|HEALTHNET [149500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65.99||||65.99|28.38|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|65.99||||65.99|61.37|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65.99||||65.99|39.59|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MULTIPLAN [1680]|HMA [168003]|65.99||||65.99|23.1|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MULTIPLAN [1680]|IHC HS [168011]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|Self-pay|Self-pay|65.99||||65.99|19.8|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65.99||||65.99|13.86|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65.99||||65.99|5.87|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|TRUSTMARK [2030]|STARMARK [203000]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65.99||||65.99|31.64|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|UMR [2035]|UMR OPTIONS [203501]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65.99||||65.99|59.39|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65.99||||65.99|0|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65.99||||65.99|24.42|61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65.99||||65.99||61.37|5.87
8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|1,000 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65.99||||65.99|33|61.37|5.87
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|AETNA ACO WILCO [101532]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43.92||||43.92|22|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.92||||43.92|15.42|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.92||||43.92|18.89|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43.92||||43.92|18.71|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43.92||||43.92|21.96|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.92||||43.92|28.55|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CORESOURCE [1315]|CORESOURCE [131500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|CORVEL CORP [2235]|CORVEL CORP [223500]|43.92||||43.92|4.15|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43.92||||43.92|16.25|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|GEHA [1415]|GEHA [141500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHNET [1495]|HEALTHNET [149500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.92||||43.92|18.89|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HEALTHSMART [1505]|HEALTHSMART [150501]|43.92||||43.92|40.85|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.92||||43.92|26.35|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MULTIPLAN [1680]|HMA [168003]|43.92||||43.92|15.37|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MULTIPLAN [1680]|IHC HS [168011]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PENDING SSI [1616]|PENDING SSI RCA [161601]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|Self-pay|Self-pay|43.92||||43.92|13.18|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.92||||43.92|9.22|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.92||||43.92|2.94|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|TRUSTMARK [2030]|STARMARK [203000]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.92||||43.92|21.06|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UMR [2035]|UMR OPTIONS [203501]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.92||||43.92|39.53|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43.92||||43.92|0|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43.92||||43.92|16.25|40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43.92||||43.92||40.85|2.94
8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|500 mg|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43.92||||43.92|21.96|40.85|2.94
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|AETNA [1015]|AETNA ACO WILCO [101532]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279.01||||279.01|139.78|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279.01||||279.01|97.93|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279.01||||279.01|119.97|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279.01||||279.01|118.86|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279.01||||279.01|139.51|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279.01||||279.01|181.36|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|CORESOURCE [1315]|CORESOURCE [131500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|279.01||||279.01|41.5|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279.01||||279.01|103.23|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|GEHA [1415]|GEHA [141500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HEALTHNET [1495]|HEALTHNET [149500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279.01||||279.01|119.97|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|279.01||||279.01|259.48|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279.01||||279.01|167.41|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MULTIPLAN [1680]|HMA [168003]|279.01||||279.01|97.65|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MULTIPLAN [1680]|IHC HS [168011]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|Self-pay|Self-pay|279.01||||279.01|83.7|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279.01||||279.01|58.59|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279.01||||279.01|29.36|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|TRUSTMARK [2030]|STARMARK [203000]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279.01||||279.01|133.79|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|UMR [2035]|UMR OPTIONS [203501]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279.01||||279.01|251.11|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|279.01||||279.01|0|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279.01||||279.01|103.23|259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279.01||||279.01||259.48|29.36
8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279.01||||279.01|139.51|259.48|29.36
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|AETNA [1015]|AETNA ACO WILCO [101532]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279.03||||279.03|139.79|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279.03||||279.03|97.94|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279.03||||279.03|119.98|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279.03||||279.03|118.87|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279.03||||279.03|139.52|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279.03||||279.03|181.37|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|CORESOURCE [1315]|CORESOURCE [131500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279.03||||279.03|103.24|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|GEHA [1415]|GEHA [141500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HEALTHNET [1495]|HEALTHNET [149500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279.03||||279.03|119.98|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|279.03||||279.03|259.5|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279.03||||279.03|167.42|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MULTIPLAN [1680]|HMA [168003]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MULTIPLAN [1680]|IHC HS [168011]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|Self-pay|Self-pay|279.03||||279.03|83.71|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279.03||||279.03|58.6|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|TRUSTMARK [2030]|STARMARK [203000]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279.03||||279.03|133.79|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|UMR [2035]|UMR OPTIONS [203501]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279.03||||279.03|251.13|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|279.03||||279.03|0|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279.03||||279.03|103.24|259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279.03||||279.03||259.5|58.6
852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|3.5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279.03||||279.03|139.52|259.5|58.6
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|AETNA [1015]|AETNA ACO WILCO [101532]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19.42||||19.42|9.73|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.42||||19.42|6.82|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.42||||19.42|8.35|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19.42||||19.42|8.27|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19.42||||19.42|9.71|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.42||||19.42|12.62|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|CORESOURCE [1315]|CORESOURCE [131500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|CORVEL CORP [2235]|CORVEL CORP [223500]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19.42||||19.42|7.19|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|GEHA [1415]|GEHA [141500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HEALTHNET [1495]|HEALTHNET [149500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.42||||19.42|8.35|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HEALTHSMART [1505]|HEALTHSMART [150501]|19.42||||19.42|18.06|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.42||||19.42|11.65|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MULTIPLAN [1680]|HMA [168003]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MULTIPLAN [1680]|IHC HS [168011]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|Self-pay|Self-pay|19.42||||19.42|5.83|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.42||||19.42|4.08|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|TRUSTMARK [2030]|STARMARK [203000]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.42||||19.42|9.31|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|UMR [2035]|UMR OPTIONS [203501]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.42||||19.42|17.48|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19.42||||19.42|0|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19.42||||19.42|7.19|18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19.42||||19.42||18.06|4.08
8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|43 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19.42||||19.42|9.71|18.06|4.08
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|2 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21.42||||21.42|10.73|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.42||||21.42|7.52|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.42||||21.42|9.21|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21.42||||21.42|9.12|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21.42||||21.42|10.71|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.42||||21.42|13.92|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21.42||||21.42|7.93|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.42||||21.42|9.21|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|21.42||||21.42|19.92|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.42||||21.42|12.85|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|Self-pay|Self-pay|21.42||||21.42|6.43|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.42||||21.42|4.5|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.42||||21.42|10.27|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.42||||21.42|19.28|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21.42||||21.42|0|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21.42||||21.42|7.93|19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21.42||||21.42||19.92|4.5
88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21.42||||21.42|10.71|19.92|4.5
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.12||||62.12|16.15|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|AETNA [1015]|AETNA ACO WILCO [101532]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.12||||62.12|16.15|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62.12||||62.12|31.12|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.12||||62.12|21.8|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.12||||62.12|26.71|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62.12||||62.12|26.46|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62.12||||62.12|31.06|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.12||||62.12|40.38|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|CORESOURCE [1315]|CORESOURCE [131500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|62.12||||62.12|11.09|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62.12||||62.12|22.98|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|GEHA [1415]|GEHA [141500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HEALTHNET [1495]|HEALTHNET [149500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.12||||62.12|26.71|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|62.12||||62.12|57.77|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.12||||62.12|37.27|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MULTIPLAN [1680]|HMA [168003]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MULTIPLAN [1680]|IHC HS [168011]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|Self-pay|Self-pay|62.12||||62.12|18.64|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.12||||62.12|13.05|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.12||||62.12|12.35|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|TRUSTMARK [2030]|STARMARK [203000]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.12||||62.12|29.79|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|UMR [2035]|UMR OPTIONS [203501]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.12||||62.12|55.91|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62.12||||62.12|0|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62.12||||62.12|46.59|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62.12||||62.12|22.98|57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62.12||||62.12||57.77|11.09
88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|2 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62.12||||62.12|31.06|57.77|11.09
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30.84||||30.84|15.45|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.84||||30.84|10.82|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.84||||30.84|13.26|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30.84||||30.84|13.14|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30.84||||30.84|15.42|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.84||||30.84|20.05|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30.84||||30.84|11.41|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.84||||30.84|13.26|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|30.84||||30.84|28.68|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.84||||30.84|18.5|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|Self-pay|Self-pay|30.84||||30.84|9.25|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.84||||30.84|6.48|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.84||||30.84|14.79|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.84||||30.84|27.76|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30.84||||30.84|0|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30.84||||30.84|11.41|28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30.84||||30.84||28.68|6.48
88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30.84||||30.84|15.42|28.68|6.48
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61.2||||61.2|30.66|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.2||||61.2|21.48|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.2||||61.2|26.32|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61.2||||61.2|26.07|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61.2||||61.2|30.6|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.2||||61.2|39.78|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61.2||||61.2|22.64|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.2||||61.2|26.32|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|61.2||||61.2|56.92|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.2||||61.2|36.72|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|Self-pay|Self-pay|61.2||||61.2|18.36|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.2||||61.2|12.85|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.2||||61.2|29.35|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.2||||61.2|55.08|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61.2||||61.2|0|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61.2||||61.2|22.64|56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61.2||||61.2||56.92|12.85
88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61.2||||61.2|30.6|56.92|12.85
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36.29||||36.29|18.18|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.29||||36.29|12.74|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.29||||36.29|15.6|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36.29||||36.29|15.46|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36.29||||36.29|18.15|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.29||||36.29|23.59|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36.29||||36.29|13.43|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.29||||36.29|15.6|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|36.29||||36.29|33.75|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.29||||36.29|21.77|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|Self-pay|Self-pay|36.29||||36.29|10.89|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.29||||36.29|7.62|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.29||||36.29|17.4|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.29||||36.29|32.66|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36.29||||36.29|0|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36.29||||36.29|13.43|33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36.29||||36.29||33.75|7.62
89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36.29||||36.29|18.15|33.75|7.62
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23.56||||23.56|11.8|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.56||||23.56|8.27|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.56||||23.56|10.13|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23.56||||23.56|10.04|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23.56||||23.56|11.78|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.56||||23.56|15.31|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23.56||||23.56|8.72|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.56||||23.56|10.13|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|23.56||||23.56|21.91|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.56||||23.56|14.14|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|Self-pay|Self-pay|23.56||||23.56|7.07|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.56||||23.56|4.95|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.56||||23.56|11.3|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.56||||23.56|21.2|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23.56||||23.56|0|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23.56||||23.56|8.72|21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23.56||||23.56||21.91|4.95
89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23.56||||23.56|11.78|21.91|4.95
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17.2||||17.2|8.62|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.2||||17.2|6.04|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.2||||17.2|7.4|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17.2||||17.2|7.33|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17.2||||17.2|8.6|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.2||||17.2|11.18|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17.2||||17.2|6.36|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|GEHA [1415]|GEHA [141500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.2||||17.2|7.4|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|17.2||||17.2|16|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.2||||17.2|10.32|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|HMA [168003]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|Self-pay|Self-pay|17.2||||17.2|5.16|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.2||||17.2|3.61|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.2||||17.2|8.25|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.2||||17.2|15.48|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17.2||||17.2|0|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17.2||||17.2|6.36|16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17.2||||17.2||16|3.61
8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17.2||||17.2|8.6|16|3.61
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|AETNA [1015]|AETNA ACO WILCO [101532]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57.58||||57.58|28.85|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.58||||57.58|20.21|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.58||||57.58|24.76|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57.58||||57.58|24.53|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57.58||||57.58|28.79|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.58||||57.58|37.43|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|CORESOURCE [1315]|CORESOURCE [131500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|CORVEL CORP [2235]|CORVEL CORP [223500]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57.58||||57.58|21.3|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|GEHA [1415]|GEHA [141500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HEALTHNET [1495]|HEALTHNET [149500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.58||||57.58|24.76|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HEALTHSMART [1505]|HEALTHSMART [150501]|57.58||||57.58|53.55|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.58||||57.58|34.55|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MULTIPLAN [1680]|HMA [168003]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MULTIPLAN [1680]|IHC HS [168011]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|PENDING SSI [1616]|PENDING SSI RCA [161601]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|Self-pay|Self-pay|57.58||||57.58|17.27|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.58||||57.58|12.09|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|TRUSTMARK [2030]|STARMARK [203000]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.58||||57.58|27.61|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|UMR [2035]|UMR OPTIONS [203501]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.58||||57.58|51.82|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57.58||||57.58|0|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57.58||||57.58|21.3|53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57.58||||57.58||53.55|12.09
89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|1 each|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57.58||||57.58|28.79|53.55|12.09
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|1348.78||||1348.78|0|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1348.78||||1348.78|107|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1348.78||||1348.78|141|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1348.78||||1348.78|141|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1348.78||||1348.78|675.74|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1348.78||||1348.78|473.42|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1348.78||||1348.78|579.98|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1348.78||||1348.78|574.58|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1348.78||||1348.78|674.39|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1348.78||||1348.78|876.71|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|1348.78||||1348.78|102.8|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1348.78||||1348.78|499.05|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|GEHA [1415]|GEHA [141500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1348.78||||1348.78|236.03|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1348.78||||1348.78|579.98|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|1348.78||||1348.78|1254.37|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1348.78||||1348.78|809.27|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1348.78||||1348.78|115.39|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1348.78||||1348.78|674.39|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1348.78||||1348.78|136.18|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1348.78||||1348.78|141.62|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1348.78||||1348.78|107|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|HMA [168003]|1348.78||||1348.78|472.07|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|1348.78||||1348.78|146.55|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1348.78||||1348.78|115.39|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|Self-pay|Self-pay|1348.78||||1348.78|404.63|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1348.78||||1348.78|283.24|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1348.78||||1348.78|102.8|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1348.78||||1348.78|111.19|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1348.78||||1348.78|646.74|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|UMR [2035]|UMR OPTIONS [203501]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1348.78||||1348.78|129.7|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1348.78||||1348.78|1213.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1348.78||||1348.78|0|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1348.78||||1348.78|499.05|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1348.78||||1348.78|104.9|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1348.78||||1348.78|674.39|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|674.39||||674.39|0|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|674.39||||674.39|53.5|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|674.39||||674.39|70.5|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|674.39||||674.39|70.5|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|674.39||||674.39|337.87|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|674.39||||674.39|236.71|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|674.39||||674.39|289.99|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|674.39||||674.39|287.29|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|674.39||||674.39|337.2|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|674.39||||674.39|438.35|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|674.39||||674.39|51.4|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|674.39||||674.39|249.52|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|674.39||||674.39|118.01|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|674.39||||674.39|289.99|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|674.39||||674.39|627.18|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|674.39||||674.39|404.63|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|674.39||||674.39|57.7|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|674.39||||674.39|337.2|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|674.39||||674.39|68.09|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|674.39||||674.39|70.81|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|674.39||||674.39|53.5|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|674.39||||674.39|236.04|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|674.39||||674.39|73.28|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|674.39||||674.39|57.7|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|Self-pay|Self-pay|674.39||||674.39|202.32|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|674.39||||674.39|141.62|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|674.39||||674.39|51.4|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|674.39||||674.39|55.6|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|674.39||||674.39|323.37|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|674.39||||674.39|64.85|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|674.39||||674.39|606.95|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|674.39||||674.39|0|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|674.39||||674.39|249.52|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|674.39||||674.39|52.45|1254.37|51.4
8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|674.39||||674.39|337.2|1254.37|51.4
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.56|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|Self-pay|Self-pay|29||||29|8.7|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.8|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|2.56
9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|1.5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|2.56
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|AETNA [1015]|AETNA ACO WILCO [101532]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|78.76||||78.76|39.46|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78.76||||78.76|27.64|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78.76||||78.76|33.87|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|78.76||||78.76|33.55|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|78.76||||78.76|39.38|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78.76||||78.76|51.19|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|CORESOURCE [1315]|CORESOURCE [131500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|CORVEL CORP [2235]|CORVEL CORP [223500]|78.76||||78.76|5.13|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|78.76||||78.76|29.14|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|GEHA [1415]|GEHA [141500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HEALTHNET [1495]|HEALTHNET [149500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78.76||||78.76|33.87|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HEALTHSMART [1505]|HEALTHSMART [150501]|78.76||||78.76|73.25|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78.76||||78.76|47.26|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MULTIPLAN [1680]|HMA [168003]|78.76||||78.76|27.57|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MULTIPLAN [1680]|IHC HS [168011]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|Self-pay|Self-pay|78.76||||78.76|23.63|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78.76||||78.76|16.54|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78.76||||78.76|5.6|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|TRUSTMARK [2030]|STARMARK [203000]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78.76||||78.76|37.77|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|UMR [2035]|UMR OPTIONS [203501]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78.76||||78.76|70.88|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|78.76||||78.76|0|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|78.76||||78.76|29.14|73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|78.76||||78.76||73.25|5.13
9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|3 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|78.76||||78.76|39.38|73.25|5.13
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|Self-pay|Self-pay|90||||90|27|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|1.78|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.01|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|1.78
91278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|1.78
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|AETNA [1015]|AETNA ACO WILCO [101532]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40.73||||40.73|20.41|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40.73||||40.73|14.3|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40.73||||40.73|17.51|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40.73||||40.73|17.35|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40.73||||40.73|20.37|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40.73||||40.73|26.47|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|CORESOURCE [1315]|CORESOURCE [131500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|40.73||||40.73|2.67|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40.73||||40.73|15.07|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|GEHA [1415]|GEHA [141500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HEALTHNET [1495]|HEALTHNET [149500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40.73||||40.73|17.51|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|40.73||||40.73|37.88|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40.73||||40.73|24.44|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MULTIPLAN [1680]|HMA [168003]|40.73||||40.73|14.26|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MULTIPLAN [1680]|IHC HS [168011]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|Self-pay|Self-pay|40.73||||40.73|12.22|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40.73||||40.73|8.55|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40.73||||40.73|3.02|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|TRUSTMARK [2030]|STARMARK [203000]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40.73||||40.73|19.53|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|UMR [2035]|UMR OPTIONS [203501]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40.73||||40.73|36.66|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40.73||||40.73|0|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40.73||||40.73|15.07|37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40.73||||40.73||37.88|2.67
91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|0.75 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40.73||||40.73|20.37|37.88|2.67
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|145.25||||145.25|72.77|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145.25||||145.25|50.98|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145.25||||145.25|62.46|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|145.25||||145.25|61.88|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|145.25||||145.25|72.63|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145.25||||145.25|94.41|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|145.25||||145.25|17.78|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|145.25||||145.25|53.74|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145.25||||145.25|62.46|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|145.25||||145.25|135.08|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145.25||||145.25|87.15|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|145.25||||145.25|50.84|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|145.25||||145.25|43.57|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145.25||||145.25|30.5|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145.25||||145.25|20.14|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145.25||||145.25|69.65|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145.25||||145.25|130.73|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|145.25||||145.25|0|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|145.25||||145.25|53.74|135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|145.25||||145.25||135.08|17.78
91281|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|145.25||||145.25|72.63|135.08|17.78
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|AETNA [1015]|AETNA ACO WILCO [101532]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16.93||||16.93|8.48|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.93||||16.93|5.94|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.93||||16.93|7.28|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16.93||||16.93|7.21|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16.93||||16.93|8.47|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.93||||16.93|11|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|CORESOURCE [1315]|CORESOURCE [131500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|CORVEL CORP [2235]|CORVEL CORP [223500]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16.93||||16.93|6.26|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|GEHA [1415]|GEHA [141500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HEALTHNET [1495]|HEALTHNET [149500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.93||||16.93|7.28|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HEALTHSMART [1505]|HEALTHSMART [150501]|16.93||||16.93|15.74|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.93||||16.93|10.16|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MULTIPLAN [1680]|HMA [168003]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MULTIPLAN [1680]|IHC HS [168011]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|Self-pay|Self-pay|16.93||||16.93|5.08|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.93||||16.93|3.56|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|TRUSTMARK [2030]|STARMARK [203000]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.93||||16.93|8.12|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|UMR [2035]|UMR OPTIONS [203501]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.93||||16.93|15.24|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16.93||||16.93|0|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16.93||||16.93|6.26|15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16.93||||16.93||15.74|3.56
9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|15 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16.93||||16.93|8.47|15.74|3.56
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA ACO WILCO [101532]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120.35||||120.35|60.3|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120.35||||120.35|42.24|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120.35||||120.35|51.75|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120.35||||120.35|51.27|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120.35||||120.35|60.18|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120.35||||120.35|78.23|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|CORESOURCE [1315]|CORESOURCE [131500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|CORVEL CORP [2235]|CORVEL CORP [223500]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120.35||||120.35|44.53|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|GEHA [1415]|GEHA [141500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHNET [1495]|HEALTHNET [149500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120.35||||120.35|51.75|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART [150501]|120.35||||120.35|111.93|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120.35||||120.35|72.21|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|HMA [168003]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|IHC HS [168011]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|Self-pay|Self-pay|120.35||||120.35|36.1|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120.35||||120.35|25.27|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|TRUSTMARK [2030]|STARMARK [203000]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120.35||||120.35|57.71|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|UMR [2035]|UMR OPTIONS [203501]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120.35||||120.35|108.32|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120.35||||120.35|0|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120.35||||120.35|44.53|111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120.35||||120.35||111.93|25.27
9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|1 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120.35||||120.35|60.18|111.93|25.27
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA ACO WILCO [101532]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|240.7||||240.7|120.59|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240.7||||240.7|84.49|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240.7||||240.7|103.5|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|240.7||||240.7|102.54|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|240.7||||240.7|120.35|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240.7||||240.7|156.46|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|CORESOURCE [1315]|CORESOURCE [131500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|CORVEL CORP [2235]|CORVEL CORP [223500]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|240.7||||240.7|89.06|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|GEHA [1415]|GEHA [141500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHNET [1495]|HEALTHNET [149500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240.7||||240.7|103.5|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART [150501]|240.7||||240.7|223.85|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240.7||||240.7|144.42|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|HMA [168003]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|IHC HS [168011]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|Self-pay|Self-pay|240.7||||240.7|72.21|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240.7||||240.7|50.55|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|TRUSTMARK [2030]|STARMARK [203000]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240.7||||240.7|115.42|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|UMR [2035]|UMR OPTIONS [203501]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240.7||||240.7|216.63|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|240.7||||240.7|0|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|240.7||||240.7|89.06|223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|240.7||||240.7||223.85|50.55
9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|2 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|240.7||||240.7|120.35|223.85|50.55
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|AETNA [1015]|AETNA ACO WILCO [101532]|1534||||1534|0|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1534||||1534|186.18|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1534||||1534|186.18|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1534||||1534|768.53|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1534||||1534|538.43|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1534||||1534|659.62|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1534||||1534|653.48|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1534||||1534|767|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1534||||1534|997.1|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|CORESOURCE [1315]|CORESOURCE [131500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1534||||1534|0|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1534||||1534|567.58|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|GEHA [1415]|GEHA [141500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HEALTHNET [1495]|HEALTHNET [149500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1534||||1534|659.62|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1534||||1534|1426.62|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1534||||1534|920.4|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1534||||1534|324.96|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1534||||1534|179.82|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MULTIPLAN [1680]|HMA [168003]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MULTIPLAN [1680]|IHC HS [168011]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1534||||1534|193.51|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|Self-pay|Self-pay|1534||||1534|460.2|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1534||||1534|322.14|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|TRUSTMARK [2030]|STARMARK [203000]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1534||||1534|735.55|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|UMR [2035]|UMR OPTIONS [203501]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1534||||1534|171.25|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1534||||1534|1380.6|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1534||||1534|0|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1534||||1534|567.58|1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1534||||1534||1426.62|171.25
92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC BREATH HYDROGEN/METHANE TEST|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1534||||1534|767|1426.62|171.25
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1227||||1227|598.78|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1227||||1227|218.46|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1227||||1227|204.57|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1227||||1227|204.57|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1227||||1227|212.16|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1227||||1227|614.73|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1227||||1227|430.68|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1227||||1227|527.61|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1227||||1227|522.7|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1227||||1227|613.5|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1227||||1227|797.55|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1227||||1227|0|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1227||||1227|453.99|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|GEHA [1415]|GEHA [141500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1227||||1227|481.9|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1227||||1227|527.61|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1227||||1227|1141.11|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1227||||1227|736.2|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1227||||1227|233.38|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1227||||1227|551.1|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1227||||1227|197.59|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1227||||1227|289.14|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1227||||1227|218.46|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MULTIPLAN [1680]|HMA [168003]|1227||||1227|321.27|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1227||||1227|212.62|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1227||||1227|233.38|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|Self-pay|Self-pay|1227||||1227|368.1|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1227||||1227|257.67|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1227||||1227|209.89|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1227||||1227|312.7|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1227||||1227|588.35|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|UMR [2035]|UMR OPTIONS [203501]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1227||||1227|188.17|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1227||||1227|1104.3|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1227||||1227|0|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1227||||1227|453.99|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1227||||1227|214.18|1141.11|188.17
92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1227||||1227|613.5|1141.11|188.17
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1829||||1829|892.55|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1829||||1829|106.28|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1829||||1829|87.57|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1829||||1829|87.57|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1829||||1829|103.21|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1829||||1829|916.33|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1829||||1829|641.98|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1829||||1829|786.47|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1829||||1829|779.15|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1829||||1829|914.5|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1829||||1829|1188.85|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1829||||1829|0|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1829||||1829|676.73|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|GEHA [1415]|GEHA [141500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1829||||1829|234.43|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1829||||1829|786.47|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1829||||1829|1700.97|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1829||||1829|1097.4|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1829||||1829|103.02|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1829||||1829|113.53|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1829||||1829|254.52|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1829||||1829|84.58|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1829||||1829|140.66|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1829||||1829|106.28|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MULTIPLAN [1680]|HMA [168003]|1829||||1829|156.29|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1829||||1829|91.02|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1829||||1829|113.53|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|Self-pay|Self-pay|1829||||1829|548.7|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1829||||1829|384.09|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1829||||1829|102.11|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1829||||1829|152.12|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1829||||1829|877.01|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|UMR [2035]|UMR OPTIONS [203501]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1829||||1829|80.55|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1829||||1829|1646.1|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1829||||1829|0|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1829||||1829|676.73|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1829||||1829|104.19|1700.97|80.55
92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1829||||1829|914.5|1700.97|80.55
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1442||||1442|214.18|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1442||||1442|703.7|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1442||||1442|218.46|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1442||||1442|204.57|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1442||||1442|204.57|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1442||||1442|212.16|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1442||||1442|722.44|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1442||||1442|506.14|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1442||||1442|620.06|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1442||||1442|614.29|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1442||||1442|721|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1442||||1442|937.3|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1442||||1442|0|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1442||||1442|533.54|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|GEHA [1415]|GEHA [141500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1442||||1442|476.46|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1442||||1442|620.06|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1442||||1442|1341.06|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1442||||1442|865.2|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1442||||1442|233.38|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1442||||1442|551.1|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1442||||1442|197.59|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1442||||1442|285.88|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1442||||1442|218.46|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MULTIPLAN [1680]|HMA [168003]|1442||||1442|321.27|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1442||||1442|212.62|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1442||||1442|233.38|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|Self-pay|Self-pay|1442||||1442|432.6|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1442||||1442|302.82|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1442||||1442|214.18|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1442||||1442|207.53|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1442||||1442|312.7|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1442||||1442|691.44|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|UMR [2035]|UMR OPTIONS [203501]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1442||||1442|188.17|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1442||||1442|1297.8|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1442||||1442|0|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1442||||1442|533.54|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1442||||1442|211.76|1341.06|188.17
92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1442||||1442|721|1341.06|188.17
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1274||||1274|101.42|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1274||||1274|621.71|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1274||||1274|102.28|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1274||||1274|128.35|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1274||||1274|128.35|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1274||||1274|100.46|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1274||||1274|638.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1274||||1274|447.17|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1274||||1274|547.82|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1274||||1274|542.72|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1274||||1274|637|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1274||||1274|828.1|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1274||||1274|0|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1274||||1274|471.38|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|GEHA [1415]|GEHA [141500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1274||||1274|225.62|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1274||||1274|547.82|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1274||||1274|1184.82|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1274||||1274|764.4|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1274||||1274|101.42|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1274||||1274|110.51|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1274||||1274|268.93|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1274||||1274|123.97|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1274||||1274|135.37|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1274||||1274|102.28|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MULTIPLAN [1680]|HMA [168003]|1274||||1274|150.41|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1274||||1274|133.4|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1274||||1274|110.51|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|Self-pay|Self-pay|1274||||1274|382.2|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1274||||1274|267.54|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1274||||1274|98.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1274||||1274|148.07|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1274||||1274|610.88|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|UMR [2035]|UMR OPTIONS [203501]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1274||||1274|118.07|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1274||||1274|1146.6|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1274||||1274|0|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1274||||1274|471.38|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1274||||1274|100.27|1184.82|98.27
92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1274||||1274|637|1184.82|98.27
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1533||||1533|748.1|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1533||||1533|218.46|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1533||||1533|204.57|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1533||||1533|204.57|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1533||||1533|212.16|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1533||||1533|768.03|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1533||||1533|538.08|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1533||||1533|659.19|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1533||||1533|653.06|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1533||||1533|766.5|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1533||||1533|996.45|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1533||||1533|0|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1533||||1533|567.21|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|GEHA [1415]|GEHA [141500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1533||||1533|481.9|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1533||||1533|659.19|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1533||||1533|1425.69|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1533||||1533|919.8|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1533||||1533|233.38|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1533||||1533|551.1|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1533||||1533|197.59|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1533||||1533|289.14|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1533||||1533|218.46|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MULTIPLAN [1680]|HMA [168003]|1533||||1533|321.27|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1533||||1533|212.62|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1533||||1533|233.38|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|Self-pay|Self-pay|1533||||1533|459.9|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1533||||1533|321.93|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1533||||1533|209.89|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1533||||1533|312.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1533||||1533|735.07|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|UMR [2035]|UMR OPTIONS [203501]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1533||||1533|188.17|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1533||||1533|1379.7|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1533||||1533|0|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1533||||1533|567.21|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1533||||1533|214.18|1425.69|188.17
92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT COMPLETE BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1533||||1533|766.5|1425.69|188.17
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1507||||1507|735.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1507||||1507|103.45|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1507||||1507|128.35|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1507||||1507|128.35|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1507||||1507|100.46|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1507||||1507|755.01|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1507||||1507|528.96|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1507||||1507|648.01|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1507||||1507|641.98|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1507||||1507|753.5|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1507||||1507|979.55|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1507||||1507|0|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1507||||1507|557.59|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|GEHA [1415]|GEHA [141500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1507||||1507|228.19|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1507||||1507|648.01|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1507||||1507|1401.51|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1507||||1507|904.2|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1507||||1507|110.51|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1507||||1507|268.93|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1507||||1507|123.97|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1507||||1507|136.91|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1507||||1507|103.45|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MULTIPLAN [1680]|HMA [168003]|1507||||1507|152.13|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1507||||1507|133.4|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1507||||1507|110.51|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|Self-pay|Self-pay|1507||||1507|452.1|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1507||||1507|316.47|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1507||||1507|99.39|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1507||||1507|148.07|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1507||||1507|722.61|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|UMR [2035]|UMR OPTIONS [203501]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1507||||1507|118.07|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1507||||1507|1356.3|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1507||||1507|0|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1507||||1507|557.59|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1507||||1507|101.42|1401.51|99.39
92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1507||||1507|753.5|1401.51|99.39
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|1410||||1410|688.08|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1410||||1410|218.46|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1410||||1410|204.57|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1410||||1410|204.57|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1410||||1410|212.16|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1410||||1410|706.41|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1410||||1410|494.91|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1410||||1410|606.3|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1410||||1410|600.66|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1410||||1410|705|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1410||||1410|916.5|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1410||||1410|0|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1410||||1410|521.7|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|GEHA [1415]|GEHA [141500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1410||||1410|481.9|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1410||||1410|606.3|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1410||||1410|1311.3|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1410||||1410|846|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1410||||1410|233.38|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1410||||1410|551.1|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1410||||1410|197.59|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1410||||1410|289.14|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1410||||1410|218.46|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MULTIPLAN [1680]|HMA [168003]|1410||||1410|321.27|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MULTIPLAN [1680]|IHC HS [168011]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1410||||1410|212.62|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1410||||1410|233.38|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|Self-pay|Self-pay|1410||||1410|423|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1410||||1410|296.1|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1410||||1410|207.53|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1410||||1410|312.7|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|TRUSTMARK [2030]|STARMARK [203000]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1410||||1410|676.1|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|UMR [2035]|UMR OPTIONS [203501]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1410||||1410|188.17|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1410||||1410|1269|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1410||||1410|0|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1410||||1410|521.7|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1410||||1410|214.18|1311.3|188.17
92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1410||||1410|705|1311.3|188.17
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|AETNA [1015]|AETNA ACO WILCO [101532]|913||||913|445.54|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|913||||913|103.45|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|913||||913|128.35|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|913||||913|128.35|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|913||||913|100.46|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|913||||913|457.41|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|913||||913|320.46|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|913||||913|392.59|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|913||||913|388.94|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|913||||913|456.5|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|913||||913|593.45|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|CORESOURCE [1315]|CORESOURCE [131500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|913||||913|0|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|913||||913|337.81|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|GEHA [1415]|GEHA [141500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|913||||913|228.19|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HEALTHNET [1495]|HEALTHNET [149500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|913||||913|392.59|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|913||||913|849.09|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|913||||913|547.8|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|913||||913|110.51|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|913||||913|268.93|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|913||||913|123.97|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|913||||913|136.91|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|913||||913|103.45|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MULTIPLAN [1680]|HMA [168003]|913||||913|152.13|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MULTIPLAN [1680]|IHC HS [168011]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|913||||913|133.4|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|913||||913|110.51|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|Self-pay|Self-pay|913||||913|273.9|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|913||||913|191.73|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|913||||913|98.27|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|913||||913|148.07|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|TRUSTMARK [2030]|STARMARK [203000]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|913||||913|437.78|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|UMR [2035]|UMR OPTIONS [203501]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|913||||913|118.07|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|913||||913|821.7|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|913||||913|0|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|913||||913|337.81|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|913||||913|101.42|849.09|98.27
92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|913||||913|456.5|849.09|98.27
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1011||||1011|493.37|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1011||||1011|218.46|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1011||||1011|204.57|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1011||||1011|204.57|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1011||||1011|212.16|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1011||||1011|506.51|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1011||||1011|354.86|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1011||||1011|434.73|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1011||||1011|430.69|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1011||||1011|505.5|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1011||||1011|657.15|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1011||||1011|0|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1011||||1011|374.07|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|GEHA [1415]|GEHA [141500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1011||||1011|481.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1011||||1011|434.73|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1011||||1011|940.23|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1011||||1011|606.6|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1011||||1011|233.38|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1011||||1011|551.1|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1011||||1011|197.59|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1011||||1011|289.14|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1011||||1011|218.46|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|1011||||1011|321.27|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1011||||1011|212.62|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1011||||1011|233.38|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|Self-pay|Self-pay|1011||||1011|303.3|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1011||||1011|212.31|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1011||||1011|209.89|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1011||||1011|312.7|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1011||||1011|484.77|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1011||||1011|188.17|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1011||||1011|909.9|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1011||||1011|0|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1011||||1011|374.07|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1011||||1011|214.18|940.23|188.17
92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ART/VEIN ABD/PEL/SCROT/RETRO COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1011||||1011|505.5|940.23|188.17
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|790||||790|385.52|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|790||||790|103.45|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|790||||790|204.57|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|790||||790|204.57|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|790||||790|100.46|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|790||||790|395.79|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|790||||790|277.29|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|790||||790|339.7|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|790||||790|336.54|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|790||||790|395|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|790||||790|513.5|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|790||||790|0|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|790||||790|292.3|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|GEHA [1415]|GEHA [141500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|790||||790|228.19|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|790||||790|339.7|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|790||||790|734.7|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|790||||790|474|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|790||||790|110.51|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|790||||790|268.93|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|790||||790|197.59|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|790||||790|136.91|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|790||||790|103.45|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MULTIPLAN [1680]|HMA [168003]|790||||790|152.13|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|790||||790|212.62|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|790||||790|110.51|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|Self-pay|Self-pay|790||||790|237|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|790||||790|165.9|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|790||||790|99.39|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|790||||790|148.07|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|790||||790|378.81|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|790||||790|188.17|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|790||||790|711|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|790||||790|0|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|790||||790|292.3|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|790||||790|101.42|734.7|99.39
92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|790||||790|395|734.7|99.39
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|AETNA [1015]|AETNA ACO WILCO [101532]|806||||806|393.33|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|806||||806|218.46|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|806||||806|204.57|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|806||||806|204.57|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|806||||806|212.16|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|806||||806|403.81|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|806||||806|282.91|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|806||||806|346.58|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|806||||806|343.36|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|806||||806|403|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|806||||806|523.9|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|CORESOURCE [1315]|CORESOURCE [131500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|806||||806|0|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|806||||806|298.22|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|GEHA [1415]|GEHA [141500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|806||||806|481.9|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HEALTHNET [1495]|HEALTHNET [149500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|806||||806|346.58|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|806||||806|749.58|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|806||||806|483.6|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|806||||806|233.38|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|806||||806|551.1|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|806||||806|197.59|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|806||||806|289.14|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|806||||806|218.46|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MULTIPLAN [1680]|HMA [168003]|806||||806|321.27|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MULTIPLAN [1680]|IHC HS [168011]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|806||||806|212.62|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|806||||806|233.38|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|Self-pay|Self-pay|806||||806|241.8|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|806||||806|169.26|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|806||||806|207.53|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|806||||806|312.7|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|TRUSTMARK [2030]|STARMARK [203000]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|806||||806|386.48|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|UMR [2035]|UMR OPTIONS [203501]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|806||||806|188.17|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|806||||806|725.4|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|806||||806|0|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|806||||806|298.22|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|806||||806|214.18|749.58|169.26
92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|806||||806|403|749.58|169.26
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|AETNA [1015]|AETNA ACO WILCO [101532]|556||||556|271.33|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|556||||556|103.45|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|556||||556|128.35|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|556||||556|128.35|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|556||||556|100.46|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|556||||556|278.56|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|556||||556|195.16|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|556||||556|239.08|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|556||||556|236.86|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|556||||556|278|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|556||||556|361.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|CORESOURCE [1315]|CORESOURCE [131500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|CORVEL CORP [2235]|CORVEL CORP [223500]|556||||556|0|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|556||||556|205.72|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|GEHA [1415]|GEHA [141500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|556||||556|228.19|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HEALTHNET [1495]|HEALTHNET [149500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|556||||556|239.08|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HEALTHSMART [1505]|HEALTHSMART [150501]|556||||556|517.08|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|556||||556|333.6|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|556||||556|110.51|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|556||||556|268.93|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|556||||556|123.97|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|556||||556|136.91|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|556||||556|103.45|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MULTIPLAN [1680]|HMA [168003]|556||||556|152.13|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MULTIPLAN [1680]|IHC HS [168011]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|556||||556|133.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|556||||556|110.51|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|Self-pay|Self-pay|556||||556|166.8|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|556||||556|116.76|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|556||||556|99.39|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|556||||556|148.07|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|TRUSTMARK [2030]|STARMARK [203000]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|556||||556|266.6|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|UMR [2035]|UMR OPTIONS [203501]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|556||||556|118.07|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|556||||556|500.4|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|556||||556|0|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|556||||556|205.72|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|556||||556|101.42|517.08|99.39
92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|556||||556|278|517.08|99.39
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|AETNA [1015]|AETNA ACO WILCO [101532]|311||||311|151.77|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|311||||311|103.45|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|311||||311|128.35|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|311||||311|128.35|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|311||||311|100.46|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|311||||311|155.81|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|311||||311|109.16|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|311||||311|133.73|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|311||||311|132.49|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|311||||311|155.5|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|311||||311|202.15|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|CORESOURCE [1315]|CORESOURCE [131500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|311||||311|0|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|311||||311|115.07|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|GEHA [1415]|GEHA [141500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|311||||311|228.19|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HEALTHNET [1495]|HEALTHNET [149500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|311||||311|133.73|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|311||||311|289.23|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|311||||311|186.6|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|311||||311|110.51|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|311||||311|268.93|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|311||||311|123.97|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|311||||311|136.91|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|311||||311|103.45|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MULTIPLAN [1680]|HMA [168003]|311||||311|152.13|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MULTIPLAN [1680]|IHC HS [168011]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|311||||311|133.4|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|311||||311|110.51|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|Self-pay|Self-pay|311||||311|93.3|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|311||||311|65.31|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|311||||311|99.39|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|311||||311|148.07|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|TRUSTMARK [2030]|STARMARK [203000]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|311||||311|149.12|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|UMR [2035]|UMR OPTIONS [203501]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|311||||311|118.07|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|311||||311|279.9|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|311||||311|0|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|311||||311|115.07|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|311||||311|101.42|289.23|65.31
92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|311||||311|155.5|289.23|65.31
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|AETNA [1015]|AETNA ACO WILCO [101532]|313||||313|0|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|313||||313|105.28|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|313||||313|125.24|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|313||||313|125.24|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|313||||313|156.81|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|313||||313|109.86|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|313||||313|134.59|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|313||||313|133.34|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|313||||313|156.5|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|313||||313|203.45|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|CORESOURCE [1315]|CORESOURCE [131500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|CORVEL CORP [2235]|CORVEL CORP [223500]|313||||313|0|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|313||||313|115.81|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|GEHA [1415]|GEHA [141500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|313||||313|232.22|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HEALTHNET [1495]|HEALTHNET [149500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|313||||313|134.59|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|313||||313|291.09|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|313||||313|187.8|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|313||||313|113.53|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|313||||313|254.52|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|313||||313|120.96|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|313||||313|139.33|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|313||||313|105.28|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MULTIPLAN [1680]|HMA [168003]|313||||313|154.82|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MULTIPLAN [1680]|IHC HS [168011]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|313||||313|130.17|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|313||||313|113.53|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|Self-pay|Self-pay|313||||313|93.9|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|313||||313|65.73|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|313||||313|101.15|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|313||||313|150.69|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|TRUSTMARK [2030]|STARMARK [203000]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|313||||313|150.08|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|UMR [2035]|UMR OPTIONS [203501]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|313||||313|115.2|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|313||||313|281.7|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|313||||313|0|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|313||||313|115.81|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|313||||313|103.21|291.09|65.73
92295860|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG ONE EXTREMITY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|313||||313|156.5|291.09|65.73
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|345||||345|0|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|345||||345|106.4|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|345||||345|106.4|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|345||||345|172.85|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|345||||345|121.1|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|345||||345|148.35|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|345||||345|146.97|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|345||||345|172.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|345||||345|224.25|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|CORESOURCE [1315]|CORESOURCE [131500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|345||||345|0|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|345||||345|127.65|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|GEHA [1415]|GEHA [141500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HEALTHNET [1495]|HEALTHNET [149500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|345||||345|148.35|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|345||||345|320.85|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|345||||345|207|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|345||||345|254.52|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|345||||345|102.77|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MULTIPLAN [1680]|HMA [168003]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MULTIPLAN [1680]|IHC HS [168011]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|345||||345|110.59|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|Self-pay|Self-pay|345||||345|103.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|345||||345|72.45|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|TRUSTMARK [2030]|STARMARK [203000]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|345||||345|165.43|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|UMR [2035]|UMR OPTIONS [203501]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|345||||345|97.87|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|345||||345|310.5|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|345||||345|0|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|345||||345|127.65|320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|345||||345||320.85|72.45
92295861|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG TWO EXTREMITIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|345||||345|172.5|320.85|72.45
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|390||||390|0|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390||||390|106.4|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390||||390|106.4|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|390||||390|195.39|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390||||390|136.89|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390||||390|167.7|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|390||||390|166.14|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|390||||390|195|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390||||390|253.5|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|CORESOURCE [1315]|CORESOURCE [131500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|390||||390|0|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|390||||390|144.3|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|GEHA [1415]|GEHA [141500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HEALTHNET [1495]|HEALTHNET [149500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390||||390|167.7|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|390||||390|362.7|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390||||390|234|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390||||390|324.96|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390||||390|102.77|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MULTIPLAN [1680]|HMA [168003]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MULTIPLAN [1680]|IHC HS [168011]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|390||||390|110.59|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|Self-pay|Self-pay|390||||390|117|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390||||390|81.9|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|TRUSTMARK [2030]|STARMARK [203000]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390||||390|187.01|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|UMR [2035]|UMR OPTIONS [203501]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390||||390|97.87|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390||||390|351|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|390||||390|0|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|390||||390|144.3|362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|390||||390||362.7|81.9
92295863|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG THREE EXTREMITIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|390||||390|195|362.7|81.9
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|429||||429|0|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|429||||429|106.4|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|429||||429|106.4|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|429||||429|214.93|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|429||||429|150.58|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|429||||429|184.47|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|429||||429|182.75|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|429||||429|214.5|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|429||||429|278.85|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|CORESOURCE [1315]|CORESOURCE [131500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|429||||429|0|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|429||||429|158.73|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|GEHA [1415]|GEHA [141500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HEALTHNET [1495]|HEALTHNET [149500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|429||||429|184.47|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|429||||429|398.97|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|429||||429|257.4|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|429||||429|324.96|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|429||||429|102.77|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MULTIPLAN [1680]|HMA [168003]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MULTIPLAN [1680]|IHC HS [168011]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|429||||429|110.59|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|Self-pay|Self-pay|429||||429|128.7|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|429||||429|90.09|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|TRUSTMARK [2030]|STARMARK [203000]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|429||||429|205.71|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|UMR [2035]|UMR OPTIONS [203501]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|429||||429|97.87|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|429||||429|386.1|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|429||||429|0|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|429||||429|158.73|398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|429||||429||398.97|90.09
92295864|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG FOUR EXTREMITIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|429||||429|214.5|398.97|90.09
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|274||||274|137.27|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|274||||274|96.17|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|274||||274|117.82|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|274||||274|116.72|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|274||||274|137|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|274||||274|178.1|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|CORESOURCE [1315]|CORESOURCE [131500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|274||||274|101.38|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|GEHA [1415]|GEHA [141500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HEALTHNET [1495]|HEALTHNET [149500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|274||||274|117.82|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|274||||274|254.82|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|274||||274|164.4|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|274||||274|137|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MULTIPLAN [1680]|HMA [168003]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MULTIPLAN [1680]|IHC HS [168011]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|Self-pay|Self-pay|274||||274|82.2|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|274||||274|57.54|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|TRUSTMARK [2030]|STARMARK [203000]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|274||||274|131.38|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|UMR [2035]|UMR OPTIONS [203501]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|274||||274|246.6|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|274||||274|0|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|274||||274|101.38|254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|274||||274||254.82|57.54
92295873|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC ELECTRICAL STIMULATION GUID W/CHEMODENERVATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|274||||274|137|254.82|57.54
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|AETNA [1015]|AETNA ACO WILCO [101532]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|232||||232|116.23|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232||||232|81.43|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232||||232|99.76|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|232||||232|98.83|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|232||||232|116|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232||||232|150.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|CORESOURCE [1315]|CORESOURCE [131500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|CORVEL CORP [2235]|CORVEL CORP [223500]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|232||||232|85.84|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|GEHA [1415]|GEHA [141500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HEALTHNET [1495]|HEALTHNET [149500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232||||232|99.76|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HEALTHSMART [1505]|HEALTHSMART [150501]|232||||232|215.76|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232||||232|139.2|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232||||232|116|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MULTIPLAN [1680]|HMA [168003]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MULTIPLAN [1680]|IHC HS [168011]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|Self-pay|Self-pay|232||||232|69.6|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232||||232|48.72|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|TRUSTMARK [2030]|STARMARK [203000]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232||||232|111.24|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|UMR [2035]|UMR OPTIONS [203501]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232||||232|208.8|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|232||||232|0|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|232||||232|85.84|215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|232||||232||215.76|48.72
92295874|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NEEDLE EMG GUID W/CHEMODENERVATION|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|232||||232|116|215.76|48.72
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|AETNA [1015]|AETNA ACO WILCO [101532]|381||||381|0|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|381||||381|106.82|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|381||||381|106.82|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|381||||381|190.88|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|381||||381|133.73|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|381||||381|163.83|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|381||||381|162.31|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|381||||381|190.5|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|381||||381|247.65|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|CORESOURCE [1315]|CORESOURCE [131500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|381||||381|0|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|381||||381|140.97|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|GEHA [1415]|GEHA [141500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HEALTHNET [1495]|HEALTHNET [149500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|381||||381|163.83|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|381||||381|354.33|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|381||||381|228.6|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|381||||381|190.5|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|381||||381|103.17|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MULTIPLAN [1680]|HMA [168003]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MULTIPLAN [1680]|IHC HS [168011]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|381||||381|111.03|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|Self-pay|Self-pay|381||||381|114.3|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|381||||381|80.01|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|TRUSTMARK [2030]|STARMARK [203000]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|381||||381|182.69|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|UMR [2035]|UMR OPTIONS [203501]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|381||||381|98.25|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|381||||381|342.9|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|381||||381|0|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|381||||381|140.97|354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|381||||381||354.33|80.01
92295885|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TST LIMITED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|381||||381|190.5|354.33|80.01
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|AETNA [1015]|AETNA ACO WILCO [101532]|496||||496|0|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|496||||496|106.82|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|496||||496|106.82|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|496||||496|248.5|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|496||||496|174.1|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|496||||496|213.28|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|496||||496|211.3|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|496||||496|248|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|496||||496|322.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|CORESOURCE [1315]|CORESOURCE [131500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|496||||496|0|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|496||||496|183.52|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|GEHA [1415]|GEHA [141500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HEALTHNET [1495]|HEALTHNET [149500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|496||||496|213.28|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|496||||496|461.28|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|496||||496|297.6|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|496||||496|248|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|496||||496|103.17|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MULTIPLAN [1680]|HMA [168003]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MULTIPLAN [1680]|IHC HS [168011]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|496||||496|111.03|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|Self-pay|Self-pay|496||||496|148.8|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|496||||496|104.16|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|TRUSTMARK [2030]|STARMARK [203000]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|496||||496|237.83|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|UMR [2035]|UMR OPTIONS [203501]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|496||||496|98.25|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|496||||496|446.4|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|496||||496|0|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|496||||496|183.52|461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|496||||496||461.28|98.25
92295886|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EMG EA EXT W/NERVE TEST COMP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|496||||496|248|461.28|98.25
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|AETNA [1015]|AETNA ACO WILCO [101532]|390||||390|0|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390||||390|131.23|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390||||390|53.76|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390||||390|53.76|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|390||||390|195.39|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390||||390|136.89|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390||||390|167.7|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|390||||390|166.14|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|390||||390|195|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390||||390|253.5|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|CORESOURCE [1315]|CORESOURCE [131500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|CORVEL CORP [2235]|CORVEL CORP [223500]|390||||390|0|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|390||||390|144.3|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|GEHA [1415]|GEHA [141500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|390||||390|289.47|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HEALTHNET [1495]|HEALTHNET [149500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390||||390|167.7|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HEALTHSMART [1505]|HEALTHSMART [150501]|390||||390|362.7|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390||||390|234|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390||||390|141.52|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390||||390|324.96|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390||||390|51.92|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390||||390|173.68|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390||||390|131.23|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MULTIPLAN [1680]|HMA [168003]|390||||390|192.98|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MULTIPLAN [1680]|IHC HS [168011]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|390||||390|55.88|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390||||390|141.52|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|Self-pay|Self-pay|390||||390|117|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390||||390|81.9|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|390||||390|126.08|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390||||390|187.83|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|TRUSTMARK [2030]|STARMARK [203000]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390||||390|187.01|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|UMR [2035]|UMR OPTIONS [203501]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390||||390|49.44|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390||||390|351|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|390||||390|0|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|390||||390|144.3|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|390||||390|128.65|362.7|49.44
92295907|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION STUDY 1-2|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|390||||390|195|362.7|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|739||||739|0|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|739||||739|53.76|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|739||||739|53.76|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|739||||739|370.24|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|739||||739|259.39|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|739||||739|317.77|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|739||||739|314.81|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|739||||739|369.5|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|739||||739|480.35|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|739||||739|0|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|739||||739|273.43|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|GEHA [1415]|GEHA [141500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|739||||739|317.77|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|739||||739|687.27|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|739||||739|443.4|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|739||||739|603.08|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|739||||739|51.92|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MULTIPLAN [1680]|HMA [168003]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|739||||739|55.88|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|Self-pay|Self-pay|739||||739|221.7|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|739||||739|155.19|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|739||||739|354.35|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|739||||739|49.44|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|739||||739|665.1|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|739||||739|0|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|739||||739|273.43|687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|739||||739||687.27|49.44
92295908|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 3-4 STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|739||||739|369.5|687.27|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|813||||813|0|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|813||||813|53.76|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|813||||813|53.76|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|813||||813|407.31|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|813||||813|285.36|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|813||||813|349.59|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|813||||813|346.34|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|813||||813|406.5|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|813||||813|528.45|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|813||||813|0|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|813||||813|300.81|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|GEHA [1415]|GEHA [141500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|813||||813|349.59|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|813||||813|756.09|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|813||||813|487.8|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|813||||813|603.08|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|813||||813|51.92|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MULTIPLAN [1680]|HMA [168003]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|813||||813|55.88|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|Self-pay|Self-pay|813||||813|243.9|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|813||||813|170.73|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|813||||813|389.83|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|813||||813|49.44|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|813||||813|731.7|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|813||||813|0|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|813||||813|300.81|756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|813||||813||756.09|49.44
92295909|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 5-6 STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|813||||813|406.5|756.09|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|739||||739|0|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|739||||739|248.68|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|739||||739|53.76|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|739||||739|53.76|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|739||||739|370.24|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|739||||739|259.39|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|739||||739|317.77|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|739||||739|314.81|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|739||||739|369.5|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|739||||739|480.35|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|739||||739|0|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|739||||739|273.43|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|GEHA [1415]|GEHA [141500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|739||||739|548.56|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|739||||739|317.77|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|739||||739|687.27|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|739||||739|443.4|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|739||||739|268.18|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|739||||739|603.08|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|739||||739|51.92|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|739||||739|329.13|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|739||||739|248.68|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MULTIPLAN [1680]|HMA [168003]|739||||739|365.7|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|739||||739|55.88|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|739||||739|268.18|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|Self-pay|Self-pay|739||||739|221.7|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|739||||739|155.19|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|739||||739|238.93|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|739||||739|355.95|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|739||||739|354.35|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|739||||739|49.44|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|739||||739|665.1|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|739||||739|0|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|739||||739|273.43|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|739||||739|243.8|687.27|49.44
92295910|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 7-8 STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|739||||739|369.5|687.27|49.44
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1362||||1362|0|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1362||||1362|458.7|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1362||||1362|99.55|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1362||||1362|99.55|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1362||||1362|682.36|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1362||||1362|478.06|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1362||||1362|585.66|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1362||||1362|580.21|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1362||||1362|681|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1362||||1362|885.3|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1362||||1362|0|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1362||||1362|503.94|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|GEHA [1415]|GEHA [141500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1362||||1362|1011.84|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1362||||1362|585.66|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1362||||1362|1266.66|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1362||||1362|817.2|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1362||||1362|494.68|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1362||||1362|1088.21|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1362||||1362|96.15|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1362||||1362|607.1|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1362||||1362|458.7|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MULTIPLAN [1680]|HMA [168003]|1362||||1362|674.56|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1362||||1362|103.47|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1362||||1362|494.68|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|Self-pay|Self-pay|1362||||1362|408.6|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1362||||1362|286.02|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1362||||1362|440.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1362||||1362|656.57|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1362||||1362|653.08|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1362||||1362|91.57|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1362||||1362|1225.8|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1362||||1362|0|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1362||||1362|503.94|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1362||||1362|449.71|1266.66|91.57
92295911|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 9-10 STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1362||||1362|681|1266.66|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1499||||1499|0|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1499||||1499|458.7|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1499||||1499|99.55|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1499||||1499|99.55|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1499||||1499|751|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1499||||1499|526.15|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1499||||1499|644.57|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1499||||1499|638.57|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1499||||1499|749.5|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1499||||1499|974.35|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1499||||1499|0|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1499||||1499|554.63|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|GEHA [1415]|GEHA [141500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1499||||1499|1011.84|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1499||||1499|644.57|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1499||||1499|1394.07|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1499||||1499|899.4|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1499||||1499|494.68|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1499||||1499|1088.21|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1499||||1499|96.15|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1499||||1499|607.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1499||||1499|458.7|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MULTIPLAN [1680]|HMA [168003]|1499||||1499|674.56|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1499||||1499|103.47|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1499||||1499|494.68|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|Self-pay|Self-pay|1499||||1499|449.7|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1499||||1499|314.79|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1499||||1499|440.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1499||||1499|656.57|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1499||||1499|718.77|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1499||||1499|91.57|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1499||||1499|1349.1|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1499||||1499|0|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1499||||1499|554.63|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1499||||1499|449.71|1394.07|91.57
92295912|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 11-12 STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1499||||1499|749.5|1394.07|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|AETNA [1015]|AETNA ACO WILCO [101532]|1362||||1362|0|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1362||||1362|458.7|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1362||||1362|99.55|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1362||||1362|99.55|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1362||||1362|682.36|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1362||||1362|478.06|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1362||||1362|585.66|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1362||||1362|580.21|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1362||||1362|681|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1362||||1362|885.3|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|CORESOURCE [1315]|CORESOURCE [131500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1362||||1362|0|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1362||||1362|503.94|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|GEHA [1415]|GEHA [141500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1362||||1362|1011.84|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HEALTHNET [1495]|HEALTHNET [149500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1362||||1362|585.66|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1362||||1362|1266.66|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1362||||1362|817.2|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1362||||1362|494.68|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1362||||1362|1088.21|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1362||||1362|96.15|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1362||||1362|607.1|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1362||||1362|458.7|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MULTIPLAN [1680]|HMA [168003]|1362||||1362|674.56|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MULTIPLAN [1680]|IHC HS [168011]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1362||||1362|103.47|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1362||||1362|494.68|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|Self-pay|Self-pay|1362||||1362|408.6|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1362||||1362|286.02|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1362||||1362|440.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1362||||1362|656.57|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|TRUSTMARK [2030]|STARMARK [203000]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1362||||1362|653.08|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|UMR [2035]|UMR OPTIONS [203501]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1362||||1362|91.57|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1362||||1362|1225.8|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1362||||1362|0|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1362||||1362|503.94|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1362||||1362|449.71|1266.66|91.57
92295913|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC NERVE CONDUCTION 13+ STUDIES|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1362||||1362|681|1266.66|91.57
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2011||||2011|0|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2011||||2011|238.6|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2011||||2011|238.6|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2011||||2011|1007.51|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2011||||2011|705.86|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2011||||2011|864.73|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2011||||2011|856.69|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2011||||2011|1005.5|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2011||||2011|1307.15|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|CORESOURCE [1315]|CORESOURCE [131500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2011||||2011|0|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2011||||2011|744.07|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|GEHA [1415]|GEHA [141500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HEALTHNET [1495]|HEALTHNET [149500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2011||||2011|864.73|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2011||||2011|1870.23|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2011||||2011|1206.6|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2011||||2011|603.08|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2011||||2011|230.45|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MULTIPLAN [1680]|HMA [168003]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MULTIPLAN [1680]|IHC HS [168011]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2011||||2011|247.99|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|Self-pay|Self-pay|2011||||2011|603.3|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2011||||2011|422.31|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|TRUSTMARK [2030]|STARMARK [203000]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2011||||2011|964.27|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|UMR [2035]|UMR OPTIONS [203501]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2011||||2011|219.47|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2011||||2011|1809.9|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2011||||2011|0|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2011||||2011|744.07|1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2011||||2011||1870.23|219.47
92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2011||||2011|1005.5|1870.23|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|AETNA [1015]|AETNA ACO WILCO [101532]|2229||||2229|0|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2229||||2229|238.6|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2229||||2229|238.6|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2229||||2229|1116.73|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2229||||2229|782.38|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2229||||2229|958.47|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2229||||2229|949.55|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2229||||2229|1114.5|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2229||||2229|1448.85|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|CORESOURCE [1315]|CORESOURCE [131500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2229||||2229|0|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2229||||2229|824.73|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|GEHA [1415]|GEHA [141500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HEALTHNET [1495]|HEALTHNET [149500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2229||||2229|958.47|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2229||||2229|2072.97|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2229||||2229|1337.4|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2229||||2229|603.08|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2229||||2229|230.45|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MULTIPLAN [1680]|HMA [168003]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MULTIPLAN [1680]|IHC HS [168011]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2229||||2229|247.99|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|Self-pay|Self-pay|2229||||2229|668.7|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2229||||2229|468.09|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|TRUSTMARK [2030]|STARMARK [203000]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2229||||2229|1068.81|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|UMR [2035]|UMR OPTIONS [203501]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2229||||2229|219.47|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2229||||2229|2006.1|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2229||||2229|0|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2229||||2229|824.73|2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2229||||2229||2072.97|219.47
92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2229||||2229|1114.5|2072.97|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|1859||||1859|0|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1859||||1859|238.6|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1859||||1859|238.6|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1859||||1859|931.36|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1859||||1859|652.51|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1859||||1859|799.37|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1859||||1859|791.93|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1859||||1859|929.5|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1859||||1859|1208.35|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|CORESOURCE [1315]|CORESOURCE [131500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1859||||1859|0|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1859||||1859|687.83|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|GEHA [1415]|GEHA [141500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HEALTHNET [1495]|HEALTHNET [149500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1859||||1859|799.37|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1859||||1859|1728.87|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1859||||1859|1115.4|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1859||||1859|324.96|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1859||||1859|230.45|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MULTIPLAN [1680]|HMA [168003]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MULTIPLAN [1680]|IHC HS [168011]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1859||||1859|247.99|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|Self-pay|Self-pay|1859||||1859|557.7|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1859||||1859|390.39|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|TRUSTMARK [2030]|STARMARK [203000]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1859||||1859|891.39|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|UMR [2035]|UMR OPTIONS [203501]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1859||||1859|219.47|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1859||||1859|1673.1|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1859||||1859|0|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1859||||1859|687.83|1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1859||||1859||1728.87|219.47
92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1859||||1859|929.5|1728.87|219.47
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|157.38||||157.38|78.85|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|157.38||||157.38|55.24|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|157.38||||157.38|67.67|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|157.38||||157.38|67.04|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|157.38||||157.38|78.69|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|157.38||||157.38|102.3|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|157.38||||157.38|4.15|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|157.38||||157.38|58.23|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|GEHA [1415]|GEHA [141500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|157.38||||157.38|67.67|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|157.38||||157.38|146.36|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|157.38||||157.38|94.43|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|157.38||||157.38|55.08|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|157.38||||157.38|47.21|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|157.38||||157.38|33.05|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|157.38||||157.38|2.94|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|157.38||||157.38|75.46|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|157.38||||157.38|141.64|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|157.38||||157.38|0|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|157.38||||157.38|58.23|146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|157.38||||157.38||146.36|2.94
92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|157.38||||157.38|78.69|146.36|2.94
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32.71||||32.71|16.39|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.71||||32.71|11.48|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.71||||32.71|14.07|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32.71||||32.71|13.93|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32.71||||32.71|16.36|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.71||||32.71|21.26|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32.71||||32.71|12.1|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.71||||32.71|14.07|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|32.71||||32.71|30.42|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.71||||32.71|19.63|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|Self-pay|Self-pay|32.71||||32.71|9.81|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.71||||32.71|6.87|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.71||||32.71|15.68|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.71||||32.71|29.44|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32.71||||32.71|0|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32.71||||32.71|12.1|30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32.71||||32.71||30.42|6.87
9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32.71||||32.71|16.36|30.42|6.87
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30.29||||30.29|15.18|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.29||||30.29|10.63|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.29||||30.29|13.02|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30.29||||30.29|12.9|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30.29||||30.29|15.15|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.29||||30.29|19.69|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30.29||||30.29|11.21|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.29||||30.29|13.02|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|30.29||||30.29|28.17|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.29||||30.29|18.17|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|Self-pay|Self-pay|30.29||||30.29|9.09|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.29||||30.29|6.36|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.29||||30.29|14.52|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.29||||30.29|27.26|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30.29||||30.29|0|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30.29||||30.29|11.21|28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30.29||||30.29||28.17|6.36
9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30.29||||30.29|15.15|28.17|6.36
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29.5||||29.5|14.78|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.5||||29.5|10.35|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.5||||29.5|12.69|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29.5||||29.5|12.57|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29.5||||29.5|14.75|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.5||||29.5|19.18|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29.5||||29.5|10.92|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|GEHA [1415]|GEHA [141500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.5||||29.5|12.69|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29.5||||29.5|27.44|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.5||||29.5|17.7|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MULTIPLAN [1680]|HMA [168003]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|Self-pay|Self-pay|29.5||||29.5|8.85|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.5||||29.5|6.2|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.5||||29.5|14.15|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|UMR [2035]|UMR OPTIONS [203501]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.5||||29.5|26.55|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29.5||||29.5|0|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29.5||||29.5|10.92|27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29.5||||29.5||27.44|6.2
9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29.5||||29.5|14.75|27.44|6.2
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|498.21||||498.21|249.6|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|498.21||||498.21|174.87|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|498.21||||498.21|214.23|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|498.21||||498.21|212.24|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|498.21||||498.21|249.11|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|498.21||||498.21|323.84|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|498.21||||498.21|144.54|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|498.21||||498.21|184.34|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|GEHA [1415]|GEHA [141500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|498.21||||498.21|214.23|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|498.21||||498.21|463.34|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|498.21||||498.21|298.93|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|498.21||||498.21|249.11|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MULTIPLAN [1680]|HMA [168003]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MULTIPLAN [1680]|IHC HS [168011]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|Self-pay|Self-pay|498.21||||498.21|149.46|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|498.21||||498.21|104.62|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|498.21||||498.21|156.46|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|TRUSTMARK [2030]|STARMARK [203000]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|498.21||||498.21|238.89|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|UMR [2035]|UMR OPTIONS [203501]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|498.21||||498.21|448.39|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|498.21||||498.21|0|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|498.21||||498.21|184.34|463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|498.21||||498.21||463.34|104.62
93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|498.21||||498.21|249.11|463.34|104.62
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|3 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|AETNA [1015]|AETNA ACO WILCO [101532]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|150||||150|75.15|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150||||150|52.65|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150||||150|64.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|150||||150|63.9|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|150||||150|75|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150||||150|97.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|CORESOURCE [1315]|CORESOURCE [131500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|150||||150|55.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|GEHA [1415]|GEHA [141500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HEALTHNET [1495]|HEALTHNET [149500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150||||150|64.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|150||||150|139.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150||||150|90|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MULTIPLAN [1680]|HMA [168003]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MULTIPLAN [1680]|IHC HS [168011]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|Self-pay|Self-pay|150||||150|45|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150||||150|31.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|TRUSTMARK [2030]|STARMARK [203000]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150||||150|71.93|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|UMR [2035]|UMR OPTIONS [203501]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150||||150|135|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|150||||150|0|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|150||||150|55.5|139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|150||||150||139.5|31.5
94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|150||||150|75|139.5|31.5
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|AETNA [1015]|AETNA ACO WILCO [101532]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|194||||194|97.19|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194||||194|68.09|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194||||194|83.42|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|194||||194|82.64|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|194||||194|97|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194||||194|126.1|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|CORESOURCE [1315]|CORESOURCE [131500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|194||||194|71.78|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|GEHA [1415]|GEHA [141500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HEALTHNET [1495]|HEALTHNET [149500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194||||194|83.42|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|194||||194|180.42|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194||||194|116.4|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MULTIPLAN [1680]|HMA [168003]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MULTIPLAN [1680]|IHC HS [168011]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|Self-pay|Self-pay|194||||194|58.2|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194||||194|40.74|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|TRUSTMARK [2030]|STARMARK [203000]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194||||194|93.02|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|UMR [2035]|UMR OPTIONS [203501]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194||||194|174.6|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|194||||194|0|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|194||||194|71.78|180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|194||||194||180.42|40.74
94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|194||||194|97|180.42|40.74
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|AETNA [1015]|AETNA ACO WILCO [101532]|1097||||1097|0|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1097||||1097|167.25|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1097||||1097|167.25|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1097||||1097|549.6|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1097||||1097|385.05|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1097||||1097|471.71|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1097||||1097|467.32|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1097||||1097|548.5|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1097||||1097|713.05|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|CORESOURCE [1315]|CORESOURCE [131500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1097||||1097|0|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1097||||1097|405.89|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|GEHA [1415]|GEHA [141500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HEALTHNET [1495]|HEALTHNET [149500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1097||||1097|471.71|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1097||||1097|1020.21|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1097||||1097|658.2|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1097||||1097|591.53|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1097||||1097|161.54|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MULTIPLAN [1680]|HMA [168003]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MULTIPLAN [1680]|IHC HS [168011]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1097||||1097|173.84|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|Self-pay|Self-pay|1097||||1097|329.1|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1097||||1097|230.37|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|TRUSTMARK [2030]|STARMARK [203000]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1097||||1097|526.01|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|UMR [2035]|UMR OPTIONS [203501]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1097||||1097|153.84|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1097||||1097|987.3|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1097||||1097|0|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1097||||1097|405.89|1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1097||||1097||1020.21|153.84
94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1097||||1097|548.5|1020.21|153.84
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|Self-pay|Self-pay|10||||10|3|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|1 lozenge|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|145||||145|0|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145||||145|32.45|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145||||145|21.69|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145||||145|21.69|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|145||||145|72.65|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145||||145|50.9|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145||||145|62.35|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|145||||145|61.77|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|145||||145|72.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145||||145|94.25|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|145||||145|0|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|145||||145|53.65|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|GEHA [1415]|GEHA [141500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|145||||145|71.57|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145||||145|62.35|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|145||||145|134.85|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145||||145|87|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145||||145|34.99|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145||||145|72.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145||||145|20.95|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145||||145|42.94|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145||||145|32.45|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MULTIPLAN [1680]|HMA [168003]|145||||145|47.72|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MULTIPLAN [1680]|IHC HS [168011]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|145||||145|22.54|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145||||145|34.99|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|Self-pay|Self-pay|145||||145|43.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145||||145|30.45|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|145||||145|31.17|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145||||145|44.53|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|TRUSTMARK [2030]|STARMARK [203000]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145||||145|69.53|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|UMR [2035]|UMR OPTIONS [203501]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145||||145|19.96|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145||||145|130.5|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|145||||145|0|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|145||||145|53.65|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|145||||145|31.81|134.85|19.96
94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|145||||145|72.5|134.85|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|110||||110|0|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110||||110|27.69|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110||||110|21.69|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110||||110|21.69|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110||||110|55.11|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110||||110|38.61|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110||||110|47.3|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110||||110|46.86|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110||||110|55|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110||||110|71.5|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110||||110|0|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110||||110|40.7|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|GEHA [1415]|GEHA [141500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110||||110|61.09|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110||||110|47.3|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110||||110|102.3|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110||||110|66|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110||||110|29.87|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110||||110|55|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110||||110|20.95|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110||||110|36.65|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110||||110|27.69|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MULTIPLAN [1680]|HMA [168003]|110||||110|40.73|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MULTIPLAN [1680]|IHC HS [168011]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110||||110|22.54|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110||||110|29.87|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|Self-pay|Self-pay|110||||110|33|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110||||110|23.1|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110||||110|26.61|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110||||110|38.01|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|TRUSTMARK [2030]|STARMARK [203000]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110||||110|52.75|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|UMR [2035]|UMR OPTIONS [203501]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110||||110|19.96|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110||||110|99|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110||||110|0|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110||||110|40.7|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110||||110|27.15|102.3|19.96
94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110||||110|55|102.3|19.96
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|AETNA [1015]|AETNA ACO WILCO [101532]|48||||48|0|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48||||48|17.3|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48||||48|17.3|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48||||48|24.05|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48||||48|16.85|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48||||48|20.64|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48||||48|20.45|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48||||48|24|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48||||48|31.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|CORESOURCE [1315]|CORESOURCE [131500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48||||48|0|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48||||48|17.76|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|GEHA [1415]|GEHA [141500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HEALTHNET [1495]|HEALTHNET [149500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48||||48|20.64|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48||||48|44.64|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48||||48|28.8|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48||||48|24|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48||||48|16.71|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MULTIPLAN [1680]|HMA [168003]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MULTIPLAN [1680]|IHC HS [168011]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48||||48|17.98|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|Self-pay|Self-pay|48||||48|14.4|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48||||48|10.08|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|TRUSTMARK [2030]|STARMARK [203000]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48||||48|23.02|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|UMR [2035]|UMR OPTIONS [203501]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48||||48|15.91|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48||||48|43.2|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48||||48|0|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48||||48|17.76|44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48||||48||44.64|10.08
94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48||||48|24|44.64|10.08
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA ACO WILCO [101532]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51.66||||51.66|25.88|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51.66||||51.66|18.13|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51.66||||51.66|22.21|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51.66||||51.66|22.01|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51.66||||51.66|25.83|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51.66||||51.66|33.58|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|CORESOURCE [1315]|CORESOURCE [131500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|CORVEL CORP [2235]|CORVEL CORP [223500]|51.66||||51.66|8.24|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51.66||||51.66|19.11|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|GEHA [1415]|GEHA [141500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHNET [1495]|HEALTHNET [149500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51.66||||51.66|22.21|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART [150501]|51.66||||51.66|48.04|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51.66||||51.66|31|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|HMA [168003]|51.66||||51.66|18.08|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|IHC HS [168011]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|Self-pay|Self-pay|51.66||||51.66|15.5|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51.66||||51.66|10.85|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51.66||||51.66|8.27|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|TRUSTMARK [2030]|STARMARK [203000]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51.66||||51.66|24.77|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|UMR [2035]|UMR OPTIONS [203501]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51.66||||51.66|46.49|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51.66||||51.66|0|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51.66||||51.66|19.11|48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51.66||||51.66||48.04|8.24
9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|2 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51.66||||51.66|25.83|48.04|8.24
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|2.53|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|Self-pay|Self-pay|29||||29|8.7|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|2.67|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|2.53
9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|1 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|2.53
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|14.53|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|10.18|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|12.35|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|5.06|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29||||29|17.4|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|HMA [168003]|29||||29|10.15|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|Self-pay|Self-pay|29||||29|8.7|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29|5.34|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|13.91|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|5.06
9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|2 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|5.06
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14.31||||14.31|7.17|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.31||||14.31|5.02|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.31||||14.31|6.15|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14.31||||14.31|6.1|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14.31||||14.31|7.16|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.31||||14.31|9.3|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14.31||||14.31|5.29|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.31||||14.31|6.15|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|14.31||||14.31|13.31|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.31||||14.31|8.59|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|Self-pay|Self-pay|14.31||||14.31|4.29|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.31||||14.31|3.01|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.31||||14.31|6.86|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.31||||14.31|12.88|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14.31||||14.31|0|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14.31||||14.31|5.29|13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14.31||||14.31||13.31|3.01
9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14.31||||14.31|7.16|13.31|3.01
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76.86||||76.86|38.51|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76.86||||76.86|26.98|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76.86||||76.86|33.05|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76.86||||76.86|32.74|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76.86||||76.86|38.43|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76.86||||76.86|49.96|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76.86||||76.86|28.44|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|GEHA [1415]|GEHA [141500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76.86||||76.86|33.05|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|76.86||||76.86|71.48|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.86||||76.86|46.12|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MULTIPLAN [1680]|HMA [168003]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MULTIPLAN [1680]|IHC HS [168011]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|Self-pay|Self-pay|76.86||||76.86|23.06|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76.86||||76.86|16.14|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|TRUSTMARK [2030]|STARMARK [203000]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76.86||||76.86|36.85|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|UMR [2035]|UMR OPTIONS [203501]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76.86||||76.86|69.17|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76.86||||76.86|0|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76.86||||76.86|28.44|71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76.86||||76.86||71.48|16.14
9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76.86||||76.86|38.43|71.48|16.14
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|Self-pay|Self-pay|10||||10|3|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|15 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38.96||||38.96|19.52|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.96||||38.96|13.67|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.96||||38.96|16.75|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38.96||||38.96|16.6|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38.96||||38.96|19.48|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.96||||38.96|25.32|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|CORESOURCE [1315]|CORESOURCE [131500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38.96||||38.96|14.42|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|GEHA [1415]|GEHA [141500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HEALTHNET [1495]|HEALTHNET [149500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.96||||38.96|16.75|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|38.96||||38.96|36.23|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.96||||38.96|23.38|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MULTIPLAN [1680]|HMA [168003]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MULTIPLAN [1680]|IHC HS [168011]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|Self-pay|Self-pay|38.96||||38.96|11.69|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.96||||38.96|8.18|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|TRUSTMARK [2030]|STARMARK [203000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.96||||38.96|18.68|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|UMR [2035]|UMR OPTIONS [203501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38.96||||38.96|14.42|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|2.5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38.96||||38.96|19.48|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|AETNA ACO WILCO [101532]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38.96||||38.96|19.52|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.96||||38.96|13.67|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.96||||38.96|16.75|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38.96||||38.96|16.6|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38.96||||38.96|19.48|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.96||||38.96|25.32|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|CORESOURCE [1315]|CORESOURCE [131500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38.96||||38.96|14.42|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|GEHA [1415]|GEHA [141500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHNET [1495]|HEALTHNET [149500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.96||||38.96|16.75|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|38.96||||38.96|36.23|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.96||||38.96|23.38|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MULTIPLAN [1680]|HMA [168003]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MULTIPLAN [1680]|IHC HS [168011]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|Self-pay|Self-pay|38.96||||38.96|11.69|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.96||||38.96|8.18|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|TRUSTMARK [2030]|STARMARK [203000]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.96||||38.96|18.68|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|UMR [2035]|UMR OPTIONS [203501]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.96||||38.96|35.06|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38.96||||38.96|0|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38.96||||38.96|14.42|36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38.96||||38.96||36.23|8.18
9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|5 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38.96||||38.96|19.48|36.23|8.18
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21.87||||21.87|10.96|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.87||||21.87|7.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.87||||21.87|9.4|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21.87||||21.87|9.32|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21.87||||21.87|10.94|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.87||||21.87|14.22|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21.87||||21.87|8.09|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.87||||21.87|9.4|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|21.87||||21.87|20.34|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.87||||21.87|13.12|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|Self-pay|Self-pay|21.87||||21.87|6.56|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.87||||21.87|4.59|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.87||||21.87|10.49|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.87||||21.87|19.68|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21.87||||21.87|0|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21.87||||21.87|8.09|20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21.87||||21.87||20.34|4.59
9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21.87||||21.87|10.94|20.34|4.59
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48.1||||48.1|24.1|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.1||||48.1|16.88|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.1||||48.1|20.68|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48.1||||48.1|20.49|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48.1||||48.1|24.05|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.1||||48.1|31.27|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48.1||||48.1|17.8|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.1||||48.1|20.68|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|48.1||||48.1|44.73|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.1||||48.1|28.86|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|Self-pay|Self-pay|48.1||||48.1|14.43|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.1||||48.1|10.1|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.1||||48.1|23.06|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.1||||48.1|43.29|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48.1||||48.1|0|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48.1||||48.1|17.8|44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48.1||||48.1||44.73|10.1
96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48.1||||48.1|24.05|44.73|10.1
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57.22||||57.22|28.67|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.22||||57.22|20.08|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.22||||57.22|24.6|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57.22||||57.22|24.38|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57.22||||57.22|28.61|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.22||||57.22|37.19|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57.22||||57.22|21.17|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.22||||57.22|24.6|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|57.22||||57.22|53.21|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.22||||57.22|34.33|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|Self-pay|Self-pay|57.22||||57.22|17.17|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.22||||57.22|12.02|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.22||||57.22|27.44|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.22||||57.22|51.5|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57.22||||57.22|0|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57.22||||57.22|21.17|53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57.22||||57.22||53.21|12.02
96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57.22||||57.22|28.61|53.21|12.02
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55.09||||55.09|27.6|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.09||||55.09|19.34|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.09||||55.09|23.69|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55.09||||55.09|23.47|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55.09||||55.09|27.55|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.09||||55.09|35.81|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55.09||||55.09|20.38|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.09||||55.09|23.69|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|55.09||||55.09|51.23|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.09||||55.09|33.05|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|Self-pay|Self-pay|55.09||||55.09|16.53|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.09||||55.09|11.57|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.09||||55.09|26.42|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.09||||55.09|49.58|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55.09||||55.09|0|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55.09||||55.09|20.38|51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55.09||||55.09||51.23|11.57
96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55.09||||55.09|27.55|51.23|11.57
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50.51||||50.51|25.31|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.51||||50.51|17.73|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.51||||50.51|21.72|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50.51||||50.51|21.52|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50.51||||50.51|25.26|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.51||||50.51|32.83|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|50.51||||50.51|2.4|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50.51||||50.51|18.69|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.51||||50.51|21.72|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|50.51||||50.51|46.97|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.51||||50.51|30.31|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|Self-pay|Self-pay|50.51||||50.51|15.15|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.51||||50.51|10.61|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.51||||50.51|24.22|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.51||||50.51|45.46|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50.51||||50.51|0|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50.51||||50.51|18.69|46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50.51||||50.51||46.97|2.4
9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50.51||||50.51|25.26|46.97|2.4
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48.32||||48.32|24.21|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.32||||48.32|16.96|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.32||||48.32|20.78|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48.32||||48.32|20.58|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48.32||||48.32|24.16|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.32||||48.32|31.41|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48.32||||48.32|17.88|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.32||||48.32|20.78|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|48.32||||48.32|44.94|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.32||||48.32|28.99|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|Self-pay|Self-pay|48.32||||48.32|14.5|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.32||||48.32|10.15|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.32||||48.32|23.17|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.32||||48.32|43.49|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48.32||||48.32|0|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48.32||||48.32|17.88|44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48.32||||48.32||44.94|10.15
97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48.32||||48.32|24.16|44.94|10.15
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|AETNA [1015]|AETNA ACO WILCO [101532]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51.9||||51.9|26|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51.9||||51.9|18.22|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51.9||||51.9|22.32|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51.9||||51.9|22.11|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51.9||||51.9|25.95|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51.9||||51.9|33.74|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|CORESOURCE [1315]|CORESOURCE [131500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|CORVEL CORP [2235]|CORVEL CORP [223500]|51.9||||51.9|8.3|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51.9||||51.9|19.2|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|GEHA [1415]|GEHA [141500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HEALTHNET [1495]|HEALTHNET [149500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51.9||||51.9|22.32|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HEALTHSMART [1505]|HEALTHSMART [150501]|51.9||||51.9|48.27|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51.9||||51.9|31.14|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MULTIPLAN [1680]|HMA [168003]|51.9||||51.9|18.17|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MULTIPLAN [1680]|IHC HS [168011]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|Self-pay|Self-pay|51.9||||51.9|15.57|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51.9||||51.9|10.9|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51.9||||51.9|5.87|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|TRUSTMARK [2030]|STARMARK [203000]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51.9||||51.9|24.89|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|UMR [2035]|UMR OPTIONS [203501]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51.9||||51.9|46.71|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51.9||||51.9|0|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51.9||||51.9|19.2|48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51.9||||51.9||48.27|5.87
97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|0.75 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51.9||||51.9|25.95|48.27|5.87
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|18.9
9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|18.9
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|1.96|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.29|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|1.96
9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA ACO WILCO [101532]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90||||90|45.09|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90||||90|31.59|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90||||90|38.7|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90||||90|38.34|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90||||90|45|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90||||90|58.5|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CORESOURCE [1315]|CORESOURCE [131500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|90||||90|1.96|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90||||90|33.3|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|GEHA [1415]|GEHA [141500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHNET [1495]|HEALTHNET [149500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90||||90|38.7|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|90||||90|83.7|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90||||90|54|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|HMA [168003]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MULTIPLAN [1680]|IHC HS [168011]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|Self-pay|Self-pay|90||||90|27|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90||||90|18.9|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90||||90|2.29|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|TRUSTMARK [2030]|STARMARK [203000]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90||||90|43.16|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UMR [2035]|UMR OPTIONS [203501]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90||||90|81|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90||||90|0|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90||||90|33.3|83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90||||90||83.7|1.96
9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|1,000 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90||||90|45|83.7|1.96
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|AETNA [1015]|AETNA ACO WILCO [101532]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55.14||||55.14|27.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.14||||55.14|19.35|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.14||||55.14|23.71|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55.14||||55.14|23.49|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55.14||||55.14|27.57|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.14||||55.14|35.84|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|CORESOURCE [1315]|CORESOURCE [131500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|55.14||||55.14|5.79|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55.14||||55.14|20.4|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|GEHA [1415]|GEHA [141500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HEALTHNET [1495]|HEALTHNET [149500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.14||||55.14|23.71|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|55.14||||55.14|51.28|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.14||||55.14|33.08|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.14||||55.14|27.57|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MULTIPLAN [1680]|HMA [168003]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MULTIPLAN [1680]|IHC HS [168011]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|Self-pay|Self-pay|55.14||||55.14|16.54|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.14||||55.14|11.58|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.14||||55.14|5.72|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|TRUSTMARK [2030]|STARMARK [203000]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.14||||55.14|26.44|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|UMR [2035]|UMR OPTIONS [203501]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.14||||55.14|49.63|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55.14||||55.14|0|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55.14||||55.14|20.4|51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55.14||||55.14||51.28|5.72
9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|30 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55.14||||55.14|27.57|51.28|5.72
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10788||||10788|5404.79|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10788||||10788|3786.59|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10788||||10788|4638.84|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10788||||10788|4595.69|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10788||||10788|5394|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10788||||10788|7012.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10788||||10788|3991.56|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|GEHA [1415]|GEHA [141500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10788||||10788|4638.84|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|10788||||10788|10032.84|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10788||||10788|6472.8|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10788||||10788|5394|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MULTIPLAN [1680]|HMA [168003]|10788||||10788|3775.8|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MULTIPLAN [1680]|IHC HS [168011]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|Self-pay|Self-pay|10788||||10788|3236.4|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10788||||10788|2265.48|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|TRUSTMARK [2030]|STARMARK [203000]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10788||||10788|5172.85|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|UMR [2035]|UMR OPTIONS [203501]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10788||||10788|9709.2|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10788||||10788|0|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10788||||10788|3991.56|10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10788||||10788||10032.84|2265.48
98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|15 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10788||||10788|5394|10032.84|2265.48
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2940||||2940|1472.94|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2940||||2940|1031.94|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2940||||2940|1264.2|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2940||||2940|1252.44|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2940||||2940|1470|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2940||||2940|1911|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2940||||2940|1087.8|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|GEHA [1415]|GEHA [141500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2940||||2940|1264.2|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|2940||||2940|2734.2|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2940||||2940|1764|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2940||||2940|1470|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MULTIPLAN [1680]|HMA [168003]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MULTIPLAN [1680]|IHC HS [168011]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|Self-pay|Self-pay|2940||||2940|882|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2940||||2940|617.4|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|TRUSTMARK [2030]|STARMARK [203000]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2940||||2940|1409.73|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|UMR [2035]|UMR OPTIONS [203501]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2940||||2940|2646|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2940||||2940|0|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2940||||2940|1087.8|2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2940||||2940||2734.2|617.4
98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|0.5 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2940||||2940|1470|2734.2|617.4
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|561||||561|281.06|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|561||||561|196.91|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|561||||561|241.23|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|561||||561|238.99|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|561||||561|280.5|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|561||||561|364.65|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|561||||561|207.57|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|GEHA [1415]|GEHA [141500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|561||||561|241.23|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|561||||561|521.73|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|561||||561|336.6|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|561||||561|280.5|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MULTIPLAN [1680]|HMA [168003]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MULTIPLAN [1680]|IHC HS [168011]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|Self-pay|Self-pay|561||||561|168.3|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|561||||561|117.81|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|TRUSTMARK [2030]|STARMARK [203000]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|561||||561|269|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|UMR [2035]|UMR OPTIONS [203501]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|561||||561|504.9|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|561||||561|0|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|561||||561|207.57|521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|561||||561||521.73|117.81
98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|10 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|561||||561|280.5|521.73|117.81
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|AETNA [1015]|AETNA ACO WILCO [101532]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|163.42||||163.42|81.87|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163.42||||163.42|57.36|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163.42||||163.42|70.27|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|163.42||||163.42|69.62|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|163.42||||163.42|81.71|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163.42||||163.42|106.22|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|CORESOURCE [1315]|CORESOURCE [131500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|CORVEL CORP [2235]|CORVEL CORP [223500]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|163.42||||163.42|60.47|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|FIRST HEALTH [1375]|QUALCHOICE [137513]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|FMH BENEFIT SERVICES [1390]|FMH [139000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|GEHA [1415]|GEHA [141500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HEALTHNET [1495]|HEALTHNET [149500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163.42||||163.42|70.27|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HEALTHSMART [1505]|HEALTHSMART [150501]|163.42||||163.42|151.98|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163.42||||163.42|98.05|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163.42||||163.42|81.71|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MULTIPLAN [1680]|HMA [168003]|163.42||||163.42|57.2|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MULTIPLAN [1680]|IHC HS [168011]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|PENDING SSI [1616]|PENDING SSI RCA [161601]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|Self-pay|Self-pay|163.42||||163.42|49.03|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163.42||||163.42|34.32|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|TRIWEST [3750]|TRIWEST TWVACCN [375000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|TRUSTMARK [2030]|STARMARK [203000]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163.42||||163.42|78.36|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|UMR [2035]|UMR OPTIONS [203501]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163.42||||163.42|147.08|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|163.42||||163.42|0|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|163.42||||163.42|60.47|151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|163.42||||163.42||151.98|34.32
98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|1 millicurie|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|163.42||||163.42|81.71|151.98|34.32
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13.76||||13.76|6.89|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.76||||13.76|4.83|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.76||||13.76|5.92|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13.76||||13.76|5.86|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13.76||||13.76|6.88|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.76||||13.76|8.94|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13.76||||13.76|5.09|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.76||||13.76|5.92|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|13.76||||13.76|12.8|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.76||||13.76|8.26|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|Self-pay|Self-pay|13.76||||13.76|4.13|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.76||||13.76|2.89|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.76||||13.76|6.6|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.76||||13.76|12.38|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13.76||||13.76|0|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13.76||||13.76|5.09|12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13.76||||13.76||12.8|2.89
9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13.76||||13.76|6.88|12.8|2.89
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14.44||||14.44|7.23|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.44||||14.44|5.07|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.44||||14.44|6.21|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14.44||||14.44|6.15|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14.44||||14.44|7.22|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.44||||14.44|9.39|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14.44||||14.44|5.34|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.44||||14.44|6.21|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|14.44||||14.44|13.43|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.44||||14.44|8.66|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|Self-pay|Self-pay|14.44||||14.44|4.33|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.44||||14.44|3.03|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.44||||14.44|6.92|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.44||||14.44|13|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14.44||||14.44|0|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14.44||||14.44|5.34|13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14.44||||14.44||13.43|3.03
9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14.44||||14.44|7.22|13.43|3.03
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43.07||||43.07|21.58|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.07||||43.07|15.12|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.07||||43.07|18.52|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43.07||||43.07|18.35|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43.07||||43.07|21.54|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.07||||43.07|28|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|43.07||||43.07|2.29|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43.07||||43.07|15.94|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.07||||43.07|18.52|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|43.07||||43.07|40.06|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.07||||43.07|25.84|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.07||||43.07|21.54|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|Self-pay|Self-pay|43.07||||43.07|12.92|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.07||||43.07|9.04|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.07||||43.07|1.44|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.07||||43.07|20.65|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.07||||43.07|38.76|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43.07||||43.07|0|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43.07||||43.07|15.94|40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43.07||||43.07||40.06|1.44
9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43.07||||43.07|21.54|40.06|1.44
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|766.75||||766.75|0|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|766.75||||766.75|112|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|766.75||||766.75|112|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|766.75||||766.75|384.14|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|766.75||||766.75|269.13|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|766.75||||766.75|329.7|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|766.75||||766.75|326.64|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|766.75||||766.75|383.38|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|766.75||||766.75|498.39|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|766.75||||766.75|117.11|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|766.75||||766.75|283.7|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|766.75||||766.75|329.7|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|766.75||||766.75|713.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|766.75||||766.75|460.05|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|766.75||||766.75|383.38|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|766.75||||766.75|112.41|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|766.75||||766.75|116.41|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|766.75||||766.75|230.02|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|766.75||||766.75|161.02|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|766.75||||766.75|367.66|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|766.75||||766.75|107.06|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|766.75||||766.75|690.08|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|766.75||||766.75|0|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|766.75||||766.75|283.7|713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|766.75||||766.75||713.08|107.06
9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|766.75||||766.75|383.38|713.08|107.06
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|AETNA [1015]|AETNA ACO WILCO [101532]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|793.64||||793.64|397.61|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|793.64||||793.64|278.57|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|793.64||||793.64|341.27|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|793.64||||793.64|338.09|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|793.64||||793.64|396.82|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|793.64||||793.64|515.87|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|CORESOURCE [1315]|CORESOURCE [131500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|CORVEL CORP [2235]|CORVEL CORP [223500]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|793.64||||793.64|293.65|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|GEHA [1415]|GEHA [141500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HEALTHNET [1495]|HEALTHNET [149500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|793.64||||793.64|341.27|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HEALTHSMART [1505]|HEALTHSMART [150501]|793.64||||793.64|738.09|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|793.64||||793.64|476.18|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MULTIPLAN [1680]|HMA [168003]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MULTIPLAN [1680]|IHC HS [168011]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|Self-pay|Self-pay|793.64||||793.64|238.09|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|793.64||||793.64|166.66|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|TRUSTMARK [2030]|STARMARK [203000]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|793.64||||793.64|380.55|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|UMR [2035]|UMR OPTIONS [203501]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|793.64||||793.64|714.28|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|793.64||||793.64|0|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|793.64||||793.64|293.65|738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|793.64||||793.64||738.09|166.66
9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|42.5 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|793.64||||793.64|396.82|738.09|166.66
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA ACO WILCO [101532]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|59.64||||59.64|29.88|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59.64||||59.64|20.93|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59.64||||59.64|25.65|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|59.64||||59.64|25.41|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|59.64||||59.64|29.82|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59.64||||59.64|38.77|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|CORESOURCE [1315]|CORESOURCE [131500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|CORVEL CORP [2235]|CORVEL CORP [223500]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|59.64||||59.64|22.07|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|FIRST HEALTH [1375]|QUALCHOICE [137513]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|FMH BENEFIT SERVICES [1390]|FMH [139000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|GEHA [1415]|GEHA [141500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HEALTHNET [1495]|HEALTHNET [149500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59.64||||59.64|25.65|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HEALTHSMART [1505]|HEALTHSMART [150501]|59.64||||59.64|55.47|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59.64||||59.64|35.78|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|HMA [168003]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MULTIPLAN [1680]|IHC HS [168011]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|PENDING SSI [1616]|PENDING SSI RCA [161601]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|Self-pay|Self-pay|59.64||||59.64|17.89|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59.64||||59.64|12.52|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|TRUSTMARK [2030]|STARMARK [203000]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59.64||||59.64|28.6|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|UMR [2035]|UMR OPTIONS [203501]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59.64||||59.64|53.68|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|59.64||||59.64|0|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|59.64||||59.64|22.07|55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|59.64||||59.64||55.47|12.52
99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|1 packet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|59.64||||59.64|29.82|55.47|12.52
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27.23||||27.23|13.64|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.23||||27.23|9.56|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.23||||27.23|11.71|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27.23||||27.23|11.6|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27.23||||27.23|13.62|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.23||||27.23|17.7|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27.23||||27.23|10.08|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.23||||27.23|11.71|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|27.23||||27.23|25.32|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.23||||27.23|16.34|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|Self-pay|Self-pay|27.23||||27.23|8.17|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.23||||27.23|5.72|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.23||||27.23|13.06|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.23||||27.23|24.51|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27.23||||27.23|0|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27.23||||27.23|10.08|25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27.23||||27.23||25.32|5.72
9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27.23||||27.23|13.62|25.32|5.72
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|AETNA [1015]|AETNA ACO WILCO [101532]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|AETNA [1015]|COVENTRY HEALTHCARE [101502]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|930.04||||930.04|465.95|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|930.04||||930.04|326.44|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|930.04||||930.04|399.92|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|930.04||||930.04|396.2|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|930.04||||930.04|465.02|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|930.04||||930.04|604.53|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|CORESOURCE [1315]|CORESOURCE [131500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|CORVEL CORP [2235]|CORVEL CORP [223500]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|930.04||||930.04|344.11|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|FIRST HEALTH [1375]|QUALCHOICE [137513]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|FMH BENEFIT SERVICES [1390]|FMH [139000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|GEHA [1415]|GEHA [141500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HEALTHNET [1495]|HEALTHNET [149500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930.04||||930.04|399.92|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HEALTHSMART [1505]|HEALTHSMART [150501]|930.04||||930.04|864.94|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930.04||||930.04|558.02|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MULTIPLAN [1680]|HMA [168003]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MULTIPLAN [1680]|IHC HS [168011]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|PENDING SSI [1616]|PENDING SSI RCA [161601]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|Self-pay|Self-pay|930.04||||930.04|279.01|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|930.04||||930.04|195.31|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|TRIWEST [3750]|TRIWEST TWVACCN [375000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|TRUSTMARK [2030]|STARMARK [203000]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930.04||||930.04|445.95|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|UMR [2035]|UMR OPTIONS [203501]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|930.04||||930.04|837.04|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930.04||||930.04|0|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930.04||||930.04|344.11|864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|930.04||||930.04||864.94|195.31
9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|30 g|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|930.04||||930.04|465.02|864.94|195.31
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.01|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|3.51|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.26|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10||||10|6|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|4.8|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|Self-pay|Self-pay|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900056|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OUTPATIENT IN A BED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|AETNA [1015]|AETNA ACO WILCO [101532]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|CORESOURCE [1315]|CORESOURCE [131500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|GEHA [1415]|GEHA [141500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HEALTHNET [1495]|HEALTHNET [149500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MULTIPLAN [1680]|HMA [168003]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MULTIPLAN [1680]|IHC HS [168011]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|Self-pay|Self-pay|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|TRUSTMARK [2030]|STARMARK [203000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|UMR [2035]|UMR OPTIONS [203501]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0||||0|0||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|0||||0|||
99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|0||||0|0||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|989314.27|506522.63|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|989314.27|611324.81|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|989314.27|630507.12|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|989314.27|547235.15|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|989314.27|526187.64|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|989314.27|684043.94|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|GEHA [1415]|GEHA [141500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|989314.27|491688.21|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|989314.27|547235.15|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|989314.27|978709.01|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|989314.27|473568.88|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|989314.27|473568.88|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|989314.27|14450|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MULTIPLAN [1680]|HMA [168003]|989314.27|11904.48|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|989314.27|434707.43|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|Self-pay|Self-pay|989314.27|296794.28|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|989314.27|526187.64|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|989314.27|438264.04|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|989314.27|336864.11|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|UMR [2035]|UMR OPTIONS [203501]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|989314.27|127859.3|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|989314.27|189969.8|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|989314.27|947137.75|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|989314.27|12325|978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|989314.27||978709.01|11904.48||||
MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|989314.27|526187.64|978709.01|11904.48||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|919921.83|478625.08|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|919921.83|628300.53|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|919921.83|428447.3|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|919921.83|411968.56|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|919921.83|535559.13|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|GEHA [1415]|GEHA [141500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|919921.83|226613.01|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|919921.83|428447.3|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|919921.83|766261.53|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|919921.83|370771.7|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|919921.83|370771.7|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|919921.83|25500|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MULTIPLAN [1680]|HMA [168003]|919921.83|3986.27|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|919921.83|599677.88|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|Self-pay|Self-pay|919921.83|275976.55|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|919921.83|411968.56|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|919921.83|287350.34|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|919921.83|220866.49|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|UMR [2035]|UMR OPTIONS [203501]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|919921.83|119404.32|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|919921.83|125806.33|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|919921.83|741543.41|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|919921.83|15950|766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|919921.83||766261.53|3986.27||||
MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|919921.83|411968.56|766261.53|3986.27||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|828689.13|579277.64|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|828689.13|497525.56|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|828689.13|518547.72|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|828689.13|498603.58|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|828689.13|648184.65|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|GEHA [1415]|GEHA [141500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|828689.13|149270.73|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|828689.13|518547.72|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|828689.13|927402.66|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|828689.13|448743.22|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|828689.13|78591.39|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|828689.13|448743.22|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|828689.13|13600|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MULTIPLAN [1680]|HMA [168003]|828689.13|12161.98|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|828689.13|819638.99|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|Self-pay|Self-pay|828689.13|248606.74|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|828689.13|498603.58|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|828689.13|179480.48|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|828689.13|137955.06|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|UMR [2035]|UMR OPTIONS [203501]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|828689.13|74375.17|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|828689.13|78466.03|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|828689.13|897486.44|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|828689.13|22475|927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|828689.13||927402.66|12161.98||||
MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|828689.13|498603.58|927402.66|12161.98||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|GEHA [1415]|GEHA [141500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MULTIPLAN [1680]|HMA [168003]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|Self-pay|Self-pay|247933.77|74380.13|74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|UMR [2035]|UMR OPTIONS [203501]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|247933.77||74380.13|74380.13||||
MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|247933.77||74380.13|74380.13||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|GEHA [1415]|GEHA [141500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MULTIPLAN [1680]|HMA [168003]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MULTIPLAN [1680]|IHC HS [168011]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|Self-pay|Self-pay|268531.12|80559.34|80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|TRUSTMARK [2030]|STARMARK [203000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|UMR [2035]|UMR OPTIONS [203501]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|268531.12||80559.34|80559.34||||
MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|268531.12||80559.34|80559.34||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|AETNA [1015]|AETNA ACO WILCO [101532]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202286.2|116700.03|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|CORESOURCE [1315]|CORESOURCE [131500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|GEHA [1415]|GEHA [141500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HEALTHNET [1495]|HEALTHNET [149500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HEALTHSMART [1505]|HEALTHSMART [150501]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202286.2|3400|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MULTIPLAN [1680]|HMA [168003]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MULTIPLAN [1680]|IHC HS [168011]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|Self-pay|Self-pay|202286.2|60685.86|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|TRUSTMARK [2030]|STARMARK [203000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|UMR [2035]|UMR OPTIONS [203501]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202286.2|29026.56|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202286.2|37445.6|116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|202286.2||116700.03|3400||||
MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|202286.2||116700.03|3400||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|GEHA [1415]|GEHA [141500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MULTIPLAN [1680]|HMA [168003]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|130963.98|123483.32|123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|Self-pay|Self-pay|130963.98|39289.19|123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|UMR [2035]|UMR OPTIONS [203501]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|130963.98||123483.32|39289.19||||
MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|130963.98||123483.32|39289.19||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|173835.91|60218.74|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173835.91|100981.28|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173835.91|115087.76|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173835.91|90394.67|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|173835.91|50146.01|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173835.91|112993.33|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|GEHA [1415]|GEHA [141500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|173835.91|56331.34|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173835.91|90394.67|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|173835.91|161667.4|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173835.91|65212.3|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173835.91|63687.68|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173835.91|1700|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|173835.91|376.16|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|173835.91|123579.89|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|Self-pay|Self-pay|173835.91|52150.77|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173835.91|58222.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173835.91|57247.53|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173835.91|52238.47|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173835.91|28414.95|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173835.91|29737.79|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173835.91|156452.31|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|173835.91|2175|161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|173835.91||161667.4|376.16||||
MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|173835.91|50146.01|161667.4|376.16||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|120042.29|40491.65|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120042.29|89842.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120042.29|65204.66|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120042.29|80423.92|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120042.29|34141.3|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120042.29|100529.91|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|GEHA [1415]|GEHA [141500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120042.29|37385.23|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120042.29|80423.92|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120042.29|143835.08|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120042.29|44399|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120042.29|43360.98|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120042.29|5100|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|120042.29|884.68|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|Self-pay|Self-pay|120042.29|36012.69|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120042.29|40520.79|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120042.29|154114.11|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120042.29|35001.95|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120042.29|35564.54|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120042.29|21071.97|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120042.29|20317.77|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120042.29|139195.25|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120042.29|2175|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120042.29|128428.43|154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120042.29||154114.11|884.68||||
MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120042.29|34141.3|154114.11|884.68||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|134238.44|32726.99|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134238.44|80093.34|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134238.44|76479.68|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134238.44|71696.57|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|134238.44|28034.45|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134238.44|89620.71|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|134238.44|30930.57|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134238.44|71696.57|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|134238.44|128226.54|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134238.44|36457.35|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134238.44|35605|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134238.44|850|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|134238.44|563.24|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|Self-pay|Self-pay|134238.44|40271.53|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134238.44|31995.08|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134238.44|38005.32|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134238.44|29212.23|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134238.44|20380.84|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134238.44|16723.44|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134238.44|124090.22|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|134238.44|725|128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|134238.44||128226.54|563.24||||
MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|134238.44|28034.45|128226.54|563.24||||
MS028|DRG||Spinal Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|GEHA [1415]|GEHA [141500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|Self-pay|Self-pay|403701.31|121110.39|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|403701.31|38499.11|121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|403701.31||121110.39|38499.11||||
MS028|DRG||Spinal Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|403701.31||121110.39|38499.11||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|AETNA [1015]|AETNA ACO WILCO [101532]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|143643.89|68065.1|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|143643.89|146051.59|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|143643.89|60929.33|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|143643.89|36759.32|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|143643.89|76161.66|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|CORESOURCE [1315]|CORESOURCE [131500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|CORVEL CORP [2235]|CORVEL CORP [223500]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|GEHA [1415]|GEHA [141500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|143643.89|39429.09|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HEALTHNET [1495]|HEALTHNET [149500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|143643.89|60929.33|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HEALTHSMART [1505]|HEALTHSMART [150501]|143643.89|108969.74|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|143643.89|47803.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|143643.89|46685.98|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|143643.89|6800|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MULTIPLAN [1680]|HMA [168003]|143643.89|1515.89|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MULTIPLAN [1680]|IHC HS [168011]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|Self-pay|Self-pay|143643.89|43093.17|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|143643.89|44260.42|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|143643.89|49855.69|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|TRUSTMARK [2030]|STARMARK [203000]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|143643.89|38320.85|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|UMR [2035]|UMR OPTIONS [203501]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|143643.89|22425.78|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|143643.89|18252.01|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|143643.89|105454.6|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|143643.89|5075|146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|143643.89||146051.59|1515.89||||
MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|143643.89|36759.32|146051.59|1515.89||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71788.74|41702.08|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71788.74|58656.17|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71788.74|14401.76|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71788.74|26278.32|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71788.74|46662.68|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71788.74|27103.2|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71788.74|14401.76|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71788.74|66763.52|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71788.74|34173.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71788.74|33374.64|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71788.74|2550|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|71788.74|115.5|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|Self-pay|Self-pay|71788.74|21536.62|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71788.74|28842.22|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71788.74|35664.6|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71788.74|27413.07|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71788.74|14115.66|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71788.74|64609.87|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71788.74|2175|66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71788.74||66763.52|115.5||||
MS030|DRG||Spinal Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71788.74|26278.32|66763.52|115.5||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|GEHA [1415]|GEHA [141500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|Self-pay|Self-pay|134854.99|40456.5|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134854.99|28912.87|40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|134854.99||40456.5|28912.87||||
MS031|DRG||Ventricular Shunt Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|134854.99||40456.5|28912.87||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|GEHA [1415]|GEHA [141500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|Self-pay|Self-pay|128725.45|38617.63|38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128725.45||38617.63|38617.63||||
MS032|DRG||Ventricular Shunt Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128725.45||38617.63|38617.63||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98024.18|56617.49|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98024.18|12598.62|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|98024.18|19202.53|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98024.18|63352.32|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|98024.18|26197.95|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98024.18|12598.62|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|98024.18|90642.53|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98024.18|24971.9|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98024.18|24388.07|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|98024.18|202.74|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|Self-pay|Self-pay|98024.18|29407.25|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98024.18|22973.18|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98024.18|26035.41|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98024.18|20011.74|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98024.18|87718.58|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|98024.18|725|90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|98024.18||90642.53|202.74||||
MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|98024.18|19202.53|90642.53|202.74||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|GEHA [1415]|GEHA [141500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|Self-pay|Self-pay|123622.91|37086.87|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123622.91|26329.81|37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123622.91||37086.87|26329.81||||
MS034|DRG||Carotid Artery Stent Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123622.91||37086.87|26329.81||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94157.88|54125.73|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94157.88|48001.93|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94157.88|17853.02|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94157.88|26087.66|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94157.88|60564.16|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|GEHA [1415]|GEHA [141500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94157.88|30516.63|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94157.88|17853.02|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|94157.88|86653.33|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94157.88|33925.65|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94157.88|33132.49|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94157.88|850|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|94157.88|258.27|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|Self-pay|Self-pay|94157.88|28247.36|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94157.88|30119.86|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94157.88|35361.98|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94157.88|27180.47|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94157.88|12374.33|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94157.88|15577.59|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94157.88|83858.06|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94157.88|1450|86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94157.88||86653.33|258.27||||
MS035|DRG||Carotid Artery Stent Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94157.88|26087.66|86653.33|258.27||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|93612.09|12398.44|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|Self-pay|Self-pay|93612.09|28083.63|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93612.09|12378.96|28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|93612.09||28083.63|12378.96||||
MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|93612.09||28083.63|12378.96||||
MS037|DRG||Extracranial Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124233.01|37589.68|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124233.01|25403.14|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124233.01|36545.24|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124233.01|42061.09|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|GEHA [1415]|GEHA [141500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124233.01|37692.4|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124233.01|25403.14|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124233.01|60179.7|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124233.01|47525.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124233.01|46414.09|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|124233.01|197.73|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|Self-pay|Self-pay|124233.01|37269.9|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124233.01|42843.53|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124233.01|49548.54|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124233.01|38084.76|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124233.01|20542.2|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124233.01|58238.44|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124233.01|725|60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124233.01||60179.7|197.73||||
MS037|DRG||Extracranial Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124233.01|36545.24|60179.7|197.73||||
MS038|DRG||Extracranial Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89837.43|52185.9|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89837.43|12815.03|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89837.43|18495.62|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89837.43|58393.58|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|GEHA [1415]|GEHA [141500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89837.43|19076.2|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89837.43|12815.03|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89837.43|83547.73|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89837.43|24052.6|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89837.43|23490.27|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|89837.43|257.53|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|Self-pay|Self-pay|89837.43|26951.23|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89837.43|21195.3|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89837.43|25076.13|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89837.43|19274.4|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89837.43|11109.08|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89837.43|80852.64|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89837.43|1450|83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89837.43||83547.73|257.53||||
MS038|DRG||Extracranial Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89837.43|18495.62|83547.73|257.53||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71550.03|36794.03|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71550.03|8544.97|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71550.03|12700.97|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71550.03|41170.8|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71550.03|13894.95|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71550.03|8544.97|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71550.03|58905.91|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71550.03|16516.95|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71550.03|16130.8|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|71550.03|795.3|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|Self-pay|Self-pay|71550.03|21465.01|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71550.03|15057.22|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71550.03|10392.96|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71550.03|13246.57|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71550.03|7698.49|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71550.03|57005.73|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71550.03|725|58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71550.03||58905.91|725||||
MS039|DRG||Extracranial Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71550.03|12700.97|58905.91|725||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|121360.52|77102.06|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|121360.52|291794.87|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|121360.52|69018.89|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|121360.52|43092.52|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|121360.52|86273.61|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|GEHA [1415]|GEHA [141500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|121360.52|51584.31|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|121360.52|69018.89|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|121360.52|123437.63|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|121360.52|56039.6|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|121360.52|54729.43|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|121360.52|28900|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|121360.52|320.83|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|121360.52|54584.55|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|Self-pay|Self-pay|121360.52|36408.16|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|121360.52|51481.46|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|121360.52|46029.21|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|121360.52|22876.71|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|121360.52|20257.44|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|121360.52|119455.78|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|121360.52|5075|291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|121360.52||291794.87|320.83||||
MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|121360.52|43092.52|291794.87|320.83||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|AETNA [1015]|AETNA ACO WILCO [101532]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98247.69|54465.43|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98247.69|48450.43|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98247.69|17173.1|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|98247.69|26199.16|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98247.69|60944.29|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|CORESOURCE [1315]|CORESOURCE [131500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|CORVEL CORP [2235]|CORVEL CORP [223500]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|GEHA [1415]|GEHA [141500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|98247.69|34160.66|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HEALTHNET [1495]|HEALTHNET [149500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98247.69|17173.1|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HEALTHSMART [1505]|HEALTHSMART [150501]|98247.69|87197.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98247.69|34070.65|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98247.69|33274.1|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98247.69|1700|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MULTIPLAN [1680]|HMA [168003]|98247.69|61.95|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MULTIPLAN [1680]|IHC HS [168011]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|Self-pay|Self-pay|98247.69|29474.31|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98247.69|31516.47|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98247.69|35569.27|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|TRUSTMARK [2030]|STARMARK [203000]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98247.69|27343.29|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|UMR [2035]|UMR OPTIONS [203501]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98247.69|11798.93|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98247.69|15643.22|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98247.69|84384.41|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|98247.69|2175|87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|98247.69||87197.22|61.95||||
MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|98247.69|26199.16|87197.22|61.95||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73474.68|42681.44|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73474.68|71050.53|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73474.68|15008.2|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73474.68|21198.38|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73474.68|47758.55|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73474.68|21863.8|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73474.68|15008.2|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|73474.68|68331.45|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73474.68|27567.4|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73474.68|26922.89|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73474.68|850|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|Self-pay|Self-pay|73474.68|22042.4|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73474.68|25829.96|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73474.68|21878.16|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73474.68|21921.39|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73474.68|9438.24|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73474.68|12699.87|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73474.68|66127.22|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73474.68|725|71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73474.68||71050.53|725||||
MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73474.68|21198.38|71050.53|725||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139397.67|35741.16|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139397.67|18630|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139397.67|93508.16|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139397.67|69932.21|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139397.67|46860.6|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139397.67|46860.6|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139397.67|46860.6|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|GEHA [1415]|GEHA [141500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139397.67|46860.6|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139397.67|46860.6|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139397.67|13600|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139397.67|36455.99|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139397.67|30574.53|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|Self-pay|Self-pay|139397.67|41819.3|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139397.67|35741.16|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139397.67|21632|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139397.67|35741.16|93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139397.67||93508.16|13600||||
MS052|DRG||Spinal Disorders And Injuries With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139397.67||93508.16|13600||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|GEHA [1415]|GEHA [141500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|Self-pay|Self-pay|32872.2|9861.66|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32872.2|7692.73|9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32872.2||9861.66|7692.73||||
MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32872.2||9861.66|7692.73||||
MS054|DRG||Nervous System Neoplasms With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72421.58|17355.46|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72421.58|9315|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72421.58|14959.81|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72421.58|27298.71|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72421.58|14016.16|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72421.58|10536.26|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72421.58|15256.55|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72421.58|16739.33|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72421.58|14016.16|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72421.58|14016.16|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|GEHA [1415]|GEHA [141500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72421.58|15735.45|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72421.58|10536.26|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72421.58|23950.11|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72421.58|19840.35|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72421.58|14016.16|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72421.58|14016.16|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72421.58|19376.5|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72421.58|2550|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72421.58|17702.57|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MULTIPLAN [1680]|HMA [168003]|72421.58|145.36|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MULTIPLAN [1680]|IHC HS [168011]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72421.58|22311.41|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72421.58|35019.47|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|Self-pay|Self-pay|72421.58|21726.47|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72421.58|17778.8|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72421.58|17355.46|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72421.58|18721.01|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|TRUSTMARK [2030]|STARMARK [203000]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72421.58|15884.25|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|UMR [2035]|UMR OPTIONS [203501]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72421.58|7081.13|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72421.58|17355.46|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72421.58|23177.53|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72421.58|2175|35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72421.58||35019.47|145.36||||
MS054|DRG||Nervous System Neoplasms With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72421.58|15256.55|35019.47|145.36||||
MS055|DRG||Nervous System Neoplasms Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73547.66|36446.67|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73547.66|18630|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73547.66|17331.69|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73547.66|42723.83|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73547.66|34358.74|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73547.66|8229.23|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73547.66|11647.29|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73547.66|19393.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73547.66|34358.74|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73547.66|34358.74|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|GEHA [1415]|GEHA [141500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73547.66|12012.9|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73547.66|8229.23|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|73547.66|27747.44|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73547.66|15146.7|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73547.66|34358.74|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73547.66|34358.74|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73547.66|14792.58|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73547.66|9350|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73547.66|37175.6|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MULTIPLAN [1680]|HMA [168003]|73547.66|180.69|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73547.66|6517.08|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|Self-pay|Self-pay|73547.66|22064.3|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73547.66|13513.24|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73547.66|36446.67|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73547.66|15787.38|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73547.66|12134.74|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|UMR [2035]|UMR OPTIONS [203501]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73547.66|15548|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73547.66|36446.67|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73547.66|26852.36|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73547.66|1450|42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73547.66||42723.83|180.69||||
MS055|DRG||Nervous System Neoplasms Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73547.66|11647.29|42723.83|180.69||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103946|28080.96|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103946|15525|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103946|50795.51|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103946|72503.93|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103946|26034.29|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103946|4505.12|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103946|9120|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|103946|5470.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|103946|24477.6|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103946|51306.77|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103946|26034.29|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103946|26034.29|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|103946||73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|103946||73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|GEHA [1415]|GEHA [141500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|103946|25871.08|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103946|9120|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|103946|73408.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103946|30681.3|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103946|26034.29|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|103946|22019.25|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103946|26034.29|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103946|7656|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103946|13600|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103946|28642.58|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|103946|625.13|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|103946|25222.35|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|103946|42032.5|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|Self-pay|Self-pay|103946|31183.8|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103946|25870.52|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103946|28080.96|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|103946|24213.45|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103946|6494.48|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103946|25438.3|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103946|21632|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103946|28080.96|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103946|71040.14|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|103946|5800|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|103946|25222.35|73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|103946||73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|103946||73408.14|625.13||||
MS056|DRG||Degenerative Nervous System Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|103946|24477.6|73408.14|625.13||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94026.7|25222.35|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|94026.7|15905.99|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94026.7|18787.74|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94026.7|14490|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94026.7|46706.65|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94026.7|50982.49|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94026.7|25546.94|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94026.7|9741.72|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94026.7|6757.68|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94026.7|13680|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94026.7|8205.72|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94026.7|14132.63|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94026.7|52262.57|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94026.7|25546.94|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94026.7|25546.94|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|94026.7||74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94026.7||74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|GEHA [1415]|GEHA [141500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94026.7|14576.25|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94026.7|13680|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|94026.7|74775.68|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94026.7|18378.75|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94026.7|25546.94|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94026.7|21192.73|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94026.7|20666.51|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94026.7|25546.94|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94026.7|11484|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94026.7|9350|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94026.7|25363.45|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94026.7|25726.79|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|94026.7|32878.54|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94026.7|24049.08|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|94026.7|20489.04|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94026.7|20666.51|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|Self-pay|Self-pay|94026.7|28208.01|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94026.7|15346.55|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94026.7|25222.35|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94026.7|23087.12|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94026.7|30624.02|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94026.7|14702.65|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94026.7|14872|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94026.7|25222.35|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94026.7|72363.56|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94026.7|8700|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94026.7|24049.08|74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94026.7||74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94026.7||74775.68|6757.68||||
MS057|DRG||Degenerative Nervous System Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94026.7|14132.63|74775.68|6757.68||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|GEHA [1415]|GEHA [141500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MULTIPLAN [1680]|HMA [168003]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MULTIPLAN [1680]|IHC HS [168011]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46750.69|32134.78|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|Self-pay|Self-pay|46750.69|14025.21|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|TRUSTMARK [2030]|STARMARK [203000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|UMR [2035]|UMR OPTIONS [203501]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46750.69|11281.82|32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46750.69||32134.78|11281.82||||
MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46750.69||32134.78|11281.82||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47101.19|20071.12|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47101.19|27361.08|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47101.19|8309.18|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47101.19|12569.4|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47101.19|22458.66|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|GEHA [1415]|GEHA [141500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47101.19|12963.95|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47101.19|8309.18|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47101.19|32133.15|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47101.19|16345.85|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47101.19|15963.7|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47101.19|2550|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MULTIPLAN [1680]|HMA [168003]|47101.19|235.57|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|Self-pay|Self-pay|47101.19|14130.36|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47101.19|14500.2|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47101.19|17044.74|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47101.19|13101.2|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|UMR [2035]|UMR OPTIONS [203501]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47101.19|5649.11|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47101.19|7621.04|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47101.19|31096.59|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47101.19|1450|32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47101.19||32133.15|235.57||||
MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47101.19|12569.4|32133.15|235.57||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60375.76|30905.4|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60375.76|35072.29|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60375.76|6352.6|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60375.76|10232.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60375.76|34581.7|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|GEHA [1415]|GEHA [141500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60375.76|10553.55|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60375.76|6352.6|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60375.76|49478.44|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60375.76|13306.65|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60375.76|12995.55|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60375.76|1700|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|60375.76|358.01|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60375.76|16653.82|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60375.76|29217.79|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|Self-pay|Self-pay|60375.76|18112.73|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60375.76|11421.7|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60375.76|13853.68|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60375.76|10648.43|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60375.76|4400.73|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60375.76|6245.52|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60375.76|47882.36|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60375.76|2900|49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60375.76||49478.44|358.01||||
MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60375.76|10232.36|49478.44|358.01||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|GEHA [1415]|GEHA [141500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MULTIPLAN [1680]|HMA [168003]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MULTIPLAN [1680]|IHC HS [168011]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|Self-pay|Self-pay|114633.75|34390.12|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|TRUSTMARK [2030]|STARMARK [203000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|UMR [2035]|UMR OPTIONS [203501]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114633.75|19196.88|34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|114633.75||34390.12|19196.88||||
MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|114633.75||34390.12|19196.88||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71002.96|36578.49|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71002.96|29317.8|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71002.96|14983.16|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71002.96|22169.55|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71002.96|40929.62|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|GEHA [1415]|GEHA [141500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71002.96|30699.76|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71002.96|14983.16|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71002.96|58560.84|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71002.96|28830.35|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71002.96|28156.32|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71002.96|850|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MULTIPLAN [1680]|HMA [168003]|71002.96|7834.31|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71002.96|66030.84|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|Self-pay|Self-pay|71002.96|21300.89|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71002.96|26121.99|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71002.96|30067.75|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71002.96|23111.14|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|UMR [2035]|UMR OPTIONS [203501]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71002.96|12958.69|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71002.96|13271.47|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71002.96|56671.79|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71002.96|725|66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71002.96||66030.84|725||||
MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71002.96|22169.55|66030.84|725||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66036.2|35937.38|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66036.2|41824.16|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66036.2|12191.64|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66036.2|19063.16|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66036.2|40212.25|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|GEHA [1415]|GEHA [141500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66036.2|27503.66|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66036.2|12191.64|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66036.2|57534.44|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66036.2|24790.65|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66036.2|24211.06|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66036.2|1700|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|66036.2|7842.11|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|Self-pay|Self-pay|66036.2|19810.86|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66036.2|21860.49|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66036.2|25872|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66036.2|19886.14|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66036.2|11287.19|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66036.2|11443.13|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66036.2|55678.5|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66036.2|1450|57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66036.2||57534.44|1450||||
MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66036.2|19063.16|57534.44|1450||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68998.67|31366.86|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68998.67|53556.16|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68998.67|14035.16|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68998.67|21395.74|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68998.67|35098.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68998.67||53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68998.67||53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|GEHA [1415]|GEHA [141500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68998.67|22067.35|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68998.67|14035.16|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68998.67|50217.21|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68998.67|27824.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68998.67|12836.22|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68998.67|27173.54|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68998.67|1700|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MULTIPLAN [1680]|HMA [168003]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MULTIPLAN [1680]|IHC HS [168011]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68998.67||53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68998.67|33589.15|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|Self-pay|Self-pay|68998.67|20699.6|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68998.67|23910.12|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68998.67|31726.23|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68998.67|28945.05|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|TRUSTMARK [2030]|STARMARK [203000]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68998.67|22248.19|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|UMR [2035]|UMR OPTIONS [203501]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68998.67|10808.94|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68998.67|12816.04|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68998.67|48597.3|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68998.67|3625|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68998.67|26438.53|53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68998.67||53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68998.67||53556.16|1700||||
MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68998.67|21395.74|53556.16|1700||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|AETNA [1015]|AETNA ACO WILCO [101532]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41801.23|24397.91|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41801.23|25190.43|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41801.23|15406.09|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41801.23|15406.09|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41801.23|8594.22|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41801.23|11373|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41801.23|27300.1|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|CORESOURCE [1315]|CORESOURCE [131500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41801.23||39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41801.23||39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|GEHA [1415]|GEHA [141500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41801.23|11730|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HEALTHNET [1495]|HEALTHNET [149500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41801.23|8594.22|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41801.23|39060.15|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41801.23|14790|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41801.23||39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41801.23|14444.22|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41801.23|850|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MULTIPLAN [1680]|HMA [168003]|41801.23|101.42|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MULTIPLAN [1680]|IHC HS [168011]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41801.23|15165.49|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41801.23|13204.09|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|Self-pay|Self-pay|41801.23|12540.37|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41801.23|13940.47|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41801.23|32784.47|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41801.23|12977.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|TRUSTMARK [2030]|STARMARK [203000]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41801.23|11841.67|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|UMR [2035]|UMR OPTIONS [203501]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41801.23|7799.76|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41801.23|6916.88|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41801.23|37800.14|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41801.23|725|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41801.23|27320.38|39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41801.23||39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41801.23||39060.15|101.42||||
MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41801.23|11373|39060.15|101.42||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35102.92|9060.55|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35102.92|9060.55|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35102.92|21453.42|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35102.92|17341.47|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35102.92|10756.42|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35102.92|10756.42|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35102.92|6080.48|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35102.92|10756.42|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35102.92|7934.34|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35102.92|24005.38|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|GEHA [1415]|GEHA [141500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35102.92|8183.4|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35102.92|6080.48|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35102.92|34346.17|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35102.92|10318.2|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35102.92|9060.55|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35102.92|10076.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35102.92|1700|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35102.92|9060.55|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|35102.92|10.15|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35102.92|25222.35|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35102.92|8821.83|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35102.92|9060.55|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|Self-pay|Self-pay|35102.92|10530.88|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35102.92|10094.03|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35102.92|9060.55|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35102.92|8267.77|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35102.92|6302.89|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35102.92|4892.97|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35102.92|33238.22|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35102.92|1450|34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35102.92||34346.17|10.15||||
MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35102.92|7934.34|34346.17|10.15||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|GEHA [1415]|GEHA [141500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MULTIPLAN [1680]|HMA [168003]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MULTIPLAN [1680]|IHC HS [168011]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|Self-pay|Self-pay|46888.4|14066.52|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|TRUSTMARK [2030]|STARMARK [203000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|UMR [2035]|UMR OPTIONS [203501]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46888.4|10676.44|14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46888.4||14066.52|10676.44||||
MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46888.4||14066.52|10676.44||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40653.23|14147.24|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40653.23|6778.96|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40653.23|9911.24|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40653.23|15830.1|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|GEHA [1415]|GEHA [141500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40653.23|10222.35|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40653.23|6778.96|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40653.23|22649.22|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40653.23|12889.05|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40653.23|12587.71|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MULTIPLAN [1680]|HMA [168003]|40653.23|31.5|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|Self-pay|Self-pay|40653.23|12195.97|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40653.23|12112.57|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40653.23|13445.15|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40653.23|10334.42|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|UMR [2035]|UMR OPTIONS [203501]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40653.23|5880.4|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40653.23|21918.6|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40653.23|725|22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40653.23||22649.22|31.5||||
MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40653.23|9911.24|22649.22|31.5||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|AETNA [1015]|AETNA ACO WILCO [101532]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32742.67|21281.82|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32742.67|14671.61|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32742.67|5640.39|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32742.67|8776.17|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32742.67|23813.36|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|CORESOURCE [1315]|CORESOURCE [131500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32742.67||37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32742.67||37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|GEHA [1415]|GEHA [141500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32742.67|9051.65|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HEALTHNET [1495]|HEALTHNET [149500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32742.67|5640.39|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32742.67|34071.42|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32742.67|11412.95|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32742.67||37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32742.67|11146.12|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32742.67|850|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MULTIPLAN [1680]|HMA [168003]|32742.67|84.62|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MULTIPLAN [1680]|IHC HS [168011]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32742.67||37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32742.67|10882.55|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|Self-pay|Self-pay|32742.67|9822.8|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32742.67|10168.39|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32742.67|37679.34|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32742.67|11894.25|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|TRUSTMARK [2030]|STARMARK [203000]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32742.67|9142.34|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|UMR [2035]|UMR OPTIONS [203501]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32742.67|5847.72|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32742.67|5388.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32742.67|32972.35|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32742.67|725|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32742.67|31399.45|37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32742.67||37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32742.67||37679.34|84.62||||
MS069|DRG||Transient Ischemia Without Thrombolytic|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32742.67|8776.17|37679.34|84.62||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|74737.07|21388.9|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74737.07|40829.53|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74737.07|52633.67|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74737.07|14146.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74737.07|13273.69|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74737.07|18727.54|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74737.07|45686.31|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74737.07||65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74737.07||65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|GEHA [1415]|GEHA [141500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74737.07|19315.4|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74737.07|13273.69|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74737.07|65366.57|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74737.07|24354.2|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74737.07||65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74737.07|23784.82|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74737.07|11900|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|74737.07|90.1|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74737.07|30624.79|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74737.07|42193.25|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|Self-pay|Self-pay|74737.07|22421.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74737.07|22289.07|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74737.07|27764.9|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74737.07|25365.12|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74737.07|19496.53|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74737.07|18928|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74737.07|11245.59|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74737.07|63257.98|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74737.07|5075|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74737.07|28921.77|65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74737.07||65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74737.07||65366.57|90.1||||
MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74737.07|18727.54|65366.57|90.1||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|80587.94|12815.4|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80587.94|15294.12|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80587.94|46621.85|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80587.94|35235.1|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80587.94|6149.06|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|80587.94|8929.91|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80587.94|6194.54|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80587.94|12540|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|80587.94|7521.91|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|80587.94|11281.57|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80587.94|52167.66|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|80587.94||74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|80587.94||74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|GEHA [1415]|GEHA [141500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|80587.94|11635.7|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80587.94|12540|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|80587.94|74639.88|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80587.94|14671.1|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|80587.94||74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80587.94|15294.12|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80587.94|10527|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80587.94|7650|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80587.94|15294.12|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|80587.94|7|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|80587.94|21035.7|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|80587.94|43657.37|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80587.94|15294.12|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|Self-pay|Self-pay|80587.94|24176.38|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80587.94|13379.39|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|80587.94|27727.92|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80587.94|15294.12|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80587.94|11755.6|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80587.94|12168|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80587.94|6863.07|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80587.94|72232.15|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|80587.94|7975|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|80587.94|28883.25|74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|80587.94||74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|80587.94||74639.88|7||||
MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|80587.94|11281.57|74639.88|7||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|61644.02|9646|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61644.02|51606.44|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61644.02|32396.2|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61644.02|5609.7|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61644.02|8604.46|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61644.02|25961.35|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61644.02||51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61644.02||51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61644.02|8874.55|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61644.02|5609.7|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61644.02|37144.7|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61644.02|11189.65|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61644.02||51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61644.02|10928.04|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61644.02|3400|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|61644.02|60.31|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61644.02|28873.59|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61644.02||51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|Self-pay|Self-pay|61644.02|18493.21|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61644.02|10277.9|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61644.02|27718.64|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61644.02|11668.8|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61644.02|8969.06|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61644.02|6289.81|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61644.02|5287.38|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61644.02|35946.49|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61644.02|1450|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61644.02|28873.59|51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61644.02||51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61644.02||51606.44|60.31||||
MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61644.02|8604.46|51606.44|60.31||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56457.98|42606.66|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56457.98|27693.42|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56457.98|10731.68|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|56457.98|16199.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56457.98|47674.87|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|GEHA [1415]|GEHA [141500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|56457.98|18765.53|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56457.98|10731.68|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|56457.98|68211.73|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56457.98|21067.05|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56457.98|20574.52|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56457.98|1700|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|56457.98|2057.18|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|56457.98|35664.02|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|Self-pay|Self-pay|56457.98|16937.39|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56457.98|18979.38|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56457.98|15212.95|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56457.98|16856.52|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56457.98|4531.48|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56457.98|9757.84|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56457.98|66011.35|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|56457.98|3625|68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|56457.98||68211.73|1700||||
MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|56457.98|16199.84|68211.73|1700||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83051.46|18305.17|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83051.46|52169.67|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83051.46|7143.95|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83051.46|11361.85|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83051.46|20482.62|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|GEHA [1415]|GEHA [141500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83051.46|11718.5|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83051.46|7143.95|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83051.46|29305.9|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83051.46|14775.5|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83051.46|14430.06|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83051.46|11900|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|83051.46|26.77|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83051.46|20639.45|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83051.46|27929.98|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|Self-pay|Self-pay|83051.46|24915.44|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83051.46|12891.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83051.46|12979.69|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83051.46|11843.99|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83051.46|18928|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83051.46|6910.32|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83051.46|28360.55|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83051.46|725|52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83051.46||52169.67|26.77||||
MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83051.46|11361.85|52169.67|26.77||||
MS075|DRG||Viral Meningitis With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176174.81|102089.57|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176174.81|91386.78|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|176174.81|18141.05|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176174.81|114233.48|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|GEHA [1415]|GEHA [141500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|176174.81|22660|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176174.81|91386.78|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|176174.81|163441.75|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176174.81|23591.5|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176174.81|23039.95|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|176174.81|3949.5|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|Self-pay|Self-pay|176174.81|52852.44|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176174.81|22312.06|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176174.81|24602.53|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176174.81|18910.38|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176174.81|158169.43|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|176174.81|9425|163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|176174.81||163441.75|3949.5||||
MS075|DRG||Viral Meningitis With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|176174.81|18141.05|163441.75|3949.5||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16899.69|9817.05|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16899.69|6967.92|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16899.69|10981.64|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16899.69|10984.8|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16899.69|12059.84|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16899.69|6967.92|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|16899.69|15716.71|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16899.69|14281.05|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16899.69|13947.17|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|16899.69|733.49|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|Self-pay|Self-pay|16899.69|5069.91|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16899.69|12999.48|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16899.69|12501.75|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16899.69|11407.87|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16899.69|15209.72|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16899.69|1450|15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16899.69||15716.71|733.49||||
MS076|DRG||Viral Meningitis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16899.69|10981.64|15716.71|733.49||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|GEHA [1415]|GEHA [141500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MULTIPLAN [1680]|HMA [168003]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|Self-pay|Self-pay|68605.93|20581.78|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|UMR [2035]|UMR OPTIONS [203501]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68605.93|10282.86|20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68605.93||20581.78|10282.86||||
MS077|DRG||Hypertensive Encephalopathy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68605.93||20581.78|10282.86||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47330.75|35138.83|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47330.75|17401.74|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47330.75|7559.01|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47330.75|10591.39|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47330.75|39318.7|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|GEHA [1415]|GEHA [141500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47330.75|10923.85|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47330.75|7559.01|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47330.75|56255.99|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47330.75|13773.55|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47330.75|13451.53|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47330.75|850|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MULTIPLAN [1680]|HMA [168003]|47330.75|48.1|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|Self-pay|Self-pay|47330.75|14199.22|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47330.75|13428.06|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47330.75|11122.95|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47330.75|11036.87|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47330.75|4299.44|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47330.75|6456.84|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47330.75|54441.28|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47330.75|2900|56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47330.75||56255.99|48.1||||
MS078|DRG||Hypertensive Encephalopathy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47330.75|10591.39|56255.99|48.1||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|Self-pay|Self-pay|16631|4989.3|4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16631||4989.3|4989.3||||
MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16631||4989.3|4989.3||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37964.75|17697.76|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|GEHA [1415]|GEHA [141500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37964.75|1700|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MULTIPLAN [1680]|HMA [168003]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MULTIPLAN [1680]|IHC HS [168011]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|Self-pay|Self-pay|37964.75|11389.42|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|TRUSTMARK [2030]|STARMARK [203000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|UMR [2035]|UMR OPTIONS [203501]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37964.75|5874.69|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37964.75|0|17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37964.75||17697.76|1700||||
MS080|DRG||Nontraumatic Stupor And Coma With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37964.75||17697.76|1700||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40540.68|16361.96|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40540.68|6210|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40540.68|13213.81|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40540.68|13213.81|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40540.68|13213.81|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|GEHA [1415]|GEHA [141500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40540.68|13213.81|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40540.68|13213.81|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40540.68|16689.2|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MULTIPLAN [1680]|HMA [168003]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|Self-pay|Self-pay|40540.68|12162.2|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40540.68|16361.96|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|UMR [2035]|UMR OPTIONS [203501]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40540.68|16361.96|16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40540.68||16689.2|6210||||
MS081|DRG||Nontraumatic Stupor And Coma Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40540.68||16689.2|6210||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39851.97|14801.91|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|GEHA [1415]|GEHA [141500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39851.97|1700|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MULTIPLAN [1680]|HMA [168003]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MULTIPLAN [1680]|IHC HS [168011]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|Self-pay|Self-pay|39851.97|11955.59|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39851.97|116222.34|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|TRUSTMARK [2030]|STARMARK [203000]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|UMR [2035]|UMR OPTIONS [203501]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39851.97|16126.75|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39851.97|15080.15|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39851.97|96851.95|116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39851.97||116222.34|1700||||
MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39851.97||116222.34|1700||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30568|8205.8|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30568|10013.81|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30568|10594.5|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30568|9181.9|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|GEHA [1415]|GEHA [141500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30568|14126|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30568|10013.81|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30568|13137.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30568|14126|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30568|14126|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MULTIPLAN [1680]|HMA [168003]|30568|157.5|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|Self-pay|Self-pay|30568|9170.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30568|14126|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30568|7063|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30568|14126|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|UMR [2035]|UMR OPTIONS [203501]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30568|9043.18|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30568|12713.4|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30568|725|14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30568||14126|157.5||||
MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30568|10594.5|14126|157.5||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26145.08|6126.18|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|GEHA [1415]|GEHA [141500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26145.08|850|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|Self-pay|Self-pay|26145.08|7843.52|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26145.08|9804.23|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26145.08|6166.12|9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26145.08||9804.23|850||||
MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26145.08||9804.23|850||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41498.08|58332.32|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41498.08|52216.9|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41498.08|25775.46|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41498.08|65271.13|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|GEHA [1415]|GEHA [141500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41498.08|27912.94|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41498.08|52216.9|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41498.08|93387.91|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41498.08|33519.65|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41498.08|32735.98|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MULTIPLAN [1680]|HMA [168003]|41498.08|1328.39|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MULTIPLAN [1680]|IHC HS [168011]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|Self-pay|Self-pay|41498.08|12449.42|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41498.08|27686.26|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41498.08|34897.47|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|TRUSTMARK [2030]|STARMARK [203000]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41498.08|26823.43|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|UMR [2035]|UMR OPTIONS [203501]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41498.08|15393.84|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41498.08|90375.4|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41498.08|4350|93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41498.08||93387.91|1328.39||||
MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41498.08|25775.46|93387.91|1328.39||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45684.42|29059.48|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45684.42|15551.3|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45684.42|9028.66|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|45684.42|14210.68|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45684.42|32516.2|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|GEHA [1415]|GEHA [141500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|45684.42|14656.75|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45684.42|9028.66|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|45684.42|46523.18|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45684.42|18480.25|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45684.42|18048.19|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45684.42|850|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MULTIPLAN [1680]|HMA [168003]|45684.42|353.12|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|45684.42|27144.02|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|Self-pay|Self-pay|45684.42|13705.33|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45684.42|15984.7|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45684.42|19259.88|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45684.42|14803.83|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|UMR [2035]|UMR OPTIONS [203501]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45684.42|6304.91|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45684.42|8587.08|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45684.42|45022.43|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|45684.42|2900|46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|45684.42||46523.18|353.12||||
MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|45684.42|14210.68|46523.18|353.12||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21225.25|12329.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21225.25|21535.24|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21225.25|6023.95|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21225.25|9629.14|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21225.25|13796.41|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|GEHA [1415]|GEHA [141500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21225.25|9931.4|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21225.25|6023.95|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|21225.25|19739.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21225.25|12522.2|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21225.25|12229.44|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21225.25|850|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|Self-pay|Self-pay|21225.25|6367.57|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21225.25|11248.64|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21225.25|13051.75|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21225.25|10032.04|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21225.25|5993.85|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21225.25|5890.48|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21225.25|19102.73|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21225.25|725|21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21225.25||21535.24|725||||
MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21225.25|9629.14|21535.24|725||||
MS088|DRG||Concussion With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|GEHA [1415]|GEHA [141500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MULTIPLAN [1680]|HMA [168003]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MULTIPLAN [1680]|IHC HS [168011]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|Self-pay|Self-pay|30121|9036.3|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|TRUSTMARK [2030]|STARMARK [203000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|UMR [2035]|UMR OPTIONS [203501]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30121|9788.23|9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30121||9788.23|9036.3||||
MS088|DRG||Concussion With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30121||9788.23|9036.3||||
MS089|DRG||Concussion With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|GEHA [1415]|GEHA [141500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MULTIPLAN [1680]|HMA [168003]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|Self-pay|Self-pay|44146.65|13243.99|39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44146.65|39511.13|39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|UMR [2035]|UMR OPTIONS [203501]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44146.65|32925.94|39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44146.65||39511.13|13243.99||||
MS089|DRG||Concussion With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44146.65||39511.13|13243.99||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89401.63|22681.56|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|89401.63|24949.03|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89401.63|24949.03|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89401.63|10350|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89401.63|73201.1|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89401.63|40632.04|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89401.63|21186.75|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89401.63|63132.63|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89401.63|44230.65|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89401.63|65526.87|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89401.63|53681.62|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89401.63|18406.42|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89401.63|81908.59|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89401.63|21186.75|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89401.63|21186.75|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89401.63||117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89401.63||117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|GEHA [1415]|GEHA [141500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89401.63|19827.43|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89401.63|65526.87|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89401.63|117192.29|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89401.63|23936.6|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89401.63|21186.75|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89401.63||117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89401.63|24949.03|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89401.63|21186.75|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89401.63|15312|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89401.63|6800|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89401.63|24949.03|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89401.63|23135.19|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MULTIPLAN [1680]|HMA [168003]|89401.63|843.23|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89401.63|16787.38|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89401.63||117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89401.63|24949.03|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|Self-pay|Self-pay|89401.63|26820.49|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89401.63|20820.8|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89401.63|22681.56|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89401.63|26109.86|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89401.63|24949.03|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89401.63|19176.71|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|UMR [2035]|UMR OPTIONS [203501]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89401.63|10816|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89401.63|22681.56|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89401.63|113411.9|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89401.63|11600|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89401.63|27197.77|117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89401.63||117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89401.63||117192.29|843.23||||
MS091|DRG||Other Disorders Of Nervous System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89401.63|18406.42|117192.29|843.23||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|96663.8|17998.15|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96663.8|17998.15|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96663.8|57546.49|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96663.8|56152|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96663.8|9741.72|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96663.8|34771.58|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96663.8|13680|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96663.8|8205.72|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96663.8|11026.24|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96663.8|64391.81|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|GEHA [1415]|GEHA [141500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96663.8|14265.11|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96663.8|13680|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96663.8|92129.82|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96663.8|14339.05|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96663.8|17998.15|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96663.8|11484|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96663.8|11050|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96663.8|17998.15|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MULTIPLAN [1680]|HMA [168003]|96663.8|2892.76|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96663.8|26792.3|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96663.8|66880.12|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96663.8|17998.15|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|Self-pay|Self-pay|96663.8|28999.14|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96663.8|12665.54|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96663.8|17998.15|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96663.8|11468.34|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|UMR [2035]|UMR OPTIONS [203501]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96663.8|17576|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96663.8|6712.77|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96663.8|89157.89|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96663.8|8700|92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96663.8||92129.82|2892.76||||
MS092|DRG||Other Disorders Of Nervous System With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96663.8|11026.24|92129.82|2892.76||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74107.95|11761.03|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74107.95|27246.11|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74107.95|5477.27|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74107.95|8721.53|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74107.95|13160.05|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74107.95||46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74107.95||46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|GEHA [1415]|GEHA [141500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74107.95|8995.3|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74107.95|5477.27|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74107.95|18828.99|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74107.95|11341.9|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74107.95|5364.5|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74107.95|11076.73|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74107.95|1700|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|74107.95|31.5|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74107.95|46300.57|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74107.95|43049.31|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|Self-pay|Self-pay|74107.95|22232.38|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74107.95|9856.08|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74107.95|15987.67|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74107.95|9226.94|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74107.95|9086.52|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74107.95|4779.01|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74107.95|5285.46|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74107.95|18221.61|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74107.95|725|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74107.95|16653.82|46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74107.95||46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74107.95||46300.57|31.5||||
MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74107.95|8721.53|46300.57|31.5||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127119.77|53280.25|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127119.77|30015|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127119.77|49014.16|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127119.77|53877.04|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127119.77|53877.04|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127119.77|53877.04|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|GEHA [1415]|GEHA [141500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127119.77|53877.04|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127119.77|53877.04|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127119.77|9350|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127119.77|54345.86|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MULTIPLAN [1680]|HMA [168003]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|127119.77|32151.88|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|Self-pay|Self-pay|127119.77|38135.93|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127119.77|53280.25|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|UMR [2035]|UMR OPTIONS [203501]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127119.77|14872|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127119.77|53280.25|54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|127119.77||54345.86|9350||||
MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|127119.77||54345.86|9350||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100749.29|58525.26|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100749.29|74128.48|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100749.29|42850.8|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100749.29|63482.64|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100749.29|52006.94|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100749.29|27956.4|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100749.29|79353.31|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|GEHA [1415]|GEHA [141500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100749.29|32385.87|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100749.29|63482.64|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100749.29|113536.27|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100749.29|36355.85|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100749.29|15312|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100749.29|16150|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MULTIPLAN [1680]|HMA [168003]|100749.29|3551.92|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100749.29|23639.31|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|Self-pay|Self-pay|100749.29|30224.79|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100749.29|31790.93|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100749.29|61163.09|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100749.29|29168.04|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|UMR [2035]|UMR OPTIONS [203501]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100749.29|25688|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100749.29|109873.81|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100749.29|11600|113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100749.29||113536.27|3551.92||||
MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100749.29|27956.4|113536.27|3551.92||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110067.76|25628.26|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110067.76|13455|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110067.76|28710.47|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110067.76|28710.47|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110067.76|28710.47|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|GEHA [1415]|GEHA [141500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110067.76|28710.47|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110067.76|7524.65|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110067.76|28710.47|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110067.76|26140.82|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|Self-pay|Self-pay|110067.76|33020.33|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110067.76|25628.26|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110067.76|25628.26|33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110067.76||33020.33|7524.65||||
MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110067.76||33020.33|7524.65||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64421.47|37849.07|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64421.47|4505.12|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64421.47|9120|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64421.47|5470.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64421.47|41928.46|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64421.47|42351.36|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|GEHA [1415]|GEHA [141500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64421.47|43244.6|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64421.47|9120|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64421.47|60595.02|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64421.47|54525.8|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64421.47|7656|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MULTIPLAN [1680]|HMA [168003]|64421.47|38.13|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64421.47|17935.33|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|Self-pay|Self-pay|64421.47|19326.44|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64421.47|46023.43|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64421.47|6494.48|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64421.47|43642.74|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64421.47|58640.35|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64421.47|5800|60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64421.47||60595.02|38.13||||
MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64421.47|41928.46|60595.02|38.13||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84404.87|37417.43|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84404.87|37417.43|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84404.87|45473.79|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84404.87|67368.55|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84404.87|55190.39|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84404.87|23554.38|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84404.87|84210.69|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|GEHA [1415]|GEHA [141500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84404.87|24833.98|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84404.87|67368.55|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84404.87|120486.06|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84404.87|30631.25|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84404.87|17226|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84404.87|6800|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MULTIPLAN [1680]|HMA [168003]|84404.87|540.23|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84404.87|21035.7|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|Self-pay|Self-pay|84404.87|25321.46|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84404.87|25331.07|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84404.87|64907.02|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84404.87|24549.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84404.87|10816|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84404.87|14108.77|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84404.87|116599.41|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84404.87|13050|120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84404.87||120486.06|540.23||||
MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84404.87|23554.38|120486.06|540.23||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49886.69|45886.3|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49886.69|9374.27|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49886.69|15631.19|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49886.69|51344.63|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49886.69|16121.85|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49886.69|9374.27|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49886.69|73462.32|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49886.69|20327.55|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49886.69|19852.31|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|49886.69|371.72|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|Self-pay|Self-pay|49886.69|14966.01|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49886.69|16303.77|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49886.69|21142.14|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49886.69|16250.6|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49886.69|71092.56|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49886.69|2900|73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49886.69||73462.32|371.72||||
MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49886.69|15631.19|73462.32|371.72||||
MS100|DRG||Seizures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61207.06|17939.4|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61207.06|35285.69|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61207.06|12357.98|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61207.06|20921.86|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61207.06|20073.35|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61207.06||35285.69|479.68||||
MS100|DRG||Seizures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61207.06||35285.69|479.68||||
MS100|DRG||Seizures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|GEHA [1415]|GEHA [141500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61207.06|21578.6|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61207.06|12357.98|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61207.06|28720.33|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61207.06|27207.8|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61207.06|12556.85|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61207.06|26571.7|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61207.06|4250|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MULTIPLAN [1680]|HMA [168003]|61207.06|479.68|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61207.06|22864.22|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61207.06|12714.68|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|Self-pay|Self-pay|61207.06|18362.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61207.06|22278.26|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61207.06||35285.69|479.68||||
MS100|DRG||Seizures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61207.06|28348.9|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61207.06|21789.97|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|UMR [2035]|UMR OPTIONS [203501]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61207.06|4545.28|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61207.06|12537.12|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61207.06|27793.87|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61207.06|725|35285.69|479.68||||
MS100|DRG||Seizures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61207.06||35285.69|479.68||||
MS100|DRG||Seizures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61207.06||35285.69|479.68||||
MS100|DRG||Seizures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61207.06||35285.69|479.68||||
MS100|DRG||Seizures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61207.06|20921.86|35285.69|479.68||||
MS101|DRG||Seizures Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38142.29|26779.04|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38142.29|17944.49|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38142.29|6110.35|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38142.29|9905.66|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38142.29|29964.48|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|38142.29||52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38142.29||52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|GEHA [1415]|GEHA [141500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38142.29|10216.6|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38142.29|6110.35|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|38142.29|42872.26|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38142.29|12881.8|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38142.29||52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38142.29|12580.63|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38142.29|2550|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MULTIPLAN [1680]|HMA [168003]|38142.29|223.37|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38142.29|16653.82|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|38142.29|22225.2|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|Self-pay|Self-pay|38142.29|11442.69|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38142.29|11202.67|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38142.29|52835.39|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38142.29|13420.94|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38142.29|10315.81|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|UMR [2035]|UMR OPTIONS [203501]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38142.29|3585.8|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38142.29|6053.23|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38142.29|41489.28|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38142.29|2175|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38142.29|44029.5|52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38142.29||52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38142.29||52835.39|223.37||||
MS101|DRG||Seizures Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38142.29|9905.66|52835.39|223.37||||
MS102|DRG||Headaches With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39972.8|23220.21|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39972.8|29205.09|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39972.8|8133.95|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39972.8|12857.07|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39972.8|25982.32|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|GEHA [1415]|GEHA [141500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39972.8|13260.65|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39972.8|8133.95|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39972.8|37174.7|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39972.8|16719.95|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39972.8|16329.05|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39972.8|1700|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MULTIPLAN [1680]|HMA [168003]|39972.8|190.18|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MULTIPLAN [1680]|IHC HS [168011]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|Self-pay|Self-pay|39972.8|11991.84|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39972.8|14346.07|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|TRUSTMARK [2030]|STARMARK [203000]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39972.8|13394.27|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|UMR [2035]|UMR OPTIONS [203501]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39972.8|4498.61|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39972.8|35975.52|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39972.8|725|37174.7|190.18||||
MS102|DRG||Headaches With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39972.8||37174.7|190.18||||
MS102|DRG||Headaches With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39972.8|12857.07|37174.7|190.18||||
MS103|DRG||Headaches Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35032.93|19433.44|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35032.93|16270.43|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35032.93|5583.86|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35032.93|9248.93|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35032.93|21745.11|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35032.93||31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35032.93||31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|GEHA [1415]|GEHA [141500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35032.93|9539.25|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35032.93|5583.86|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35032.93|31112.22|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35032.93|12027.75|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35032.93|5675.42|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35032.93|11746.55|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35032.93|850|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MULTIPLAN [1680]|HMA [168003]|35032.93|172.31|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35032.93||31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35032.93||31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|Self-pay|Self-pay|35032.93|10509.88|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35032.93|10135.94|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35032.93|27966.51|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35032.93|10277.96|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35032.93|9631.97|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|UMR [2035]|UMR OPTIONS [203501]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35032.93|3083.34|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35032.93|5388.45|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35032.93|30108.6|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35032.93|725|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35032.93|23340.78|31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35032.93||31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35032.93||31112.22|172.31||||
MS103|DRG||Headaches Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35032.93|9248.93|31112.22|172.31||||
MS113|DRG||Orbital Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83820.15|48691.11|48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83820.15|5950|48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|Self-pay|Self-pay|83820.15|25146.04|48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83820.15|5911|48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83820.15||48691.11|5911||||
MS113|DRG||Orbital Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83820.15||48691.11|5911||||
MS115|DRG||Extraocular Procedures Except Orbit|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|AETNA [1015]|AETNA ACO WILCO [101532]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|CORESOURCE [1315]|CORESOURCE [131500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|GEHA [1415]|GEHA [141500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HEALTHNET [1495]|HEALTHNET [149500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MULTIPLAN [1680]|HMA [168003]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MULTIPLAN [1680]|IHC HS [168011]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|Self-pay|Self-pay|58884.29|17665.29|52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58884.29|52995.86|52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|TRUSTMARK [2030]|STARMARK [203000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|UMR [2035]|UMR OPTIONS [203501]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58884.29|44163.22|52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58884.29||52995.86|17665.29||||
MS115|DRG||Extraocular Procedures Except Orbit|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58884.29||52995.86|17665.29||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|Self-pay|Self-pay|39546.98|11864.09|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39546.98|11980.32|11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39546.98||11980.32|11864.09||||
MS116|DRG||Intraocular Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39546.98||11980.32|11864.09||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|78298.36|45478.66|45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|Self-pay|Self-pay|78298.36|23489.51|45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|78298.36||45478.66|23489.51||||
MS117|DRG||Intraocular Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|78298.36||45478.66|23489.51||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|GEHA [1415]|GEHA [141500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|Self-pay|Self-pay|39524.13|11857.24|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39524.13|7573.64|11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39524.13||11857.24|7573.64||||
MS121|DRG||Acute Major Eye Infections With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39524.13||11857.24|7573.64||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|GEHA [1415]|GEHA [141500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|Self-pay|Self-pay|114950.85|34485.25|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114950.85|4214.05|34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|114950.85||34485.25|4214.05||||
MS122|DRG||Acute Major Eye Infections Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|114950.85||34485.25|4214.05||||
MS123|DRG||Neurological Eye Disorders|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|AETNA [1015]|AETNA ACO WILCO [101532]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|CORESOURCE [1315]|CORESOURCE [131500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|GEHA [1415]|GEHA [141500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HEALTHNET [1495]|HEALTHNET [149500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MULTIPLAN [1680]|HMA [168003]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MULTIPLAN [1680]|IHC HS [168011]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|Self-pay|Self-pay|36919.93|11075.98|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|TRUSTMARK [2030]|STARMARK [203000]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|UMR [2035]|UMR OPTIONS [203501]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36919.93|5255.22|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36919.93|11579.53|11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36919.93||11579.53|5255.22||||
MS123|DRG||Neurological Eye Disorders|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36919.93|11579.53|11579.53|5255.22||||
MS124|DRG||Other Disorders Of The Eye With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34814.1|20223.5|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34814.1|9231.34|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34814.1|15632.3|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34814.1|22629.17|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|GEHA [1415]|GEHA [141500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34814.1|16123|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34814.1|9231.34|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34814.1|32377.11|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34814.1|20329|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34814.1|19853.72|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MULTIPLAN [1680]|HMA [168003]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MULTIPLAN [1680]|IHC HS [168011]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|Self-pay|Self-pay|34814.1|10444.23|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34814.1|16885.13|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34814.1|16517.45|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|TRUSTMARK [2030]|STARMARK [203000]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34814.1|16268.04|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|UMR [2035]|UMR OPTIONS [203501]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34814.1|31332.69|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34814.1|1450|32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34814.1||32377.11|1450||||
MS124|DRG||Other Disorders Of The Eye With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34814.1|15632.3|32377.11|1450||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35777.23|17940.79|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|GEHA [1415]|GEHA [141500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35777.23|1700|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MULTIPLAN [1680]|HMA [168003]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|Self-pay|Self-pay|35777.23|10733.17|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|UMR [2035]|UMR OPTIONS [203501]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35777.23|3089.44|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35777.23|5715.91|17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35777.23||17940.79|1700||||
MS125|DRG||Other Disorders Of The Eye Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35777.23||17940.79|1700||||
MS137|DRG||Mouth Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137352.21|79787.88|79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137352.21|7650|79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|Self-pay|Self-pay|137352.21|41205.66|79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137352.21|6553.86|79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|137352.21||79787.88|6553.86||||
MS137|DRG||Mouth Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|137352.21||79787.88|6553.86||||
MS139|DRG||Salivary Gland Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|GEHA [1415]|GEHA [141500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MULTIPLAN [1680]|HMA [168003]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|Self-pay|Self-pay|53948.21|16184.46|16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|UMR [2035]|UMR OPTIONS [203501]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53948.21||16184.46|16184.46||||
MS139|DRG||Salivary Gland Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53948.21||16184.46|16184.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67524.66|39225.07|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67524.66|17896.87|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67524.66|43891.04|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67524.66|20291.68|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67524.66|62797.93|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67524.66|23273.95|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67524.66|22729.82|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|67524.66|256.46|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|Self-pay|Self-pay|67524.66|20257.4|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67524.66|24342.29|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67524.66|18710.34|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67524.66|60772.2|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67524.66|725|62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67524.66||62797.93|256.46||||
MS142|DRG||Major Head And Neck Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67524.66|17896.87|62797.93|256.46||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|165363.18|96059.47|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|165363.18|49281.77|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|165363.18|107486.06|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|165363.18|56363.16|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|165363.18|165363.18|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|165363.18|153787.76|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|165363.18|165363.18|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|165363.18|165363.18|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|165363.18|842.1|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|Self-pay|Self-pay|165363.18|49608.95|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|165363.18|165363.18|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|165363.18|54218.9|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|165363.18|165363.18|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|165363.18|148826.86|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|165363.18|5800|165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|165363.18||165363.18|842.1||||
MS143|DRG||Other Ear, Nose, Mouth And Throat O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|165363.18|49281.77|165363.18|842.1||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134085.85|77890.48|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134085.85|69724.64|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|134085.85|22758.27|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134085.85|87155.81|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|GEHA [1415]|GEHA [141500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|134085.85|28719.58|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134085.85|69724.64|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|134085.85|124699.83|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134085.85|29595.95|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134085.85|28904.02|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MULTIPLAN [1680]|HMA [168003]|134085.85|5246.93|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|Self-pay|Self-pay|134085.85|40225.75|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134085.85|25994.9|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134085.85|24119.67|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134085.85|23644.95|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|UMR [2035]|UMR OPTIONS [203501]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134085.85|120677.28|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|134085.85|7975|124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|134085.85||124699.83|5246.93||||
MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|134085.85|22758.27|124699.83|5246.93||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|Self-pay|Self-pay|79242.56|23772.77|23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79242.56||23772.77|23772.77||||
MS148|DRG||Ear, Nose, Mouth And Throat Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79242.56||23772.77|23772.77||||
MS149|DRG||Dysequilibrium|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|AETNA [1015]|AETNA ACO WILCO [101532]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39585.4|25331.99|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39585.4|21012.38|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39585.4|5121.17|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39585.4|8217.55|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39585.4|28345.33|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|CORESOURCE [1315]|CORESOURCE [131500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39585.4||40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39585.4||40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|GEHA [1415]|GEHA [141500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39585.4|8475.5|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HEALTHNET [1495]|HEALTHNET [149500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39585.4|5121.17|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39585.4|40555.61|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39585.4|10686.5|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39585.4||40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39585.4|10436.66|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39585.4|850|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MULTIPLAN [1680]|HMA [168003]|39585.4|81.68|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MULTIPLAN [1680]|IHC HS [168011]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39585.4||40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39585.4|13347.71|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|Self-pay|Self-pay|39585.4|11875.62|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39585.4|9520.78|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39585.4|15376.22|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39585.4|11128.64|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|TRUSTMARK [2030]|STARMARK [203000]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39585.4|8553.87|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|UMR [2035]|UMR OPTIONS [203501]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39585.4|3242.49|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39585.4|5059.65|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39585.4|39247.37|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39585.4|1450|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39585.4|12813.52|40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39585.4||40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39585.4||40555.61|81.68||||
MS149|DRG||Dysequilibrium|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39585.4|8217.55|40555.61|81.68||||
MS150|DRG||Epistaxis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|GEHA [1415]|GEHA [141500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MULTIPLAN [1680]|HMA [168003]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|Self-pay|Self-pay|65020.95|19506.28|19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|UMR [2035]|UMR OPTIONS [203501]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65020.95||19506.28|19506.28||||
MS150|DRG||Epistaxis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65020.95||19506.28|19506.28||||
MS151|DRG||Epistaxis Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31204.95|31117.36|31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|GEHA [1415]|GEHA [141500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31204.95|2550|31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MULTIPLAN [1680]|HMA [168003]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|Self-pay|Self-pay|31204.95|9361.48|31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|UMR [2035]|UMR OPTIONS [203501]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31204.95|3497.51|31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31204.95||31117.36|2550||||
MS151|DRG||Epistaxis Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31204.95||31117.36|2550||||
MS152|DRG||Otitis Media And Uri With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|GEHA [1415]|GEHA [141500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51751.86|8039.95|15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MULTIPLAN [1680]|HMA [168003]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MULTIPLAN [1680]|IHC HS [168011]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|Self-pay|Self-pay|51751.86|15525.56|15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|TRUSTMARK [2030]|STARMARK [203000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|UMR [2035]|UMR OPTIONS [203501]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51751.86||15525.56|8039.95||||
MS152|DRG||Otitis Media And Uri With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51751.86||15525.56|8039.95||||
MS153|DRG||Otitis Media And Uri Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30118.99|20128.83|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30118.99|12371.74|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30118.99|5558.83|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30118.99|7952.18|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30118.99|22523.2|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|GEHA [1415]|GEHA [141500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30118.99|8201.8|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30118.99|5558.83|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30118.99|32225.5|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30118.99|10341.4|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30118.99|10099.63|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30118.99|850|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MULTIPLAN [1680]|HMA [168003]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|Self-pay|Self-pay|30118.99|9035.7|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30118.99|9668.15|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30118.99|17555.69|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30118.99|9049.49|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30118.99|8264.28|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|UMR [2035]|UMR OPTIONS [203501]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30118.99|2962.03|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30118.99|31185.97|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30118.99|725|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30118.99|14629.74|32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30118.99||32225.5|725||||
MS153|DRG||Otitis Media And Uri Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30118.99|7952.18|32225.5|725||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|Self-pay|Self-pay|49580.39|14874.12|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49580.39|10374.06|14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49580.39||14874.12|10374.06||||
MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49580.39||14874.12|10374.06||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54379.99|14146.71|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54379.99|7144.76|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54379.99|10140.93|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54379.99|15829.52|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54379.99|10459.25|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54379.99|7144.76|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|54379.99|22648.38|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54379.99|13187.75|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54379.99|12879.43|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|54379.99|10.15|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|54379.99|26055.5|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|Self-pay|Self-pay|54379.99|16314|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54379.99|12134.2|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54379.99|10862.36|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54379.99|10546.08|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54379.99|6084.26|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54379.99|21917.79|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54379.99|1450|26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54379.99||26055.5|10.15||||
MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54379.99|10140.93|26055.5|10.15||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28475.74|5137.91|8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|Self-pay|Self-pay|28475.74|8542.72|8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28475.74||8542.72|5137.91||||
MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28475.74||8542.72|5137.91||||
MS157|DRG||Dental And Oral Diseases With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|GEHA [1415]|GEHA [141500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MULTIPLAN [1680]|HMA [168003]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MULTIPLAN [1680]|IHC HS [168011]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|Self-pay|Self-pay|56334.37|16900.31|16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|TRUSTMARK [2030]|STARMARK [203000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|UMR [2035]|UMR OPTIONS [203501]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|56334.37||16900.31|16900.31||||
MS157|DRG||Dental And Oral Diseases With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|56334.37||16900.31|16900.31||||
MS158|DRG||Dental And Oral Diseases With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14309.84|6644.34|6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|GEHA [1415]|GEHA [141500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14309.84|850|6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MULTIPLAN [1680]|HMA [168003]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|Self-pay|Self-pay|14309.84|4292.95|6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|UMR [2035]|UMR OPTIONS [203501]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14309.84|2847.02|6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14309.84||6644.34|850||||
MS158|DRG||Dental And Oral Diseases With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14309.84||6644.34|850||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|GEHA [1415]|GEHA [141500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|Self-pay|Self-pay|19866.57|5959.97|5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19866.57||5959.97|5959.97||||
MS159|DRG||Dental And Oral Diseases Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19866.57||5959.97|5959.97||||
MS163|DRG||Major Chest Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206147.48|93667.92|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206147.48|154404.24|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206147.48|83848.04|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|206147.48|55825.82|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206147.48|104810.06|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|GEHA [1415]|GEHA [141500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|206147.48|60533.3|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206147.48|83848.04|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|206147.48|149959|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206147.48|72598.6|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206147.48|70901.29|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206147.48|14450|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|206147.48|2955.1|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|206147.48|242948.09|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|Self-pay|Self-pay|206147.48|61844.24|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206147.48|66818.54|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206147.48|52056.11|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206147.48|57697.59|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206147.48|29342.16|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206147.48|33080.8|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206147.48|145121.61|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|206147.48|3625|242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|206147.48||242948.09|2955.1||||
MS163|DRG||Major Chest Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|206147.48|55825.82|242948.09|2955.1||||
MS164|DRG||Major Chest Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|140771.67|66033.35|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|GEHA [1415]|GEHA [141500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|140771.67|17678.65|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|140771.67|3400|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|Self-pay|Self-pay|140771.67|42231.5|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|140771.67|16211.9|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|140771.67|17650.73|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|140771.67|39881.53|66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|140771.67||66033.35|3400||||
MS164|DRG||Major Chest Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|140771.67|39881.53|66033.35|3400||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109954.07|49798.73|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109954.07|14712.65|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109954.07|21370.09|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109954.07|55722.45|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109954.07|22828.51|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109954.07|14712.65|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|109954.07|79725.97|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109954.07|27790.7|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109954.07|27140.97|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|109954.07|787.61|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|Self-pay|Self-pay|109954.07|32986.22|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109954.07|25021.46|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109954.07|28878.47|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109954.07|22255.17|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109954.07|12188.39|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109954.07|77154.16|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109954.07|2175|79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109954.07||79725.97|787.61||||
MS165|DRG||Major Chest Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109954.07|21370.09|79725.97|787.61||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105233.12|91229.18|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105233.12|52252|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105233.12|81664.97|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|105233.12|41517.03|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105233.12|102081.22|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|105233.12|43627.61|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105233.12|81664.97|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|105233.12|146054.65|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105233.12|53990.75|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105233.12|52728.48|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105233.12|1700|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|105233.12|927.76|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|Self-pay|Self-pay|105233.12|31569.94|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105233.12|47955.44|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105233.12|57340.85|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105233.12|44092.82|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105233.12|14177.38|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105233.12|24658.96|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105233.12|141343.21|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|105233.12|4350|146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|105233.12||146054.65|927.76||||
MS166|DRG||Other Respiratory System O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|105233.12|41517.03|146054.65|927.76||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146805.96|85279.57|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146805.96|76339.1|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|146805.96|20278.51|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146805.96|95423.88|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|146805.96|21495.16|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146805.96|76339.1|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|146805.96|136529.55|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146805.96|26371.15|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146805.96|25754.61|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|146805.96|580.11|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|Self-pay|Self-pay|146805.96|44041.79|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146805.96|25007.94|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146805.96|28158.25|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146805.96|21653.9|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146805.96|132125.36|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|146805.96|5800|136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|146805.96||136529.55|580.11||||
MS167|DRG||Other Respiratory System O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|146805.96|20278.51|136529.55|580.11||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128840.32|74843.33|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128840.32|66996.97|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128840.32|15101.56|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128840.32|83746.21|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128840.32|16562.8|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128840.32|66996.97|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128840.32|119821.5|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128840.32|19638.8|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128840.32|19179.66|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|128840.32|987.2|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|128840.32|38652.1|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128840.32|17446.21|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128840.32|16592.12|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128840.32|15922.63|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128840.32|115956.29|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128840.32|2900|119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128840.32||119821.5|987.2||||
MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128840.32|15101.56|119821.5|987.2||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|AETNA [1015]|AETNA ACO WILCO [101532]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47754.55|24771.66|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47754.55|26195.65|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47754.55|12331.33|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47754.55|17237.9|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47754.55|27718.31|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|CORESOURCE [1315]|CORESOURCE [131500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47754.55||39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47754.55||39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|GEHA [1415]|GEHA [141500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47754.55|17779|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HEALTHNET [1495]|HEALTHNET [149500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47754.55|12331.33|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47754.55|39658.52|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47754.55|22417|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47754.55||39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47754.55|21892.91|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47754.55|2550|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MULTIPLAN [1680]|HMA [168003]|47754.55|383.7|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MULTIPLAN [1680]|IHC HS [168011]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47754.55||39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47754.55|23313.02|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|Self-pay|Self-pay|47754.55|14326.36|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47754.55|19844.66|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47754.55|20829.4|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47754.55|23364.84|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|TRUSTMARK [2030]|STARMARK [203000]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47754.55|17959.05|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|UMR [2035]|UMR OPTIONS [203501]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47754.55|12835.57|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47754.55|10368.82|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47754.55|38379.21|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47754.55|1450|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47754.55|17404.8|39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47754.55||39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47754.55||39658.52|383.7||||
MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47754.55|17237.9|39658.52|383.7||||
MS176|DRG||Pulmonary Embolism Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31662.74|16485.02|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31662.74|22403.06|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31662.74|7808.53|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31662.74|9898.97|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31662.74|18445.98|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31662.74||26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31662.74||26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|GEHA [1415]|GEHA [141500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31662.74|10209.7|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31662.74|7808.53|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31662.74|26391.93|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31662.74|12873.1|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31662.74|6058.64|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31662.74|12572.14|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31662.74|1700|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MULTIPLAN [1680]|HMA [168003]|31662.74|243.5|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31662.74||26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31662.74|15431.8|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|Self-pay|Self-pay|31662.74|9498.82|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31662.74|12103.1|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31662.74|6049.3|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31662.74|17832.33|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31662.74|13416.4|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31662.74|10312.32|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|UMR [2035]|UMR OPTIONS [203501]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31662.74|9721.45|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31662.74|5948.09|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31662.74|25540.58|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31662.74|1450|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31662.74|14860.28|26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31662.74||26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31662.74||26391.93|243.5||||
MS176|DRG||Pulmonary Embolism Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31662.74|9898.97|26391.93|243.5||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|57950.99|27920.7|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57950.99|27920.7|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57950.99|32289.06|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57950.99|33455.43|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57950.99|27920.7|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57950.99|27920.7|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57950.99|15739.79|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57950.99|23518.68|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57950.99|20617.47|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57950.99|36129.95|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|57950.99||51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57950.99||51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|GEHA [1415]|GEHA [141500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57950.99|22037.84|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57950.99|15739.79|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|57950.99|51693.62|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57950.99|26811.95|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57950.99|14630.53|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57950.99|27920.7|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57950.99|26185.11|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57950.99|3400|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57950.99|20931.89|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57950.99|15815.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MULTIPLAN [1680]|HMA [168003]|57950.99|773.19|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MULTIPLAN [1680]|IHC HS [168011]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57950.99||51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|57950.99|34594.95|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57950.99|21747.64|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|Self-pay|Self-pay|57950.99|17385.3|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57950.99|25021.46|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57950.99|14630.53|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57950.99|44535.73|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57950.99|25164.51|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|TRUSTMARK [2030]|STARMARK [203000]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57950.99|21460.84|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|UMR [2035]|UMR OPTIONS [203501]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57950.99|12187.94|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57950.99|14607.2|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57950.99|50026.09|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57950.99|3625|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57950.99|37113.11|51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57950.99||51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57950.99||51693.62|773.19||||
MS177|DRG||Respiratory Infections And Inflammations With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57950.99|20617.47|51693.62|773.19||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30381.1|21870.56|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30381.1|18369.39|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30381.1|11231.52|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30381.1|13466.97|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30381.1|24472.13|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30381.1||35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30381.1||35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|GEHA [1415]|GEHA [141500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30381.1|13889.7|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30381.1|11231.52|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30381.1|35013.97|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30381.1|17513.1|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30381.1||35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30381.1|17103.66|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30381.1|850|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MULTIPLAN [1680]|HMA [168003]|30381.1|298.7|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30381.1||35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30381.1|15183.47|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|Self-pay|Self-pay|30381.1|9114.33|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30381.1|17511.1|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30381.1|9497.35|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30381.1|18246.12|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30381.1|14024.62|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|UMR [2035]|UMR OPTIONS [203501]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30381.1|7970.77|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30381.1|8853.51|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30381.1|33884.49|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30381.1|2900|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30381.1|7914.46|35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30381.1||35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30381.1||35013.97|298.7||||
MS178|DRG||Respiratory Infections And Inflammations With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30381.1|13466.97|35013.97|298.7||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41469.8|12477.89|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|GEHA [1415]|GEHA [141500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41469.8|1700|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|Self-pay|Self-pay|41469.8|12440.94|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41469.8|33579.31|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41469.8|6343.99|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41469.8|5950.2|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41469.8|28018.71|33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41469.8||33579.31|1700||||
MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41469.8||33579.31|1700||||
MS180|DRG||Respiratory Neoplasms With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96084.68|55815.6|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96084.68|13954.61|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96084.68|13621.72|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96084.68|19399.89|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96084.68|62455.04|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|GEHA [1415]|GEHA [141500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96084.68|20872.58|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96084.68|13621.72|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96084.68|89358.75|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96084.68|25228.55|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96084.68|24638.72|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96084.68|2550|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MULTIPLAN [1680]|HMA [168003]|96084.68|863.73|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MULTIPLAN [1680]|IHC HS [168011]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|Self-pay|Self-pay|96084.68|28825.4|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96084.68|22840.69|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96084.68|26294.15|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|TRUSTMARK [2030]|STARMARK [203000]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96084.68|20210.61|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|UMR [2035]|UMR OPTIONS [203501]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96084.68|10747.66|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96084.68|11641.32|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96084.68|86476.22|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96084.68|4350|89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96084.68||89358.75|863.73||||
MS180|DRG||Respiratory Neoplasms With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96084.68|19399.89|89358.75|863.73||||
MS181|DRG||Respiratory Neoplasms With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72593.61|42169.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72593.61|9352.47|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72593.61|12489.12|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72593.61|47185.84|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|GEHA [1415]|GEHA [141500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72593.61|14119.51|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72593.61|9352.47|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72593.61|67512.05|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72593.61|16241.45|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72593.61|15861.74|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MULTIPLAN [1680]|HMA [168003]|72593.61|1238.36|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|Self-pay|Self-pay|72593.61|21778.08|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72593.61|15629.12|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72593.61|10224.63|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72593.61|13036.07|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|UMR [2035]|UMR OPTIONS [203501]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72593.61|7573.8|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72593.61|65334.25|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72593.61|3625|67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72593.61||67512.05|1238.36||||
MS181|DRG||Respiratory Neoplasms With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72593.61|12489.12|67512.05|1238.36||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9393|5456.4|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9393|6531.06|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|9393|7044.75|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9393|6105.45|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|GEHA [1415]|GEHA [141500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|9393|9108|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9393|6531.06|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|9393|8735.49|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9393|9393|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9393|9393|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|Self-pay|Self-pay|9393|2817.9|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9393|9393|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9393|9158.63|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9393|8453.7|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|9393|725|9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|9393||9393|725||||
MS182|DRG||Respiratory Neoplasms Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|9393|7044.75|9393|725||||
MS183|DRG||Major Chest Trauma With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61982.69|44576.77|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61982.69|10616.54|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61982.69|12194.06|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61982.69|17381.74|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61982.69|49879.34|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|GEHA [1415]|GEHA [141500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61982.69|19062.08|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61982.69|12194.06|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61982.69|71365.82|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61982.69|22604.05|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61982.69|22075.58|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61982.69|850|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MULTIPLAN [1680]|HMA [168003]|61982.69|1134.73|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MULTIPLAN [1680]|IHC HS [168011]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|Self-pay|Self-pay|61982.69|18594.81|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61982.69|19966.34|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61982.69|23537.33|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|TRUSTMARK [2030]|STARMARK [203000]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61982.69|18091.63|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|UMR [2035]|UMR OPTIONS [203501]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61982.69|2518.82|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61982.69|10453.49|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61982.69|69063.7|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61982.69|3625|71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61982.69||71365.82|850||||
MS183|DRG||Major Chest Trauma With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61982.69|17381.74|71365.82|850||||
MS184|DRG||Major Chest Trauma With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|GEHA [1415]|GEHA [141500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MULTIPLAN [1680]|HMA [168003]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|Self-pay|Self-pay|36120.4|10836.12|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36120.4|48922.58|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|UMR [2035]|UMR OPTIONS [203501]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36120.4|6908.8|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36120.4|40768.82|48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36120.4||48922.58|6908.8||||
MS184|DRG||Major Chest Trauma With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36120.4||48922.58|6908.8||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|GEHA [1415]|GEHA [141500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|Self-pay|Self-pay|24651|7395.3|7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|24651||7395.3|7395.3||||
MS185|DRG||Major Chest Trauma Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|24651||7395.3|7395.3||||
MS186|DRG||Pleural Effusion With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66625.3|39778.79|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66625.3|27165.37|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66625.3|12477.49|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66625.3|17213.37|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66625.3|44510.59|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|GEHA [1415]|GEHA [141500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66625.3|18766.15|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66625.3|12477.49|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66625.3|63684.39|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66625.3|22385.1|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66625.3|21861.75|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66625.3|850|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MULTIPLAN [1680]|HMA [168003]|66625.3|1012.45|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MULTIPLAN [1680]|IHC HS [168011]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66625.3|25475.52|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|Self-pay|Self-pay|66625.3|19987.59|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66625.3|20612.59|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66625.3|23349.71|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|TRUSTMARK [2030]|STARMARK [203000]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66625.3|17947.42|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|UMR [2035]|UMR OPTIONS [203501]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66625.3|7879.88|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66625.3|10354.4|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66625.3|61630.07|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66625.3|2175|63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66625.3||63684.39|850||||
MS186|DRG||Pleural Effusion With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66625.3|17213.37|63684.39|850||||
MS187|DRG||Pleural Effusion With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44905.27|11720.6|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44905.27|16028.4|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44905.27|8632.98|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44905.27|11516.84|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44905.27|13114.79|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|GEHA [1415]|GEHA [141500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44905.27|11878.35|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44905.27|8632.98|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44905.27|18764.24|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44905.27|14977.05|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44905.27|14626.9|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44905.27|850|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MULTIPLAN [1680]|HMA [168003]|44905.27|20.3|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|Self-pay|Self-pay|44905.27|13471.58|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44905.27|14287.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44905.27|15617.92|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44905.27|12004.49|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|UMR [2035]|UMR OPTIONS [203501]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44905.27|6064.65|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44905.27|7001.52|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44905.27|18158.94|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44905.27|725|18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44905.27||18764.24|20.3||||
MS187|DRG||Pleural Effusion With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44905.27|11516.84|18764.24|20.3||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|GEHA [1415]|GEHA [141500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|Self-pay|Self-pay|41338.83|12401.65|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41338.83|4716.49|12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41338.83||12401.65|4716.49||||
MS188|DRG||Pleural Effusion Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41338.83||12401.65|4716.49||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|AETNA [1015]|AETNA ACO WILCO [101532]|50526.19|15533.46|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50526.19|15533.46|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50526.19|25555.86|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50526.19|24291.9|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50526.19|18532.09|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50526.19|18532.09|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50526.19|9799.82|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50526.19|18532.09|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50526.19|13671.02|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50526.19|28595.79|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|CORESOURCE [1315]|CORESOURCE [131500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50526.19||40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50526.19||40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|GEHA [1415]|GEHA [141500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50526.19|14100.15|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HEALTHNET [1495]|HEALTHNET [149500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50526.19|9799.82|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50526.19|40913.98|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50526.19|17778.45|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50526.19|9031.08|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50526.19|15533.46|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50526.19|17362.8|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50526.19|1700|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50526.19|15533.46|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MULTIPLAN [1680]|HMA [168003]|50526.19|575.09|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MULTIPLAN [1680]|IHC HS [168011]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50526.19|21306.3|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50526.19|20976.24|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50526.19|15533.46|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|Self-pay|Self-pay|50526.19|15157.86|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50526.19|16488.99|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50526.19|33383.66|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50526.19|14245.59|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|TRUSTMARK [2030]|STARMARK [203000]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50526.19|14244.42|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|UMR [2035]|UMR OPTIONS [203501]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50526.19|7632.53|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50526.19|8269.43|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50526.19|39594.18|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50526.19|2175|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50526.19|27881.1|40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50526.19||40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50526.19||40913.98|575.09||||
MS189|DRG||Pulmonary Edema And Respiratory Failure|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50526.19|13671.02|40913.98|575.09||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43908.73|27801.02|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43908.73|23847.8|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43908.73|9482.47|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43908.73|12544.87|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43908.73|31108.03|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|GEHA [1415]|GEHA [141500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43908.73|13513.99|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43908.73|9482.47|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43908.73|44508.4|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43908.73|16313.95|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43908.73|15932.54|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43908.73|1700|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MULTIPLAN [1680]|HMA [168003]|43908.73|816.14|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MULTIPLAN [1680]|IHC HS [168011]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|Self-pay|Self-pay|43908.73|13172.62|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43908.73|15583.15|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43908.73|14324.31|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|TRUSTMARK [2030]|STARMARK [203000]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43908.73|13070.96|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|UMR [2035]|UMR OPTIONS [203501]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43908.73|6932.39|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43908.73|7606.61|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43908.73|43072.66|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43908.73|2175|44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43908.73||44508.4|816.14||||
MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43908.73|12544.87|44508.4|816.14||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44042.56|25365.75|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|GEHA [1415]|GEHA [141500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44042.56|2550|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MULTIPLAN [1680]|HMA [168003]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|Self-pay|Self-pay|44042.56|13212.77|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44042.56|40566.91|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|UMR [2035]|UMR OPTIONS [203501]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44042.56|5418.25|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44042.56|5852.16|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44042.56|33805.77|40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44042.56||40566.91|2550||||
MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44042.56||40566.91|2550||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|GEHA [1415]|GEHA [141500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|Self-pay|Self-pay|30125.18|9037.55|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30125.18|4787.96|9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30125.18||9037.55|4787.96||||
MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30125.18||9037.55|4787.96||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52894.95|21899.6|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52894.95|34144.32|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52894.95|11701.48|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52894.95|14628.8|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52894.95|24504.64|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52894.95||66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52894.95||66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|GEHA [1415]|GEHA [141500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52894.95|15088|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52894.95|11701.48|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52894.95|35060.48|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52894.95|19024|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52894.95|8846.97|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52894.95|18579.23|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52894.95|3400|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MULTIPLAN [1680]|HMA [168003]|52894.95|113.47|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52894.95||66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52894.95|51979.68|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|Self-pay|Self-pay|52894.95|15868.48|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52894.95|18564.31|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52894.95|8846.97|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52894.95|66226.86|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52894.95|19831.82|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52894.95|15243.44|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|UMR [2035]|UMR OPTIONS [203501]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52894.95|8436.06|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52894.95|8833.17|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52894.95|33929.5|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52894.95|1450|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52894.95|55189.05|66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52894.95||66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52894.95||66226.86|113.47||||
MS193|DRG||Simple Pneumonia And Pleurisy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52894.95|14628.8|66226.86|113.47||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37876.1|23253.94|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37876.1|14033.99|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37876.1|7823.06|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37876.1|9632.49|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37876.1|26020.1|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|GEHA [1415]|GEHA [141500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37876.1|10674.99|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37876.1|7823.06|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37876.1|37228.75|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37876.1|12526.55|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37876.1|12233.69|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37876.1|850|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MULTIPLAN [1680]|HMA [168003]|37876.1|740.14|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37876.1|20744.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|Self-pay|Self-pay|37876.1|11362.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37876.1|12616.86|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37876.1|5798.13|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37876.1|13057.8|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37876.1|10036.69|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37876.1|6120.79|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37876.1|5892.46|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37876.1|36027.83|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37876.1|2175|37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37876.1||37228.75|740.14||||
MS194|DRG||Simple Pneumonia And Pleurisy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37876.1|9632.49|37228.75|740.14||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31565.32|18347.07|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31565.32|5688.03|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31565.32|7423.67|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31565.32|22121.02|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31565.32|7656.7|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31565.32|31650.07|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31565.32|1700|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|31565.32|329.08|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31565.32|9940.98|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|Self-pay|Self-pay|31565.32|9469.6|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31565.32|7758.94|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31565.32|7733.95|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31565.32|3871.24|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31565.32|4592.39|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31565.32|30629.11|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31565.32|1450|31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31565.32||31650.07|329.08||||
MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31565.32|7758.94|31650.07|329.08||||
MS196|DRG||Interstitial Lung Disease With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66174.91|13207.14|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66174.91|13432.76|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66174.91|17051.73|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66174.91|14778.17|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|GEHA [1415]|GEHA [141500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66174.91|19993.9|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66174.91|13432.76|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66174.91|21144.14|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66174.91|3939.02|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66174.91|26426.97|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66174.91|22735.64|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MULTIPLAN [1680]|HMA [168003]|66174.91|194.04|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MULTIPLAN [1680]|IHC HS [168011]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|Self-pay|Self-pay|66174.91|19852.47|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66174.91|21583.33|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66174.91|2873.62|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|TRUSTMARK [2030]|STARMARK [203000]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66174.91|20190.84|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|UMR [2035]|UMR OPTIONS [203501]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66174.91|11651.07|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66174.91|20462.08|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66174.91|725|26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66174.91||26426.97|194.04||||
MS196|DRG||Interstitial Lung Disease With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66174.91|17051.73|26426.97|194.04||||
MS197|DRG||Interstitial Lung Disease With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48709.95|28295.61|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48709.95|8571.61|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48709.95|11228.05|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48709.95|31661.47|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|GEHA [1415]|GEHA [141500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48709.95|11580.5|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48709.95|8571.61|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48709.95|45300.25|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48709.95|14601.5|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48709.95|14260.13|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MULTIPLAN [1680]|HMA [168003]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|Self-pay|Self-pay|48709.95|14612.98|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48709.95|14127.05|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48709.95|15215.44|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48709.95|11695.13|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|UMR [2035]|UMR OPTIONS [203501]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48709.95|43838.96|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48709.95|2175|45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48709.95||45300.25|2175||||
MS197|DRG||Interstitial Lung Disease With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48709.95|11228.05|45300.25|2175||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|GEHA [1415]|GEHA [141500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|Self-pay|Self-pay|91871.28|27561.38|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91871.28|10989.17|27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91871.28||27561.38|10989.17||||
MS198|DRG||Interstitial Lung Disease Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91871.28|10989.17|27561.38|10989.17||||
MS199|DRG||Pneumothorax With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52689.39|35636.37|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52689.39|27118.84|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52689.39|14813.59|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52689.39|19958.5|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52689.39|39875.44|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|GEHA [1415]|GEHA [141500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52689.39|20585|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52689.39|14813.59|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52689.39|57052.55|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52689.39|25955|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52689.39|25348.19|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52689.39|4250|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MULTIPLAN [1680]|HMA [168003]|52689.39|177.4|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MULTIPLAN [1680]|IHC HS [168011]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|Self-pay|Self-pay|52689.39|15806.82|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52689.39|24423.88|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52689.39|92704.59|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52689.39|27047.66|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|TRUSTMARK [2030]|STARMARK [203000]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52689.39|20789.79|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|UMR [2035]|UMR OPTIONS [203501]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52689.39|9654.88|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52689.39|11970.12|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52689.39|55212.14|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52689.39|3625|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52689.39|77301.4|92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52689.39||92704.59|177.4||||
MS199|DRG||Pneumothorax With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52689.39|19958.5|92704.59|177.4||||
MS200|DRG||Pneumothorax With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28690.68|14740.41|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28690.68|8142.83|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28690.68|12002.98|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28690.68|16493.81|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|GEHA [1415]|GEHA [141500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28690.68|12379.75|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28690.68|8142.83|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28690.68|23598.84|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28690.68|15609.25|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28690.68|15244.32|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MULTIPLAN [1680]|HMA [168003]|28690.68|185.85|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|Self-pay|Self-pay|28690.68|8607.2|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28690.68|14346.07|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28690.68|16265.51|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28690.68|12502.25|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|UMR [2035]|UMR OPTIONS [203501]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28690.68|7287.68|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28690.68|22837.59|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28690.68|1450|23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28690.68||23598.84|185.85||||
MS200|DRG||Pneumothorax With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28690.68|12002.98|23598.84|185.85||||
MS201|DRG||Pneumothorax Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23641.02|13733.07|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|GEHA [1415]|GEHA [141500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23641.02|850|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|Self-pay|Self-pay|23641.02|7092.31|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23641.02|4277.15|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23641.02|4879.83|13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23641.02||13733.07|850||||
MS201|DRG||Pneumothorax Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23641.02||13733.07|850||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33933.91|23268.97|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33933.91|16556.09|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33933.91|7085.81|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|33933.91|10782.05|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33933.91|26036.87|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|GEHA [1415]|GEHA [141500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|33933.91|11120.5|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33933.91|7085.81|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|33933.91|37252.76|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33933.91|14021.5|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33933.91|13693.69|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33933.91|1700|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|33933.91|289.54|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|33933.91|12762.08|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|Self-pay|Self-pay|33933.91|10180.17|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33933.91|12519.52|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33933.91|14610.21|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33933.91|11229.93|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33933.91|4193.34|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33933.91|6569.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33933.91|36051.06|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|33933.91|2175|37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|33933.91||37252.76|289.54||||
MS202|DRG||Bronchitis And Asthma With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|33933.91|10782.05|37252.76|289.54||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36734.37|51235.79|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36734.37|21339.01|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36734.37|5277.01|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36734.37|7883.05|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36734.37|57330.45|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|GEHA [1415]|GEHA [141500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36734.37|88200.69|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36734.37|5277.01|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36734.37|82026.64|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36734.37|10251.5|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36734.37|10011.83|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36734.37|1700|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|36734.37|174.65|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36734.37|10753.49|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|Self-pay|Self-pay|36734.37|11020.31|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36734.37|9538.36|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36734.37|9455.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36734.37|8204.97|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36734.37|4033.17|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36734.37|4862.76|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36734.37|79380.63|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36734.37|2175|88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36734.37||88200.69|174.65||||
MS203|DRG||Bronchitis And Asthma Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36734.37|7883.05|88200.69|174.65||||
MS204|DRG||Respiratory Signs And Symptoms|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|AETNA [1015]|AETNA ACO WILCO [101532]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42639.76|11500.59|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42639.76|63912.94|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42639.76|5685.61|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42639.76|8848.64|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42639.76|12868.62|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|CORESOURCE [1315]|CORESOURCE [131500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|GEHA [1415]|GEHA [141500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42639.76|9126.4|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HEALTHNET [1495]|HEALTHNET [149500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42639.76|5685.61|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42639.76|18412.03|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42639.76|11507.2|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42639.76|11238.17|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42639.76|3400|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MULTIPLAN [1680]|HMA [168003]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MULTIPLAN [1680]|IHC HS [168011]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|Self-pay|Self-pay|42639.76|12791.93|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42639.76|10359.02|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42639.76|13250.29|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42639.76|11991.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|TRUSTMARK [2030]|STARMARK [203000]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42639.76|9216.78|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|UMR [2035]|UMR OPTIONS [203501]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42639.76|12889.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42639.76|6052.13|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42639.76|17818.09|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42639.76|1450|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42639.76|11041.91|63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42639.76||63912.94|1450||||
MS204|DRG||Respiratory Signs And Symptoms|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42639.76|8848.64|63912.94|1450||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50423.38|30701.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50423.38|29312.54|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50423.38|11304.19|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50423.38|18785.52|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50423.38|34353.62|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50423.38|19375.2|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50423.38|11304.19|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50423.38|49152.1|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50423.38|17143.58|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50423.38|23858.45|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50423.38|3400|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|50423.38|367.67|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|Self-pay|Self-pay|50423.38|15127.01|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50423.38|20185.36|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50423.38|25454.39|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50423.38|19565.15|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50423.38|5821.05|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50423.38|11279.72|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50423.38|47566.55|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50423.38|2900|49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50423.38||49152.1|367.67||||
MS205|DRG||Other Respiratory System Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50423.38|18785.52|49152.1|367.67||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42243.57|40955.39|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42243.57|27394.51|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42243.57|6413.17|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42243.57|9878.9|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42243.57|45827.16|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|GEHA [1415]|GEHA [141500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42243.57|10189|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42243.57|6413.17|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42243.57|65568.08|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42243.57|12847|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42243.57|12546.65|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42243.57|1700|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MULTIPLAN [1680]|HMA [168003]|42243.57|493.28|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42243.57|19349.64|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|Self-pay|Self-pay|42243.57|12673.07|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42243.57|11516.34|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42243.57|13378.57|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42243.57|10283.25|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|UMR [2035]|UMR OPTIONS [203501]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42243.57|4990.41|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42243.57|6677.06|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42243.57|63452.99|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42243.57|5800|65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42243.57||65568.08|493.28||||
MS206|DRG||Other Respiratory System Diagnoses Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42243.57|9878.9|65568.08|493.28||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|AETNA [1015]|AETNA ACO WILCO [101532]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|362447.39|214630.96|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|362447.39|184199.25|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|362447.39|44844.31|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|362447.39|192129.61|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|362447.39|72984|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|362447.39|184740.01|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|362447.39|240162.01|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|CORESOURCE [1315]|CORESOURCE [131500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|CORVEL CORP [2235]|CORVEL CORP [223500]|362447.39||518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|362447.39||518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|GEHA [1415]|GEHA [141500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|362447.39|78493.54|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HEALTHNET [1495]|HEALTHNET [149500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|362447.39|192129.61|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HEALTHSMART [1505]|HEALTHSMART [150501]|362447.39|343616.42|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|362447.39|166266.01|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|362447.39|46714.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|362447.39|166266.01|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|362447.39|12750|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MULTIPLAN [1680]|HMA [168003]|362447.39|12528.39|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MULTIPLAN [1680]|IHC HS [168011]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|362447.39||518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|362447.39|218051.42|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|Self-pay|Self-pay|362447.39|108734.22|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|362447.39|184740.01|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|362447.39|46127.14|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|362447.39|518611.84|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|362447.39|86644.5|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|TRUSTMARK [2030]|STARMARK [203000]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|362447.39|66598.03|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|UMR [2035]|UMR OPTIONS [203501]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|362447.39|41985.71|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|362447.39|54549.88|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|362447.39|332532.02|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|362447.39|8700|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|362447.39|432176.54|518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|362447.39||518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|362447.39||518611.84|8700||||
MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|362447.39|184740.01|518611.84|8700||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|AETNA [1015]|AETNA ACO WILCO [101532]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131014.64|70887.26|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131014.64|72179.38|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131014.64|16923.59|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131014.64|63455.62|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131014.64|28374.52|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131014.64|79319.52|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|CORESOURCE [1315]|CORESOURCE [131500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|CORVEL CORP [2235]|CORVEL CORP [223500]|131014.64||136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131014.64||136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|GEHA [1415]|GEHA [141500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131014.64|30884.47|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HEALTHNET [1495]|HEALTHNET [149500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131014.64|63455.62|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HEALTHSMART [1505]|HEALTHSMART [150501]|131014.64|113487.93|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131014.64|27132.06|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131014.64|26973.51|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131014.64|36036.91|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131014.64|5950|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MULTIPLAN [1680]|HMA [168003]|131014.64|1619.27|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MULTIPLAN [1680]|IHC HS [168011]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131014.64||136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|131014.64|106376.17|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|Self-pay|Self-pay|131014.64|39304.39|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131014.64|32012.66|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131014.64|136409.91|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131014.64|38466.8|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|TRUSTMARK [2030]|STARMARK [203000]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131014.64|29566.95|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|UMR [2035]|UMR OPTIONS [203501]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131014.64|16304.15|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131014.64|20019.08|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131014.64|109827.03|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131014.64|3625|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131014.64|113674.93|136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131014.64||136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131014.64||136409.91|1619.27||||
MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131014.64|28374.52|136409.91|1619.27||||
MS215|DRG||Other Heart Assist System Implant|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|AETNA [1015]|AETNA ACO WILCO [101532]|333124|58912.56|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|333124|162918.62|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|333124|155103.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|333124|145838.67|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|333124|140229.49|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|333124|182298.33|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|CORESOURCE [1315]|CORESOURCE [131500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|CORVEL CORP [2235]|CORVEL CORP [223500]|333124||344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|333124||344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|GEHA [1415]|GEHA [141500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|333124|164173.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HEALTHNET [1495]|HEALTHNET [149500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|333124|145838.67|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HEALTHSMART [1505]|HEALTHSMART [150501]|333124|260826.86|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|333124|126206.54|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|333124||344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|333124|126206.54|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|333124|1700|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MULTIPLAN [1680]|HMA [168003]|333124|591.08|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MULTIPLAN [1680]|IHC HS [168011]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|333124||344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|333124|315675.83|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|Self-pay|Self-pay|333124|99937.2|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|333124|140229.49|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|333124|344712.44|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|333124|168826.95|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|TRUSTMARK [2030]|STARMARK [203000]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|333124|129766.38|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|UMR [2035]|UMR OPTIONS [203501]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|333124|41884.8|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|333124|69513.93|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|333124|252413.09|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|333124|4350|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|333124|287260.37|344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|333124||344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|333124||344712.44|591.08||||
MS215|DRG||Other Heart Assist System Implant|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|333124|140229.49|344712.44|591.08||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|477118.81|135659.54|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|477118.81|240459.59|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|477118.81|296959.03|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|477118.81|215250.45|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|477118.81|206971.59|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|477118.81|269063.07|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|GEHA [1415]|GEHA [141500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|477118.81|132798.35|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|477118.81|215250.45|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|477118.81|384967.14|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|477118.81|186274.43|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|477118.81|186274.43|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|477118.81|11900|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MULTIPLAN [1680]|HMA [168003]|477118.81|9358.56|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|Self-pay|Self-pay|477118.81|143135.64|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|477118.81|206971.59|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|477118.81|132933.5|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|477118.81|121302.06|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|UMR [2035]|UMR OPTIONS [203501]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|477118.81|57415.13|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|477118.81|66107.28|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|477118.81|372548.86|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|477118.81|8700|384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|477118.81||384967.14|8700||||
MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|477118.81|206971.59|384967.14|8700||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371729.13|231534.18|231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|GEHA [1415]|GEHA [141500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371729.13|10200|231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MULTIPLAN [1680]|HMA [168003]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|Self-pay|Self-pay|371729.13|111518.74|231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|UMR [2035]|UMR OPTIONS [203501]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371729.13|37036.89|231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|371729.13||231534.18|10200||||
MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|371729.13||231534.18|10200||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|244554.74|81778.8|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244554.74|138620.14|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244554.74|124087.58|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|244554.74|68118.7|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244554.74|155109.47|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|GEHA [1415]|GEHA [141500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|244554.74|76320.6|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244554.74|124087.58|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|244554.74|221925.86|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244554.74|88584.85|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244554.74|86513.8|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|244554.74|1053.75|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|Self-pay|Self-pay|244554.74|73366.42|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244554.74|76847.68|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244554.74|77820.27|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244554.74|59815.42|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244554.74|214766.97|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|244554.74|2175|221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|244554.74||221925.86|1053.75||||
MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|244554.74|68118.7|221925.86|1053.75||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|408703.64|116790.8|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|408703.64|174897.29|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|408703.64|233740.19|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|408703.64|156561.52|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|408703.64|150539.93|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|408703.64|195701.9|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|408703.64||361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|408703.64||361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|GEHA [1415]|GEHA [141500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|408703.64|112953.79|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|408703.64|156561.52|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|408703.64|280004.26|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|408703.64|135485.93|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|408703.64||361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|408703.64|135485.93|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|408703.64|11050|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MULTIPLAN [1680]|HMA [168003]|408703.64|3491.39|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|408703.64||361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|408703.64|180038.55|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|Self-pay|Self-pay|408703.64|122611.09|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|408703.64|150539.93|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|408703.64|361285.92|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|408703.64|121879.38|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|408703.64|93680.81|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|UMR [2035]|UMR OPTIONS [203501]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|408703.64|43271.27|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|408703.64|53102.08|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|408703.64|270971.86|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|408703.64|4350|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|408703.64|301071.6|361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|408703.64||361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|408703.64||361285.92|3491.39||||
MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|408703.64|150539.93|361285.92|3491.39||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|305330.08|75909.3|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|305330.08|180751.23|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|305330.08|158460.1|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|305330.08|161801.76|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|305330.08|155578.62|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|305330.08|202252.2|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|305330.08||289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|305330.08||289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|GEHA [1415]|GEHA [141500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|305330.08|74582.49|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|305330.08|161801.76|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|305330.08|289376.22|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|305330.08|140020.75|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|305330.08||289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|305330.08|140020.75|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|305330.08|3400|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MULTIPLAN [1680]|HMA [168003]|305330.08|4181.14|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|305330.08||289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|305330.08|162338.74|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|Self-pay|Self-pay|305330.08|91599.02|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|305330.08|155578.62|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|305330.08|222195.13|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|305330.08|81704.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|305330.08|62800.84|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|UMR [2035]|UMR OPTIONS [203501]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|305330.08|28023.32|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|305330.08|35696.01|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|305330.08|280041.5|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|305330.08|5800|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|305330.08|185162.61|289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|305330.08||289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|305330.08||289376.22|3400||||
MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|305330.08|155578.62|289376.22|3400||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|225669.66|69829.2|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225669.66|141820.5|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225669.66|131091.52|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225669.66|126952.42|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|225669.66|51065.89|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225669.66|158690.53|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|GEHA [1415]|GEHA [141500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|225669.66|66514.73|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225669.66|126952.42|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|225669.66|227049.51|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225669.66|66408.55|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225669.66|64855.96|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225669.66|1700|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|225669.66|3912.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|Self-pay|Self-pay|225669.66|67700.9|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225669.66|61972.98|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225669.66|58019.88|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225669.66|52943.25|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225669.66|21908.96|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225669.66|219725.34|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|225669.66|2175|227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|225669.66||227049.51|1700||||
MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|225669.66|51065.89|227049.51|1700||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|GEHA [1415]|GEHA [141500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MULTIPLAN [1680]|HMA [168003]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MULTIPLAN [1680]|IHC HS [168011]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|398951.07|244611.35|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|Self-pay|Self-pay|398951.07|119685.32|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|TRUSTMARK [2030]|STARMARK [203000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|UMR [2035]|UMR OPTIONS [203501]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|398951.07|52486.11|244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|398951.07||244611.35|52486.11||||
MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|398951.07||244611.35|52486.11||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|GEHA [1415]|GEHA [141500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MULTIPLAN [1680]|HMA [168003]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|Self-pay|Self-pay|288483.13|86544.94|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|UMR [2035]|UMR OPTIONS [203501]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288483.13|38277.08|86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|288483.13||86544.94|38277.08||||
MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|288483.13||86544.94|38277.08||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|295336.95|111002.71|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295336.95|120452.64|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295336.95|107824.7|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|295336.95|83837.97|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295336.95|134780.87|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|GEHA [1415]|GEHA [141500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|295336.95|101537.99|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295336.95|107824.7|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|295336.95|192840.33|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295336.95|109026.95|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295336.95|106477.98|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MULTIPLAN [1680]|HMA [168003]|295336.95|586.73|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MULTIPLAN [1680]|IHC HS [168011]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|Self-pay|Self-pay|295336.95|88601.08|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295336.95|99251.67|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|295336.95|271781.96|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295336.95|111395.31|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|TRUSTMARK [2030]|STARMARK [203000]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295336.95|85622.39|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|UMR [2035]|UMR OPTIONS [203501]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295336.95|49568.11|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295336.95|186619.68|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|295336.95|2900|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|295336.95|226484.97|271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|295336.95||271781.96|586.73||||
MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|295336.95|83837.97|271781.96|586.73||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|GEHA [1415]|GEHA [141500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MULTIPLAN [1680]|HMA [168003]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|Self-pay|Self-pay|262351.97|78705.59|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|UMR [2035]|UMR OPTIONS [203501]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|262351.97|37090.57|78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|262351.97||78705.59|37090.57||||
MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|262351.97||78705.59|37090.57||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|274434.37|103118.21|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|274434.37|368339.29|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|274434.37|113176.47|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|274434.37|329723.62|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|274434.37|317041.94|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|274434.37|412154.52|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|GEHA [1415]|GEHA [141500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|274434.37|95842.77|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|274434.37|329723.62|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|274434.37|589698.01|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|274434.37|285337.75|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|274434.37|285337.75|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|274434.37|3400|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MULTIPLAN [1680]|HMA [168003]|274434.37|6109.61|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|Self-pay|Self-pay|274434.37|82330.31|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|274434.37|317041.94|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|274434.37|282037.24|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|274434.37|100041.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|274434.37|76895.23|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|UMR [2035]|UMR OPTIONS [203501]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|274434.37|39438.38|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|274434.37|43306.69|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|274434.37|570675.49|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|274434.37|11600|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|274434.37|235031.03|589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|274434.37||589698.01|3400||||
MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|274434.37|317041.94|589698.01|3400||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|217982.92|86170.51|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|217982.92|164253.65|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|217982.92|129752.29|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|217982.92|147033.73|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|217982.92|141378.59|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|217982.92|183792.16|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|217982.92||312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|217982.92||312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|GEHA [1415]|GEHA [141500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|217982.92|77599.71|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|217982.92|147033.73|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|217982.92|262964.17|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|217982.92|127240.73|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|217982.92|34482.92|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|217982.92|127240.73|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|217982.92|2550|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MULTIPLAN [1680]|HMA [168003]|217982.92|607.15|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|217982.92||312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|217982.92|150934.88|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|Self-pay|Self-pay|217982.92|65394.88|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|217982.92|141378.59|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|217982.92|312333.72|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|217982.92|79464.98|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|217982.92|61079.6|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|UMR [2035]|UMR OPTIONS [203501]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|217982.92|30311.61|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|217982.92|34428.12|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|217982.92|254481.46|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|217982.92|2900|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|217982.92|260278.1|312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|217982.92||312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|217982.92||312333.72|607.15||||
MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|217982.92|141378.59|312333.72|607.15||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|324387.92|212532.71|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|324387.92|190251.34|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|324387.92|182933.98|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|324387.92|237814.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|GEHA [1415]|GEHA [141500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|324387.92|66460.41|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|324387.92|190251.34|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|324387.92|340257.21|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|324387.92|164640.58|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|324387.92|164640.58|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|324387.92|5402.76|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|324387.92|303925.24|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|Self-pay|Self-pay|324387.92|97316.38|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|324387.92|182933.98|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|324387.92|85490.6|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|324387.92|72283.94|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|324387.92|35203.8|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|324387.92|329281.17|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|324387.92|5075|340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|324387.92||340257.21|5075||||
MS228|DRG||Other Cardiothoracic Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|324387.92|182933.98|340257.21|5075||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|166033.8|60429.2|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166033.8|174473.37|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166033.8|156182.05|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|166033.8|150175.05|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166033.8|195227.56|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|GEHA [1415]|GEHA [141500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|166033.8|43428.57|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166033.8|156182.05|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|166033.8|279325.59|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166033.8|135157.54|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166033.8|135157.54|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MULTIPLAN [1680]|HMA [168003]|166033.8|3854.77|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|166033.8|95623.91|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|Self-pay|Self-pay|166033.8|49810.14|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166033.8|150175.05|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|166033.8|92051|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166033.8|60341.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166033.8|46380.44|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|UMR [2035]|UMR OPTIONS [203501]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166033.8|22806.34|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166033.8|270315.09|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|166033.8|5800|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|166033.8|76798.27|279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|166033.8||279325.59|3854.77||||
MS229|DRG||Other Cardiothoracic Procedures Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|166033.8|150175.05|279325.59|3854.77||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|376426.43|106749.5|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|376426.43|234550.3|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|376426.43|190399.73|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|376426.43|209960.68|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|376426.43|201885.27|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|376426.43|262450.84|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|GEHA [1415]|GEHA [141500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|376426.43|103388.09|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|376426.43|209960.68|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|376426.43|375506.6|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|376426.43|181696.74|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|376426.43|181696.74|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|376426.43|8500|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MULTIPLAN [1680]|HMA [168003]|376426.43|3155.24|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MULTIPLAN [1680]|IHC HS [168011]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|Self-pay|Self-pay|376426.43|112927.93|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|376426.43|201885.27|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|376426.43|128462.75|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|TRUSTMARK [2030]|STARMARK [203000]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|376426.43|98741.03|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|UMR [2035]|UMR OPTIONS [203501]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|376426.43|46382.3|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|376426.43|57422.28|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|376426.43|363393.47|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|376426.43|7250|375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|376426.43||375506.6|3155.24||||
MS231|DRG||Coronary Bypass With Ptca With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|376426.43|201885.27|375506.6|3155.24||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|GEHA [1415]|GEHA [141500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MULTIPLAN [1680]|HMA [168003]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|328651.1|190913.42|190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|Self-pay|Self-pay|328651.1|98595.33|190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|UMR [2035]|UMR OPTIONS [203501]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|328651.1||190913.42|98595.33||||
MS232|DRG||Coronary Bypass With Ptca Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|328651.1||190913.42|98595.33||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|363835.23|99290.1|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|363835.23|169389.26|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|363835.23|218815.29|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|363835.23|151630.95|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|363835.23|145798.99|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|363835.23|189538.68|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|363835.23||426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|363835.23||426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|GEHA [1415]|GEHA [141500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|363835.23|94652.35|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|363835.23|151630.95|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|363835.23|271186.13|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|363835.23|131219.09|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|363835.23|52297.47|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|363835.23|131219.09|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|363835.23|6800|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MULTIPLAN [1680]|HMA [168003]|363835.23|3545.9|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MULTIPLAN [1680]|IHC HS [168011]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|363835.23||426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|363835.23||426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|Self-pay|Self-pay|363835.23|109150.57|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|363835.23|145798.99|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|363835.23|426299.74|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|363835.23|99319.36|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|TRUSTMARK [2030]|STARMARK [203000]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|363835.23|90629.1|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|UMR [2035]|UMR OPTIONS [203501]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|363835.23|33037.13|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|363835.23|52214.17|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|363835.23|262438.18|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|363835.23|4350|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|363835.23|355249.8|426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|363835.23||426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|363835.23||426299.74|3545.9||||
MS233|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|363835.23|145798.99|426299.74|3545.9||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|311798.37|85528.7|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|311798.37|177139.11|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|311798.37|158568.33|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|311798.37|152469.55|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|311798.37|198210.41|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|GEHA [1415]|GEHA [141500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|311798.37|66857.23|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|311798.37|158568.33|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|311798.37|283593.35|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|311798.37|137222.59|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|311798.37|137222.59|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MULTIPLAN [1680]|HMA [168003]|311798.37|5734.03|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|Self-pay|Self-pay|311798.37|93539.51|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|311798.37|152469.55|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|311798.37|253693.59|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|311798.37|80456.04|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|311798.37|61841.36|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|UMR [2035]|UMR OPTIONS [203501]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|311798.37|35241.21|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|311798.37|274445.17|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|311798.37|5075|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|311798.37|211446.09|283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|311798.37||283593.35|5075||||
MS234|DRG||Coronary Bypass With Cardiac Catheterization Or Open Ablation Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|311798.37|152469.55|283593.35|5075||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|307730.62|75528.79|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|307730.62|177849.56|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|307730.62|227078.83|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|307730.62|159204.3|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|307730.62|153081.06|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|307730.62|199005.38|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|307730.62||284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|307730.62||284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|GEHA [1415]|GEHA [141500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|307730.62|74706.55|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|307730.62|159204.3|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|307730.62|284730.76|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|307730.62|137772.95|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|307730.62||284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|307730.62|137772.95|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|307730.62|12750|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MULTIPLAN [1680]|HMA [168003]|307730.62|4509.4|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|307730.62||284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|307730.62|142734.78|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|Self-pay|Self-pay|307730.62|92319.19|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|307730.62|153081.06|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|307730.62|254102.15|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|307730.62|76855.98|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|307730.62|70131.23|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|UMR [2035]|UMR OPTIONS [203501]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|307730.62|35537.2|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|307730.62|40281.97|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|307730.62|275545.89|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|307730.62|5800|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|307730.62|211751.81|284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|307730.62||284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|307730.62||284730.76|4509.4||||
MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|307730.62|153081.06|284730.76|4509.4||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|267733|51041.9|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267733|52010.53|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267733|157674.63|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267733|149698.91|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267733|61745.4|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267733|61745.4|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267733|141144.44|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267733|61745.4|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267733|135715.81|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267733|176430.56|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267733||255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267733||255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|GEHA [1415]|GEHA [141500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267733|49697.94|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267733|141144.44|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267733|252431.4|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267733|122144.23|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267733||255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267733|52010.53|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267733|122144.23|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267733|5100|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267733|52010.53|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MULTIPLAN [1680]|HMA [168003]|267733|2582.44|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267733||255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267733|142128.18|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267733|52010.53|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|Self-pay|Self-pay|267733|80319.9|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267733|135715.81|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267733|255936.31|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267733|52010.53|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267733|47459.7|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|UMR [2035]|UMR OPTIONS [203501]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267733|31010.89|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267733|27110.12|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267733|244288.46|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267733|6525|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267733|213280.27|255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267733||255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267733||255936.31|2582.44||||
MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267733|135715.81|255936.31|2582.44||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149005.14|150213.8|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149005.14|78608.71|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149005.14|134465.8|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149005.14|129294.04|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149005.14|168082.24|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|GEHA [1415]|GEHA [141500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149005.14|58757.17|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149005.14|134465.8|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|149005.14|240486.91|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149005.14|116364.63|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149005.14|116364.63|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149005.14|9350|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MULTIPLAN [1680]|HMA [168003]|149005.14|3373.17|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MULTIPLAN [1680]|IHC HS [168011]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|149005.14|92857.66|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|Self-pay|Self-pay|149005.14|44701.54|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149005.14|129294.04|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149005.14|41306.52|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|TRUSTMARK [2030]|STARMARK [203000]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149005.14|55925.18|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|UMR [2035]|UMR OPTIONS [203501]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149005.14|23667.41|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149005.14|30611.82|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149005.14|232729.27|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149005.14|8700|240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149005.14||240486.91|3373.17||||
MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149005.14|129294.04|240486.91|3373.17||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128845.56|35548.55|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128845.56|64248.96|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128845.56|22282.16|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128845.56|31095.12|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128845.56|39777.18|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|GEHA [1415]|GEHA [141500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128845.56|32630.57|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128845.56|22282.16|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128845.56|56911.96|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128845.56|40437.6|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128845.56|39492.2|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128845.56|6800|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MULTIPLAN [1680]|HMA [168003]|128845.56|559.37|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|Self-pay|Self-pay|128845.56|38653.67|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128845.56|36056.49|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128845.56|33830.23|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128845.56|32446.54|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|UMR [2035]|UMR OPTIONS [203501]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128845.56|12974.96|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128845.56|18524.87|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128845.56|55076.09|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128845.56|2900|64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128845.56||64248.96|559.37||||
MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128845.56|31095.12|64248.96|559.37||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|GEHA [1415]|GEHA [141500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|Self-pay|Self-pay|68481.95|20544.58|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68481.95|9795.57|20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68481.95||20544.58|9795.57||||
MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68481.95||20544.58|9795.57||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|118379.26|55497.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118379.26|82129.87|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118379.26|72376.79|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118379.26|73519.59|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118379.26|41562.74|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118379.26|91899.49|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|GEHA [1415]|GEHA [141500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118379.26|50360.23|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118379.26|73519.59|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118379.26|131486.95|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118379.26|54050.2|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118379.26|52786.54|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118379.26|850|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MULTIPLAN [1680]|HMA [168003]|118379.26|815.54|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MULTIPLAN [1680]|IHC HS [168011]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|Self-pay|Self-pay|118379.26|35513.78|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118379.26|50098.36|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118379.26|92400.47|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118379.26|56324.07|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|TRUSTMARK [2030]|STARMARK [203000]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118379.26|43292.68|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|UMR [2035]|UMR OPTIONS [203501]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118379.26|15151.9|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118379.26|24685.88|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118379.26|127245.44|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118379.26|2900|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118379.26|77000.39|131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118379.26||131486.95|815.54||||
MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118379.26|41562.74|131486.95|815.54||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|87913.59|37643.91|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87913.59|74925|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87913.59|45961.88|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87913.59|67070.07|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87913.59|28081.28|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87913.59|83837.58|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|GEHA [1415]|GEHA [141500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87913.59|34110.01|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87913.59|67070.07|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87913.59|119952.24|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87913.59|36518.25|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87913.59|35664.48|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87913.59|1700|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MULTIPLAN [1680]|HMA [168003]|87913.59|709.25|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|Self-pay|Self-pay|87913.59|26374.08|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87913.59|35270.98|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87913.59|178190.96|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87913.59|38320.04|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87913.59|29454.14|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|UMR [2035]|UMR OPTIONS [203501]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87913.59|15381.27|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87913.59|16750.99|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87913.59|116082.81|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87913.59|4350|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87913.59|148492.47|178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87913.59||178190.96|709.25||||
MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87913.59|28081.28|178190.96|709.25||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|73803.62|34071.16|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73803.62|39575.87|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73803.62|46712.18|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73803.62|17405.66|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73803.62|23005.8|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73803.62|44283.56|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|GEHA [1415]|GEHA [141500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73803.62|30358.71|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73803.62|17405.66|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|73803.62|63359.55|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73803.62|29917.85|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73803.62|29218.39|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73803.62|1700|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|73803.62|72.1|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|Self-pay|Self-pay|73803.62|22141.09|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73803.62|28926.04|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73803.62|31255.51|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73803.62|24024.09|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73803.62|12367.23|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73803.62|13763.68|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73803.62|61315.69|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73803.62|1450|63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73803.62||63359.55|72.1||||
MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73803.62|23005.8|63359.55|72.1||||
MS245|DRG||Aicd Generator Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|292777.03|170080.9|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|GEHA [1415]|GEHA [141500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|292777.03|3400|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MULTIPLAN [1680]|HMA [168003]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|Self-pay|Self-pay|292777.03|87833.11|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|292777.03|270726.1|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|UMR [2035]|UMR OPTIONS [203501]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|292777.03|20159.17|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|292777.03|35778.05|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|292777.03|225605.08|270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|292777.03||270726.1|3400||||
MS245|DRG||Aicd Generator Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|292777.03||270726.1|3400||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA [1015]|AETNA ACO WILCO [101532]|135195.22|44299.92|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135195.22|82149.89|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135195.22|68334.59|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135195.22|73537.53|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|135195.22|34835.95|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135195.22|91921.92|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CORESOURCE [1315]|CORESOURCE [131500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CORVEL CORP [2235]|CORVEL CORP [223500]|135195.22||189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|135195.22||189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|GEHA [1415]|GEHA [141500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|135195.22|38124.97|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHNET [1495]|HEALTHNET [149500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135195.22|73537.53|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHSMART [1505]|HEALTHSMART [150501]|135195.22|131519.05|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135195.22|45302.35|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|135195.22|20759.48|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135195.22|44243.21|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135195.22|1700|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MULTIPLAN [1680]|HMA [168003]|135195.22|589.23|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MULTIPLAN [1680]|IHC HS [168011]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|135195.22||189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|135195.22|87645.08|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|Self-pay|Self-pay|135195.22|40558.57|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135195.22|43403.26|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|135195.22|189772.85|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135195.22|47294.06|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TRUSTMARK [2030]|STARMARK [203000]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135195.22|36351.89|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UMR [2035]|UMR OPTIONS [203501]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135195.22|41898.26|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135195.22|20726.63|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135195.22|127276.5|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|135195.22|2175|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|135195.22|158144.05|189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|135195.22||189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|135195.22||189772.85|589.23||||
MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|135195.22|34835.95|189772.85|589.23||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|94489.98|28100.06|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94489.98|54041.42|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94489.98|55405.56|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94489.98|16623.2|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94489.98|25339.97|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94489.98|22001.18|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94489.98|60469.81|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|94489.98||91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94489.98||91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|GEHA [1415]|GEHA [141500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94489.98|23789.56|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94489.98|16623.2|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|94489.98|86518.35|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94489.98|28611.4|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94489.98|13193.14|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94489.98|27942.49|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94489.98|1700|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MULTIPLAN [1680]|HMA [168003]|94489.98|183.74|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94489.98||91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|94489.98|50367.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|Self-pay|Self-pay|94489.98|28346.99|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94489.98|28602.91|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94489.98|91756.87|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94489.98|30082.88|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94489.98|23122.77|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|UMR [2035]|UMR OPTIONS [203501]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94489.98|32614.76|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94489.98|13172.39|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94489.98|83727.43|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94489.98|1450|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94489.98|76464.07|91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94489.98||91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94489.98||91756.87|183.74||||
MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94489.98|22001.18|91756.87|183.74||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA [1015]|AETNA ACO WILCO [101532]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93096.16|60307.57|60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CORESOURCE [1315]|CORESOURCE [131500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|CORVEL CORP [2235]|CORVEL CORP [223500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|GEHA [1415]|GEHA [141500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHNET [1495]|HEALTHNET [149500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HEALTHSMART [1505]|HEALTHSMART [150501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93096.16|850|60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MULTIPLAN [1680]|HMA [168003]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MULTIPLAN [1680]|IHC HS [168011]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|93096.16|54079.56|60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|Self-pay|Self-pay|93096.16|27928.85|60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|TRUSTMARK [2030]|STARMARK [203000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UMR [2035]|UMR OPTIONS [203501]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93096.16|22806.42|60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|93096.16||60307.57|850||||
MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|93096.16||60307.57|850||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|84445.71|26914.3|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84445.71|57184.01|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84445.71|15187.46|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84445.71|20891.76|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84445.71|63986.25|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|GEHA [1415]|GEHA [141500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84445.71|22590.55|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84445.71|15187.46|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84445.71|91549.56|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84445.71|27168.65|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84445.71|26533.47|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MULTIPLAN [1680]|HMA [168003]|84445.71|196.3|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|Self-pay|Self-pay|84445.71|25333.71|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84445.71|26454.58|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84445.71|16901.19|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84445.71|21856.26|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|UMR [2035]|UMR OPTIONS [203501]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84445.71|12539.1|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84445.71|88596.34|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84445.71|1450|91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84445.71||91549.56|196.3||||
MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84445.71|20891.76|91549.56|196.3||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|100421.62|33628.4|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100421.62|66625.1|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100421.62|58334.92|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100421.62|59640.3|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100421.62|28118.07|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100421.62|74550.37|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|GEHA [1415]|GEHA [141500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100421.62|29000.7|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100421.62|59640.3|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100421.62|106664.38|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100421.62|36566.1|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100421.62|35711.21|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100421.62|1700|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MULTIPLAN [1680]|HMA [168003]|100421.62|177.25|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MULTIPLAN [1680]|IHC HS [168011]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|Self-pay|Self-pay|100421.62|30126.49|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100421.62|33879.77|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100421.62|38171.76|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|TRUSTMARK [2030]|STARMARK [203000]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100421.62|29340.16|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|UMR [2035]|UMR OPTIONS [203501]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100421.62|13914.69|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100421.62|16772.65|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100421.62|103223.59|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100421.62|1450|106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100421.62||106664.38|177.25||||
MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100421.62|28118.07|106664.38|177.25||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|78805.5|21811.4|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78805.5|44489.97|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78805.5|16472.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|78805.5|18491.16|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78805.5|49782.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|GEHA [1415]|GEHA [141500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|78805.5|19071.6|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78805.5|16472.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|78805.5|71226.83|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78805.5|24046.8|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78805.5|23484.6|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MULTIPLAN [1680]|HMA [168003]|78805.5|323.02|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|Self-pay|Self-pay|78805.5|23641.65|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78805.5|22479.7|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|78805.5|84697.65|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78805.5|25113.95|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78805.5|19303.47|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|UMR [2035]|UMR OPTIONS [203501]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78805.5|11106.46|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78805.5|68929.19|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|78805.5|1450|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78805.5|70581.37|84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|78805.5||84697.65|323.02||||
MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|78805.5|18491.16|84697.65|323.02||||
MS252|DRG||Other Vascular Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|148589.97|42377.4|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|148589.97|33205.99|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|148589.97|160815.59|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|148589.97|26361.65|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|148589.97|37081.56|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|148589.97|37155.95|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|GEHA [1415]|GEHA [141500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|148589.97|38245.55|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|148589.97|26361.65|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|148589.97|53161.6|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148589.97|48222.65|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|148589.97|22083.32|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|148589.97|47095.24|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|148589.97|14450|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|148589.97|95.74|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|Self-pay|Self-pay|148589.97|44576.99|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|148589.97|43715.57|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|148589.97|0|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148589.97|38619.74|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|148589.97|13874.28|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148589.97|22048.35|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|148589.97|51446.72|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|148589.97|1450|160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|148589.97||160815.59|95.74||||
MS252|DRG||Other Vascular Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|148589.97|37081.56|160815.59|95.74||||
MS253|DRG||Other Vascular Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117040.53|61212.66|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|GEHA [1415]|GEHA [141500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117040.53|2550|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|Self-pay|Self-pay|117040.53|35112.16|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117040.53|11054.47|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117040.53|17637.6|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|117040.53|40152.37|61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|117040.53||61212.66|2550||||
MS253|DRG||Other Vascular Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|117040.53|40152.37|61212.66|2550||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|102598.56|23530|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102598.56|59599.52|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102598.56|55731.79|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102598.56|53351.25|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102598.56|20247.29|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102598.56|66689.06|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102598.56|21491.01|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102598.56|53351.25|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102598.56|95416.66|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102598.56|26330.55|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102598.56|25714.96|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102598.56|1700|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|102598.56|608.16|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|Self-pay|Self-pay|102598.56|30779.57|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102598.56|24507.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102598.56|76902.4|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102598.56|27379.02|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102598.56|21044.49|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102598.56|8256.3|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102598.56|12140.08|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102598.56|92338.7|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102598.56|1450|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102598.56|64085.35|95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102598.56||95416.66|608.16||||
MS254|DRG||Other Vascular Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102598.56|20247.29|95416.66|608.16||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103789.24|60291.18|60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|GEHA [1415]|GEHA [141500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103789.24|5100|60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|Self-pay|Self-pay|103789.24|31136.77|60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103789.24|22216.38|60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|103789.24||60291.18|5100||||
MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|103789.24||60291.18|5100||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92174.81|133553.4|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|GEHA [1415]|GEHA [141500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92174.81|14450|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|Self-pay|Self-pay|92174.81|27652.44|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92174.81|8755.38|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92174.81|11030.56|133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|92174.81||133553.4|8755.38||||
MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|92174.81||133553.4|8755.38||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|GEHA [1415]|GEHA [141500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MULTIPLAN [1680]|HMA [168003]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MULTIPLAN [1680]|IHC HS [168011]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|Self-pay|Self-pay|116064.94|34819.48|34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|TRUSTMARK [2030]|STARMARK [203000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|UMR [2035]|UMR OPTIONS [203501]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116064.94||34819.48|34819.48||||
MS258|DRG||Cardiac Pacemaker Device Replacement With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116064.94||34819.48|34819.48||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|GEHA [1415]|GEHA [141500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MULTIPLAN [1680]|HMA [168003]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|Self-pay|Self-pay|64198.84|19259.65|19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|UMR [2035]|UMR OPTIONS [203501]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64198.84||19259.65|19259.65||||
MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64198.84||19259.65|19259.65||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|120581.32|49145.87|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120581.32|55076.81|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120581.32|46184.06|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120581.32|30245.72|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|120581.32|39775.4|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120581.32|61628.38|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|GEHA [1415]|GEHA [141500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|120581.32|43116.32|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120581.32|30245.72|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|120581.32|88175.97|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120581.32|51725.85|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120581.32|50516.54|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120581.32|2550|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MULTIPLAN [1680]|HMA [168003]|120581.32|132.87|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MULTIPLAN [1680]|IHC HS [168011]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|Self-pay|Self-pay|120581.32|36174.4|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120581.32|48503|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120581.32|54231.49|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|TRUSTMARK [2030]|STARMARK [203000]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120581.32|41684.25|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|UMR [2035]|UMR OPTIONS [203501]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120581.32|12572|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120581.32|23633.89|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120581.32|85331.62|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|120581.32|4350|88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|120581.32||88175.97|132.87||||
MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|120581.32|39775.4|88175.97|132.87||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|90421.72|32396.4|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90421.72|44052.21|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90421.72|38717.58|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90421.72|14980.74|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90421.72|22231.99|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90421.72|49292.37|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|GEHA [1415]|GEHA [141500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90421.72|29432.85|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90421.72|14980.74|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|90421.72|70526.01|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90421.72|28911.55|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90421.72|28235.62|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90421.72|1700|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MULTIPLAN [1680]|HMA [168003]|90421.72|59.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|Self-pay|Self-pay|90421.72|27126.52|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90421.72|26203.11|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90421.72|30129.78|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90421.72|23158.82|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|UMR [2035]|UMR OPTIONS [203501]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90421.72|8028.55|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90421.72|13308.23|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90421.72|68250.98|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90421.72|1450|70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90421.72||70526.01|59.78||||
MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90421.72|22231.99|70526.01|59.78||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|GEHA [1415]|GEHA [141500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|Self-pay|Self-pay|76673.95|23002.18|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76673.95|11420.17|23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76673.95||23002.18|11420.17||||
MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76673.95||23002.18|11420.17||||
MS263|DRG||Vein Ligation And Stripping|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|AETNA [1015]|AETNA ACO WILCO [101532]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|CORESOURCE [1315]|CORESOURCE [131500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|GEHA [1415]|GEHA [141500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HEALTHNET [1495]|HEALTHNET [149500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64333.66|15427.99|19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MULTIPLAN [1680]|HMA [168003]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MULTIPLAN [1680]|IHC HS [168011]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|Self-pay|Self-pay|64333.66|19300.1|19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|TRUSTMARK [2030]|STARMARK [203000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|UMR [2035]|UMR OPTIONS [203501]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64333.66||19300.1|15427.99||||
MS263|DRG||Vein Ligation And Stripping|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64333.66||19300.1|15427.99||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126309.47|84616.39|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|GEHA [1415]|GEHA [141500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126309.47|3400|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MULTIPLAN [1680]|HMA [168003]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|Self-pay|Self-pay|126309.47|37892.84|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|UMR [2035]|UMR OPTIONS [203501]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126309.47|10774.35|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126309.47|21575.19|84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|126309.47||84616.39|3400||||
MS264|DRG||Other Circulatory System O.R. Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|126309.47||84616.39|3400||||
MS265|DRG||Aicd Lead Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|GEHA [1415]|GEHA [141500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MULTIPLAN [1680]|HMA [168003]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|Self-pay|Self-pay|200100.57|60030.17|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|UMR [2035]|UMR OPTIONS [203501]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200100.57|22309.53|60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|200100.57||60030.17|22309.53||||
MS265|DRG||Aicd Lead Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|200100.57||60030.17|22309.53||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|277502.14|139020.65|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|277502.14|166899.19|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|277502.14|267302.53|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|277502.14|149401.93|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|277502.14|143655.7|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|277502.14|186752.41|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|GEHA [1415]|GEHA [141500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|277502.14|128453.35|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|277502.14|149401.93|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|277502.14|267199.6|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|277502.14|129290.13|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|277502.14|129290.13|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|277502.14|9350|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|277502.14|1871.35|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|Self-pay|Self-pay|277502.14|83250.64|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|277502.14|143655.7|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|277502.14|107385.68|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|277502.14|82540.44|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|277502.14|45866.94|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|277502.14|46475.8|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|277502.14|258580.26|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|277502.14|2175|267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|277502.14||267302.53|1871.35||||
MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|277502.14|143655.7|267302.53|1871.35||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|216503.13|122470.3|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216503.13|125152.18|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216503.13|112031.55|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|216503.13|62417.7|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216503.13|140039.45|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|GEHA [1415]|GEHA [141500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|216503.13|110822|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216503.13|112031.55|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|216503.13|200364.12|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216503.13|81171|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216503.13|79273.28|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MULTIPLAN [1680]|HMA [168003]|216503.13|368.45|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|Self-pay|Self-pay|216503.13|64950.94|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216503.13|82561.23|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216503.13|84745.59|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216503.13|65138.47|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|UMR [2035]|UMR OPTIONS [203501]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216503.13|36960.63|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216503.13|193900.77|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|216503.13|725|200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|216503.13||200364.12|368.45||||
MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|216503.13|62417.7|200364.12|368.45||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349181.78|258473.28|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|GEHA [1415]|GEHA [141500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349181.78|9350|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MULTIPLAN [1680]|HMA [168003]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MULTIPLAN [1680]|IHC HS [168011]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|Self-pay|Self-pay|349181.78|104754.53|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|TRUSTMARK [2030]|STARMARK [203000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|UMR [2035]|UMR OPTIONS [203501]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349181.78|20897.94|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349181.78|45920.59|258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|349181.78||258473.28|9350||||
MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|349181.78||258473.28|9350||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|149340.46|84977.41|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149340.46|78108.7|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149340.46|98811.37|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149340.46|69919.99|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|149340.46|48113.37|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149340.46|87400|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|GEHA [1415]|GEHA [141500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|149340.46|79137.86|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149340.46|69919.99|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|149340.46|125049.2|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149340.46|62568.95|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149340.46|61106.13|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149340.46|850|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MULTIPLAN [1680]|HMA [168003]|149340.46|350.02|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|Self-pay|Self-pay|149340.46|44802.14|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149340.46|56183.71|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|149340.46|138982.95|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149340.46|78683.49|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149340.46|50178.8|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|UMR [2035]|UMR OPTIONS [203501]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149340.46|9459.91|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149340.46|28541.42|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149340.46|121015.36|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|149340.46|725|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|149340.46|115819.13|138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|149340.46||138982.95|350.02||||
MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|149340.46|48113.37|138982.95|350.02||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|195566.27|65802.1|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195566.27|84495.98|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195566.27|128279.83|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195566.27|75637.63|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|195566.27|57835.05|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195566.27|94547.04|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|GEHA [1415]|GEHA [141500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|195566.27|60280.21|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195566.27|75637.63|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|195566.27|135275|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195566.27|75211.5|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195566.27|73453.11|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195566.27|5100|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|195566.27|629.71|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|195566.27|80650.93|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|Self-pay|Self-pay|195566.27|58669.88|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195566.27|66803.67|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195566.27|59026.84|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195566.27|60262.01|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195566.27|39677.68|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195566.27|34263.39|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195566.27|130911.29|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|195566.27|5075|135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|195566.27||135275|629.71||||
MS270|DRG||Other Major Cardiovascular Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|195566.27|57835.05|135275|629.71||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|195902.38|46578.48|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195902.38|162613.55|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195902.38|113799.7|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195902.38|145565.58|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|195902.38|139966.91|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195902.38|181956.99|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|GEHA [1415]|GEHA [141500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|195902.38|42161.18|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195902.38|145565.58|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|195902.38|260338.44|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195902.38|125970.21|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195902.38|125970.21|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195902.38|1700|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|195902.38|190691.86|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|Self-pay|Self-pay|195902.38|58770.71|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195902.38|139966.91|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195902.38|53934.93|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195902.38|41456.3|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195902.38|15746.61|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195902.38|23621.4|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195902.38|251940.43|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|195902.38|7250|260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|195902.38||260338.44|1700||||
MS271|DRG||Other Major Cardiovascular Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|195902.38|139966.91|260338.44|1700||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|116640.19|36516.1|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116640.19|84207.36|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116640.19|67742.04|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116640.19|75379.28|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116640.19|29974.55|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116640.19|94224.1|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116640.19|33396.25|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116640.19|75379.28|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|116640.19|134812.93|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116640.19|38980.35|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116640.19|38069.02|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116640.19|1700|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|116640.19|431.18|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|Self-pay|Self-pay|116640.19|34992.06|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116640.19|33175.38|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116640.19|40683.45|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116640.19|31270.74|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116640.19|11544.78|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116640.19|17865.32|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116640.19|130464.14|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116640.19|3625|134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116640.19||134812.93|431.18||||
MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116640.19|29974.55|134812.93|431.18||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|168382.48|47482.5|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|168382.48|131750.73|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|168382.48|81185.97|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|168382.48|117938.31|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|168382.48|42667.71|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|168382.48|147422.89|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|GEHA [1415]|GEHA [141500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|168382.48|45404.3|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|168382.48|117938.31|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|168382.48|210928.13|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|168382.48|55487.15|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|168382.48|25376.46|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|168382.48|54189.9|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|168382.48|1700|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|168382.48|1638.05|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|168382.48|84069.25|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|Self-pay|Self-pay|168382.48|50514.74|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|168382.48|48389.43|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|168382.48|58059.56|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|168382.48|44626.64|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|168382.48|41916.9|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|168382.48|25336.22|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|168382.48|204124.01|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|168382.48|2900|210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|168382.48||210928.13|1638.05||||
MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|168382.48|42667.71|210928.13|1638.05||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|133268.08|38717.9|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133268.08|81861.44|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133268.08|73669.87|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133268.08|73279.29|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|133268.08|36645.59|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133268.08|91599.11|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|GEHA [1415]|GEHA [141500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|133268.08|37795.9|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133268.08|73279.29|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|133268.08|131057.18|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133268.08|47655.7|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133268.08|46541.54|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133268.08|3400|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MULTIPLAN [1680]|HMA [168003]|133268.08|348.04|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133268.08|49710.43|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|Self-pay|Self-pay|133268.08|39980.42|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133268.08|37428.77|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|133268.08|118213.94|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133268.08|37541.25|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133268.08|38209.2|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|UMR [2035]|UMR OPTIONS [203501]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133268.08|30214.96|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133268.08|21791.75|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133268.08|126829.55|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|133268.08|1450|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|133268.08|98511.62|131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|133268.08||131057.18|348.04||||
MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|133268.08|36645.59|131057.18|348.04||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62135.99|31933.35|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62135.99|40759.32|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62135.99|13960.87|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62135.99|17916.94|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62135.99|35731.91|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|GEHA [1415]|GEHA [141500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62135.99|18479.35|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62135.99|13960.87|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|62135.99|51124.12|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62135.99|23300.05|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62135.99|11096.08|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62135.99|22755.31|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62135.99|3400|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MULTIPLAN [1680]|HMA [168003]|62135.99|156.06|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MULTIPLAN [1680]|IHC HS [168011]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62135.99|24911.15|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|62135.99|32860.53|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62135.99|24605.56|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|Self-pay|Self-pay|62135.99|18640.8|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62135.99|22412.1|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62135.99|18550.87|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|TRUSTMARK [2030]|STARMARK [203000]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62135.99|18912.71|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|UMR [2035]|UMR OPTIONS [203501]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62135.99|13140.35|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62135.99|10768.49|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62135.99|49474.95|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62135.99|1450|51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62135.99||51124.12|156.06||||
MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62135.99|17916.94|51124.12|156.06||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40371.18|25707.79|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40371.18|21529.61|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40371.18|8274.45|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40371.18|10376.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40371.18|28765.81|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40371.18||41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40371.18||41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|GEHA [1415]|GEHA [141500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40371.18|10701.9|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40371.18|8274.45|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40371.18|41157.24|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40371.18|13493.7|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40371.18||41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40371.18|13178.23|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40371.18|1700|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MULTIPLAN [1680]|HMA [168003]|40371.18|277.54|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40371.18||41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40371.18|19263.86|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|Self-pay|Self-pay|40371.18|12111.35|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40371.18|13314.5|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40371.18|38718.23|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40371.18|14103.33|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40371.18|10840.32|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|UMR [2035]|UMR OPTIONS [203501]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40371.18|12016.15|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40371.18|6330.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40371.18|39829.58|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40371.18|725|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40371.18|32265.19|41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40371.18||41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40371.18||41157.24|277.54||||
MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40371.18|10376.19|41157.24|277.54||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41392.4|24637.65|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41392.4|15739.01|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41392.4|6106.32|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41392.4|8096.02|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41392.4|27568.4|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|GEHA [1415]|GEHA [141500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41392.4|8350.15|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41392.4|6106.32|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41392.4|39444.01|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41392.4|10528.45|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41392.4|10282.3|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41392.4|850|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|41392.4|145.64|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|Self-pay|Self-pay|41392.4|12417.72|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41392.4|10256.27|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41392.4|48665.83|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41392.4|10977.33|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41392.4|8437.57|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41392.4|9743.75|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41392.4|4988.13|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41392.4|38171.62|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41392.4|725|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41392.4|40554.85|48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41392.4||48665.83|145.64||||
MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41392.4|8096.02|48665.83|145.64||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47199.23|12278.27|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47199.23|98684.04|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47199.23|13528.05|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47199.23|15852.45|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47199.23|13738.79|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|GEHA [1415]|GEHA [141500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47199.23|13528.05|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47199.23|19657.04|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47199.23|1700|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MULTIPLAN [1680]|HMA [168003]|47199.23|30.45|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MULTIPLAN [1680]|IHC HS [168011]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47199.23|303171.61|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|Self-pay|Self-pay|47199.23|14159.77|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|TRUSTMARK [2030]|STARMARK [203000]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47199.23|21136.6|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|UMR [2035]|UMR OPTIONS [203501]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47199.23|12758|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47199.23|0|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47199.23|19022.94|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47199.23|725|303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47199.23||303171.61|30.45||||
MS283|DRG||Acute Myocardial Infarction, Expired With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47199.23|15852.45|303171.61|30.45||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|GEHA [1415]|GEHA [141500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MULTIPLAN [1680]|HMA [168003]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|Self-pay|Self-pay|13094|3928.2|3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|UMR [2035]|UMR OPTIONS [203501]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|13094||3928.2|3928.2||||
MS284|DRG||Acute Myocardial Infarction, Expired With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|13094||3928.2|3928.2||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|75417.33|28566.2|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75417.33|50595.21|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75417.33|46960.03|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75417.33|17151.3|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75417.33|23819.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75417.33|56613.66|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75417.33||81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75417.33||81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|GEHA [1415]|GEHA [141500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75417.33|25144.71|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75417.33|17151.3|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75417.33|81001.09|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75417.33|30976.35|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75417.33||81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75417.33|30252.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75417.33|2550|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MULTIPLAN [1680]|HMA [168003]|75417.33|577.26|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75417.33||81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75417.33|30407.09|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|Self-pay|Self-pay|75417.33|22625.2|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75417.33|30125.26|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75417.33|44353.62|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75417.33|33500.91|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75417.33|25749.98|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|UMR [2035]|UMR OPTIONS [203501]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75417.33|7784.59|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75417.33|14242.75|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75417.33|78388.14|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75417.33|2175|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75417.33|36961.35|81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75417.33||81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75417.33||81001.09|577.26||||
MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75417.33|23819.75|81001.09|577.26||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|51944.02|14978.6|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51944.02|29487.96|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51944.02|30946.17|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51944.02|9116.68|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51944.02|14656.96|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51944.02|12433.37|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51944.02|32995.64|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51944.02||47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51944.02||47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|GEHA [1415]|GEHA [141500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51944.02|12823.65|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51944.02|9116.68|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51944.02|47209.14|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51944.02|16168.95|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51944.02|7552.71|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51944.02|15790.93|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51944.02|2550|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MULTIPLAN [1680]|HMA [168003]|51944.02|129.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51944.02||47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51944.02|29706.91|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|Self-pay|Self-pay|51944.02|15583.21|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51944.02|15886|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51944.02|43998.25|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51944.02|17400.32|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51944.02|13374.5|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|UMR [2035]|UMR OPTIONS [203501]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51944.02|6944.56|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51944.02|7540.98|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51944.02|45686.27|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51944.02|2175|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51944.02|36665.22|47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51944.02||47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51944.02||47209.14|129.27||||
MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51944.02|12433.37|47209.14|129.27||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58297.11|33864.8|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58297.11|22778.02|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58297.11|21913.94|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58297.11|29942.21|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58297.11|37893.12|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|GEHA [1415]|GEHA [141500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58297.11|32013.77|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58297.11|21913.94|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58297.11|54216.31|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58297.11|20934.57|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58297.11|38027.95|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58297.11|2550|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MULTIPLAN [1680]|HMA [168003]|58297.11|1131.67|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|Self-pay|Self-pay|58297.11|17489.13|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58297.11|36613.51|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58297.11|34169.83|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58297.11|31180.03|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|UMR [2035]|UMR OPTIONS [203501]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58297.11|14355.13|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58297.11|17597.81|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58297.11|52467.4|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58297.11|3625|54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58297.11||54216.31|1131.67||||
MS288|DRG||Acute And Subacute Endocarditis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58297.11|29942.21|54216.31|1131.67||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|GEHA [1415]|GEHA [141500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MULTIPLAN [1680]|HMA [168003]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|Self-pay|Self-pay|22717.91|6815.37|6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22717.91||6815.37|6815.37||||
MS289|DRG||Acute And Subacute Endocarditis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22717.91||6815.37|6815.37||||
MS291|DRG||Heart Failure And Shock With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55281.19|26052.86|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55281.19|33102.11|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55281.19|12190.83|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55281.19|14141.55|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55281.19|29151.9|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55281.19||50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55281.19||50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|GEHA [1415]|GEHA [141500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55281.19|14585.45|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55281.19|12190.83|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55281.19|41709.64|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55281.19|18390.35|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55281.19|9318.35|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55281.19|17960.4|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55281.19|5950|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MULTIPLAN [1680]|HMA [168003]|55281.19|219.34|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MULTIPLAN [1680]|IHC HS [168011]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55281.19||50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55281.19|35149.45|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|Self-pay|Self-pay|55281.19|16584.36|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55281.19|19954.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55281.19|8559.73|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55281.19|50644.61|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55281.19|20288.77|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|TRUSTMARK [2030]|STARMARK [203000]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55281.19|15594.67|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|UMR [2035]|UMR OPTIONS [203501]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55281.19|7232.79|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55281.19|8546.39|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55281.19|40364.17|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55281.19|2175|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55281.19|42203.85|50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55281.19||50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55281.19||50644.61|219.34||||
MS291|DRG||Heart Failure And Shock With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55281.19|14141.55|50644.61|219.34||||
MS292|DRG||Heart Failure And Shock With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42487.75|16894.29|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42487.75|21199.35|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42487.75|7932.88|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42487.75|9628.03|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42487.75|18903.94|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|GEHA [1415]|GEHA [141500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42487.75|9930.25|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42487.75|7932.88|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42487.75|27047.16|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42487.75|12520.75|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42487.75|5898.92|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42487.75|12228.02|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42487.75|2550|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MULTIPLAN [1680]|HMA [168003]|42487.75|30.45|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42487.75|61984.83|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|Self-pay|Self-pay|42487.75|12746.32|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42487.75|12962.98|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42487.75|13543.5|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42487.75|10410.01|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|UMR [2035]|UMR OPTIONS [203501]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42487.75|5059.39|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42487.75|5889.84|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42487.75|26174.67|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42487.75|1450|61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42487.75||61984.83|30.45||||
MS292|DRG||Heart Failure And Shock With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42487.75|9628.03|61984.83|30.45||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27568.79|13802.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27568.79|18665.54|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27568.79|5460.32|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27568.79|6577.39|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27568.79|15444.65|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|GEHA [1415]|GEHA [141500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27568.79|6783.85|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27568.79|5460.32|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27568.79|22097.72|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27568.79|8553.55|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27568.79|8353.57|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27568.79|1700|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|27568.79|517.61|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27568.79|24360.87|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|Self-pay|Self-pay|27568.79|8270.64|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27568.79|9107.07|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27568.79|9874.3|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27568.79|7589.74|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27568.79|3614.18|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27568.79|4078.79|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27568.79|21384.89|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27568.79|725|24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27568.79||24360.87|517.61||||
MS293|DRG||Heart Failure And Shock Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27568.79|6577.39|24360.87|517.61||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53121.54|50663.77|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|GEHA [1415]|GEHA [141500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53121.54|850|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MULTIPLAN [1680]|HMA [168003]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MULTIPLAN [1680]|IHC HS [168011]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|Self-pay|Self-pay|53121.54|15936.46|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|TRUSTMARK [2030]|STARMARK [203000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|UMR [2035]|UMR OPTIONS [203501]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53121.54|10815.58|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53121.54|10691.71|50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53121.54||50663.77|850||||
MS296|DRG||Cardiac Arrest, Unexplained With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53121.54||50663.77|850||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|GEHA [1415]|GEHA [141500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|Self-pay|Self-pay|68096.36|20428.91|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68096.36|3977.31|20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68096.36||20428.91|3977.31||||
MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68096.36||20428.91|3977.31||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|51563.28|18855.2|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51563.28|17190.02|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51563.28|30048.58|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51563.28|17639.78|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51563.28|12872.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51563.28|12872.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51563.28|11380.91|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51563.28|12872.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51563.28|17088.49|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51563.28|33622.96|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|GEHA [1415]|GEHA [141500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51563.28|17624.9|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51563.28|11380.91|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51563.28|48106.69|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51563.28|22222.7|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51563.28|9994.2|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51563.28|17190.02|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51563.28|21703.15|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51563.28|1700|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51563.28|17190.02|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|51563.28|317.74|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51563.28|17190.02|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|Self-pay|Self-pay|51563.28|15468.98|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51563.28|19079.42|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51563.28|17190.02|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51563.28|17810.18|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51563.28|7756.2|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51563.28|10280.88|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51563.28|46554.87|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51563.28|2175|48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51563.28||48106.69|317.74||||
MS299|DRG||Peripheral Vascular Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51563.28|17088.49|48106.69|317.74||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|41402.72|13308.1|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41402.72|14815.59|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41402.72|18807.87|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41402.72|7889.28|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41402.72|11638.37|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41402.72|16577.95|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41402.72||39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41402.72||39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|GEHA [1415]|GEHA [141500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41402.72|12003.7|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41402.72|7889.28|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41402.72|23719.22|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41402.72|15135.1|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41402.72|7084.05|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41402.72|14781.25|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41402.72|2550|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|41402.72|111.65|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41402.72||39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41402.72|23291.8|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|Self-pay|Self-pay|41402.72|12420.82|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41402.72|13768.77|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41402.72|39449.64|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41402.72|15769.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41402.72|12120.79|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41402.72|6152.23|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41402.72|6927|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41402.72|22954.09|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41402.72|2175|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41402.72|32874.7|39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41402.72||39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41402.72||39449.64|111.65||||
MS300|DRG||Peripheral Vascular Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41402.72|11638.37|39449.64|111.65||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|32083.67|9440.6|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32083.67|10497.41|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32083.67|21932.99|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32083.67|5471.62|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32083.67|8285.57|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32083.67|11746.1|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32083.67|8545.65|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32083.67|5471.62|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32083.67|16805.96|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32083.67|3990.72|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32083.67|10523.04|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32083.67|2550|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|32083.67|67.17|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|Self-pay|Self-pay|32083.67|9625.1|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32083.67|9803.35|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32083.67|7793.3|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32083.67|8635.28|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32083.67|3907.48|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32083.67|5099.69|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32083.67|16263.83|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32083.67|725|21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32083.67||21932.99|67.17||||
MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32083.67|8285.57|21932.99|67.17||||
MS302|DRG||Atherosclerosis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38655.69|24664.27|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|GEHA [1415]|GEHA [141500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38655.69|1700|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MULTIPLAN [1680]|HMA [168003]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|Self-pay|Self-pay|38655.69|11596.71|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|UMR [2035]|UMR OPTIONS [203501]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38655.69|5048.25|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38655.69|7407.76|24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38655.69||24664.27|1700||||
MS302|DRG||Atherosclerosis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38655.69||24664.27|1700||||
MS303|DRG||Atherosclerosis Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28758.84|16194.72|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28758.84|17308.54|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28758.84|4926.56|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28758.84|7555.24|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28758.84|18121.13|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28758.84||25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28758.84||25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|GEHA [1415]|GEHA [141500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28758.84|7792.4|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28758.84|4926.56|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28758.84|25927.14|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28758.84|9825.2|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28758.84||25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28758.84|9595.49|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28758.84|850|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MULTIPLAN [1680]|HMA [168003]|28758.84|538.96|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28758.84||25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28758.84|12039.65|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|Self-pay|Self-pay|28758.84|8627.65|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28758.84|8963.76|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28758.84|22247|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28758.84|10234.41|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28758.84|7866.53|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|UMR [2035]|UMR OPTIONS [203501]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28758.84|4165.3|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28758.84|4669.83|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28758.84|25090.78|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28758.84|1450|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28758.84|18539.17|25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28758.84||25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28758.84||25927.14|538.96||||
MS303|DRG||Atherosclerosis Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28758.84|7555.24|25927.14|538.96||||
MS304|DRG||Hypertension With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55869.36|36835.01|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55869.36|22837.46|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55869.36|8087.92|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55869.36|12231.55|58971.53|725||||
MS304|DRG||Hypertension With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55869.36|41216.66|58971.53|725||||
MS304|DRG||Hypertension With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|GEHA [1415]|GEHA [141500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55869.36|14844.38|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55869.36|8087.92|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55869.36|58971.53|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55869.36|15906.5|58971.53|725||||
MS304|DRG||Hypertension With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55869.36|15534.62|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55869.36|1700|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MULTIPLAN [1680]|HMA [168003]|55869.36|2349.28|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MULTIPLAN [1680]|IHC HS [168011]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|Self-pay|Self-pay|55869.36|16760.81|58971.53|725||||
MS304|DRG||Hypertension With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55869.36|14174.37|58971.53|725||||
MS304|DRG||Hypertension With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55869.36|16577.21|58971.53|725||||
MS304|DRG||Hypertension With McC|1|TRUSTMARK [2030]|STARMARK [203000]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55869.36|12741.83|58971.53|725||||
MS304|DRG||Hypertension With McC|1|UMR [2035]|UMR OPTIONS [203501]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55869.36|4943.15|58971.53|725||||
MS304|DRG||Hypertension With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55869.36|7422.2|58971.53|725||||
MS304|DRG||Hypertension With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55869.36|57069.23|58971.53|725||||
MS304|DRG||Hypertension With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55869.36|725|58971.53|725||||
MS304|DRG||Hypertension With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55869.36||58971.53|725||||
MS304|DRG||Hypertension With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55869.36|12231.55|58971.53|725||||
MS305|DRG||Hypertension Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34056.65|16378.46|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34056.65|21433.7|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34056.65|5064.64|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34056.65|8249.89|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34056.65|18326.75|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34056.65||26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34056.65||26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|GEHA [1415]|GEHA [141500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34056.65|8508.85|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34056.65|5064.64|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34056.65|26221.35|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34056.65|10728.55|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34056.65|5020.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34056.65||26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34056.65|10477.72|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34056.65|1700|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MULTIPLAN [1680]|HMA [168003]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34056.65||26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34056.65|7358.78|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|Self-pay|Self-pay|34056.65|10216.99|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34056.65|9350.43|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34056.65|22564.8|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34056.65|11174.03|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34056.65|8588.76|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|UMR [2035]|UMR OPTIONS [203501]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34056.65|4141.84|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34056.65|5078.68|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34056.65|25375.5|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34056.65|1450|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34056.65|18804.01|26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34056.65||26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34056.65||26221.35|1450||||
MS305|DRG||Hypertension Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34056.65|8249.89|26221.35|1450||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|GEHA [1415]|GEHA [141500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55667.16|32342.45|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|Self-pay|Self-pay|55667.16|16700.15|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55667.16|19853.82|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55667.16|16290.41|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55667.16|22752.05|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55667.16|16544.86|32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55667.16||32342.45|16290.41||||
MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55667.16|22752.05|32342.45|16290.41||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|48218.92|11128|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48218.92|28010.37|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48218.92|6216.14|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48218.92|9704.96|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48218.92|31342.3|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|GEHA [1415]|GEHA [141500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48218.92|10009.6|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48218.92|6216.14|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48218.92|44843.59|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48218.92|12620.8|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48218.92|12325.73|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|48218.92|289.49|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|Self-pay|Self-pay|48218.92|14465.68|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48218.92|11186.45|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48218.92|13139.51|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48218.92|10099.49|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48218.92|5935.1|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48218.92|43397.03|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48218.92|3625|44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48218.92||44843.59|289.49||||
MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48218.92|9704.96|44843.59|289.49||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|44029.94|15646.8|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44029.94|16477.57|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44029.94|18530.59|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44029.94|33468.54|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44029.94|15285.29|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44029.94|15285.29|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44029.94|9776.4|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44029.94|15285.29|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44029.94|13390.04|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44029.94|20734.85|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44029.94||35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44029.94||35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|GEHA [1415]|GEHA [141500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44029.94|13810.35|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44029.94|9776.4|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44029.94|29666.77|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44029.94|17413.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44029.94||35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44029.94|16477.57|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44029.94|17005.94|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44029.94|3400|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44029.94|16477.57|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|44029.94|123.15|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44029.94||35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44029.94|16151.61|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44029.94|16477.57|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|Self-pay|Self-pay|44029.94|13208.98|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44029.94|16068.52|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44029.94|35265.69|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44029.94|16477.57|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44029.94|13947.86|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44029.94|6288.69|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44029.94|8104.05|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44029.94|28709.78|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44029.94|725|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44029.94|29388.08|35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44029.94||35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44029.94||35265.69|123.15||||
MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44029.94|13390.04|35265.69|123.15||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|30323.89|9925.5|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30323.89|16351.19|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30323.89|15802.36|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30323.89|6350.99|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30323.89|8368.08|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30323.89|18296.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30323.89||26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30323.89||26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|GEHA [1415]|GEHA [141500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30323.89|8630.75|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30323.89|6350.99|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30323.89|26177.64|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30323.89|10882.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30323.89|5156.14|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30323.89|10627.83|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30323.89|2550|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|30323.89|87.5|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30323.89||26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30323.89|12240.3|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|Self-pay|Self-pay|30323.89|9097.17|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30323.89|10437.44|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30323.89|12293.51|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30323.89|11338.95|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30323.89|8715.52|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30323.89|4600.52|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30323.89|5148.25|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30323.89|25333.2|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30323.89|725|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30323.89|10244.59|26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30323.89||26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30323.89||26177.64|87.5||||
MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30323.89|8368.08|26177.64|87.5||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|26321.62|7309.9|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26321.62|7116.91|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26321.62|14927.44|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26321.62|16005.91|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26321.62|8448.99|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26321.62|8448.99|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26321.62|4435.6|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26321.62|8448.99|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26321.62|6235.08|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26321.62|16703.09|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26321.62||23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26321.62||23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26321.62|6430.8|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26321.62|4435.6|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26321.62|23898.27|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26321.62|8108.4|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26321.62|3898.69|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26321.62|7116.91|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26321.62|7918.83|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26321.62|850|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26321.62|7116.91|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|26321.62|53.2|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26321.62||23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26321.62|6476.57|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26321.62|7116.91|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|Self-pay|Self-pay|26321.62|7896.49|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26321.62|7605|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26321.62|10778.49|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26321.62|6705.75|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26321.62|6494.19|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26321.62|3764.43|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26321.62|3892.81|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26321.62|23127.35|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26321.62|1450|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26321.62|9038.92|23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26321.62||23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26321.62||23898.27|53.2||||
MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26321.62|6235.08|23898.27|53.2||||
MS311|DRG||Angina Pectoris|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|AETNA [1015]|AETNA ACO WILCO [101532]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25181.89|14350.24|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25181.89|10145.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25181.89|4572.07|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25181.89|7788.28|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25181.89|16057.25|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|CORESOURCE [1315]|CORESOURCE [131500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25181.89||31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25181.89||31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|GEHA [1415]|GEHA [141500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25181.89|8032.75|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HEALTHNET [1495]|HEALTHNET [149500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25181.89|4572.07|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25181.89|22974.21|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25181.89|10128.25|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25181.89|4814.33|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25181.89|9891.46|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25181.89|850|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MULTIPLAN [1680]|HMA [168003]|25181.89|286.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MULTIPLAN [1680]|IHC HS [168011]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25181.89||31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25181.89||31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|Self-pay|Self-pay|25181.89|7554.57|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25181.89|9184.14|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25181.89|31719.98|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25181.89|8883.39|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|TRUSTMARK [2030]|STARMARK [203000]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25181.89|8106.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|UMR [2035]|UMR OPTIONS [203501]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25181.89|4075.76|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25181.89|4806.99|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25181.89|22233.11|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25181.89|725|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25181.89|26474.96|31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25181.89||31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25181.89||31719.98|286.11||||
MS311|DRG||Angina Pectoris|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25181.89|7788.28|31719.98|286.11||||
MS312|DRG||Syncope And Collapse|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|AETNA [1015]|AETNA ACO WILCO [101532]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37892.94|20839.23|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37892.94|31170.93|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37892.94|5994.07|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37892.94|9351.51|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37892.94|23318.1|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|CORESOURCE [1315]|CORESOURCE [131500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37892.94||39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37892.94||39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|GEHA [1415]|GEHA [141500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37892.94|9645.05|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HEALTHNET [1495]|HEALTHNET [149500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37892.94|5994.07|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37892.94|33362.82|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37892.94|12161.15|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37892.94|5735.9|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37892.94|11876.83|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37892.94|1700|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MULTIPLAN [1680]|HMA [168003]|37892.94|622.64|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MULTIPLAN [1680]|IHC HS [168011]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37892.94||39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37892.94||39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|Self-pay|Self-pay|37892.94|11367.88|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37892.94|10768.68|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37892.94|39509.73|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37892.94|12667.43|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|TRUSTMARK [2030]|STARMARK [203000]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37892.94|9736.64|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|UMR [2035]|UMR OPTIONS [203501]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37892.94|3822.05|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37892.94|5727.08|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37892.94|32286.6|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37892.94|725|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37892.94|32924.78|39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37892.94||39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37892.94||39509.73|622.64||||
MS312|DRG||Syncope And Collapse|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37892.94|9351.51|39509.73|622.64||||
MS313|DRG||Chest Pain|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|AETNA [1015]|AETNA ACO WILCO [101532]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25773.89|15277.39|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25773.89|16544.17|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25773.89|4956.44|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25773.89|8043.61|24458.56|515.04||||
MS313|DRG||Chest Pain|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25773.89|17094.69|24458.56|515.04||||
MS313|DRG||Chest Pain|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|CORESOURCE [1315]|CORESOURCE [131500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25773.89||24458.56|515.04||||
MS313|DRG||Chest Pain|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25773.89||24458.56|515.04||||
MS313|DRG||Chest Pain|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|GEHA [1415]|GEHA [141500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25773.89|8296.1|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HEALTHNET [1495]|HEALTHNET [149500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25773.89|4956.44|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25773.89|24458.56|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25773.89|10460.3|24458.56|515.04||||
MS313|DRG||Chest Pain|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25773.89|4964.86|24458.56|515.04||||
MS313|DRG||Chest Pain|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25773.89|10215.75|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25773.89|850|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MULTIPLAN [1680]|HMA [168003]|25773.89|515.04|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MULTIPLAN [1680]|IHC HS [168011]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25773.89||24458.56|515.04||||
MS313|DRG||Chest Pain|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25773.89|18847.41|24458.56|515.04||||
MS313|DRG||Chest Pain|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|Self-pay|Self-pay|25773.89|7732.17|24458.56|515.04||||
MS313|DRG||Chest Pain|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25773.89|9496.45|24458.56|515.04||||
MS313|DRG||Chest Pain|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25773.89|19603.04|24458.56|515.04||||
MS313|DRG||Chest Pain|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25773.89|10906.22|24458.56|515.04||||
MS313|DRG||Chest Pain|1|TRUSTMARK [2030]|STARMARK [203000]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25773.89|8382.9|24458.56|515.04||||
MS313|DRG||Chest Pain|1|UMR [2035]|UMR OPTIONS [203501]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25773.89|3876.04|24458.56|515.04||||
MS313|DRG||Chest Pain|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25773.89|4957.27|24458.56|515.04||||
MS313|DRG||Chest Pain|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25773.89|23669.58|24458.56|515.04||||
MS313|DRG||Chest Pain|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25773.89|1450|24458.56|515.04||||
MS313|DRG||Chest Pain|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25773.89|16335.88|24458.56|515.04||||
MS313|DRG||Chest Pain|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25773.89||24458.56|515.04||||
MS313|DRG||Chest Pain|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25773.89||24458.56|515.04||||
MS313|DRG||Chest Pain|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25773.89|8043.61|24458.56|515.04||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68668.63|28566.2|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68668.63|38068.07|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68668.63|24110.4|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68668.63|17151.3|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68668.63|23819.75|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68668.63|42596.36|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68668.63||60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68668.63||60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68668.63|24567.45|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68668.63|17151.3|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68668.63|60945.58|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68668.63|30976.35|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68668.63||60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68668.63|30252.14|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68668.63|1700|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|68668.63|233.39|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68668.63||60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68668.63|39842.1|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|Self-pay|Self-pay|68668.63|20600.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68668.63|30125.26|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68668.63|34888.21|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68668.63|25296.78|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68668.63|25749.98|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68668.63|8255.63|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68668.63|13904.11|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68668.63|58979.59|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68668.63|1450|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68668.63|29073.52|60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68668.63||60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68668.63||60945.58|233.39||||
MS314|DRG||Other Circulatory System Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68668.63|23819.75|60945.58|233.39||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46713.32|21683.96|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46713.32|30169.85|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46713.32|7762.5|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46713.32|10853.41|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46713.32|24263.34|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46713.32|11194.1|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46713.32|7762.5|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46713.32|34715.23|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46713.32|14114.3|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46713.32|6621.3|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46713.32|13784.32|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46713.32|3400|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|46713.32|343.21|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|Self-pay|Self-pay|46713.32|14014|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46713.32|13057.62|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46713.32|14755.47|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46713.32|11341.58|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46713.32|6342.41|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46713.32|6611.06|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46713.32|33595.38|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46713.32|2175|34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46713.32||34715.23|343.21||||
MS315|DRG||Other Circulatory System Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46713.32|10853.41|34715.23|343.21||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46240.83|5419.21|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46240.83|8798.19|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46240.83|5014.58|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46240.83|6996.75|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46240.83|6063.85|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46240.83|8319.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46240.83|5014.58|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46240.83|8675.97|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46240.83|850|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46240.83|26861.3|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|Self-pay|Self-pay|46240.83|13872.25|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46240.83|9329|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46240.83|8716.69|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46240.83|6821.86|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46240.83|8396.1|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46240.83|725|26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46240.83||26861.3|725||||
MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46240.83|6996.75|26861.3|725||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|GEHA [1415]|GEHA [141500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|Self-pay|Self-pay|272494.64|81748.39|81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|272494.64||81748.39|81748.39||||
MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|272494.64||81748.39|81748.39||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191964.3|151027.58|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191964.3|109649.58|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191964.3|135194.25|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191964.3|129994.48|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191964.3|168992.82|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|GEHA [1415]|GEHA [141500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191964.3|64492.24|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191964.3|135194.25|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191964.3|241789.72|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191964.3|116995.03|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191964.3|116995.03|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191964.3|4250|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|191964.3|3354.79|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|Self-pay|Self-pay|191964.3|57589.29|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191964.3|129994.48|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191964.3|81368.42|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191964.3|62542.65|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191964.3|19114.16|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191964.3|35111.94|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191964.3|233990.05|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|191964.3|5800|241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191964.3||241789.72|3354.79||||
MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191964.3|129994.48|241789.72|3354.79||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83731.13|39483.82|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83731.13|49283.41|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83731.13|21424.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83731.13|28596.41|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83731.13|44180.56|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83731.13||63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83731.13||63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|GEHA [1415]|GEHA [141500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83731.13|30660.84|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83731.13|21424.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83731.13|63212.18|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83731.13|37188.15|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83731.13|17081.14|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83731.13|36318.72|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83731.13|1700|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|83731.13|1166.79|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83731.13||63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83731.13||63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|Self-pay|Self-pay|83731.13|25119.34|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83731.13|28611.02|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83731.13|45268.15|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83731.13|39485.1|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83731.13|30349.65|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83731.13|16286.43|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83731.13|16470.59|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83731.13|61173.07|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83731.13|725|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83731.13|37723.46|63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83731.13||63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83731.13||63212.18|725||||
MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83731.13|28596.41|63212.18|725||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87694.49|51658.39|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87694.49|50480.31|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87694.49|10836.92|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87694.49|25200.2|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87694.49|25200.2|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87694.49|12071.32|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87694.49|18585.94|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87694.49|57803.32|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87694.49||82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87694.49||82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87694.49|19800.49|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87694.49|12071.32|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87694.49|82703.2|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87694.49|24170.05|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87694.49||82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87694.49|23604.97|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87694.49|850|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|87694.49|631.14|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87694.49||82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87694.49|54183.52|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|Self-pay|Self-pay|87694.49|26308.35|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87694.49|20339.49|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87694.49|71435.13|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87694.49|21227.1|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87694.49|19369.77|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87694.49|9483.17|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87694.49|11162.24|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87694.49|80035.38|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87694.49|1450|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87694.49|59529.27|82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87694.49||82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87694.49||82703.2|631.14||||
MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87694.49|18585.94|82703.2|631.14||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206181.96|102484.06|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206181.96|99666.65|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206181.96|91739.89|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|206181.96|54481.13|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206181.96|114674.87|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|GEHA [1415]|GEHA [141500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|206181.96|57866.05|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206181.96|91739.89|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|206181.96|164073.27|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206181.96|70849.9|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206181.96|30415.75|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206181.96|69193.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206181.96|5950|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|206181.96|1674.75|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|206181.96|170237.61|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|Self-pay|Self-pay|206181.96|61854.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206181.96|66427.82|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206181.96|73388.48|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206181.96|56408.99|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206181.96|16750.19|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206181.96|32289.34|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206181.96|158780.59|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|206181.96|5075|170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|206181.96||170237.61|1674.75||||
MS329|DRG||Major Small And Large Bowel Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|206181.96|54481.13|170237.61|1674.75||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128923.14|71724.94|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128923.14|81060.69|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128923.14|64205.5|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|128923.14|32360.01|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|128923.14|28424.7|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128923.14|80256.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|128923.14||114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|128923.14||114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|GEHA [1415]|GEHA [141500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|128923.14|29316.95|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128923.14|64205.5|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|128923.14|114829.06|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128923.14|36964.85|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|128923.14|16979.92|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128923.14|36100.64|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128923.14|2550|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|128923.14||114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|128923.14|57685.15|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128923.14|38416.87|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|Self-pay|Self-pay|128923.14|38676.94|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128923.14|33379.53|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|128923.14|107758.55|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128923.14|29205.46|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128923.14|29528.57|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128923.14|16014.47|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128923.14|16953.11|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128923.14|111124.9|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|128923.14|1450|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|128923.14|89798.78|114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|128923.14||114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|128923.14||114829.06|1450||||
MS330|DRG||Major Small And Large Bowel Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|128923.14|28424.7|114829.06|1450||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110681.53|60162.74|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110681.53|74824.27|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110681.53|53855.44|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110681.53|21795.53|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110681.53|19072.08|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110681.53|67319.3|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110681.53|20896.76|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110681.53|53855.44|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110681.53|96318.38|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110681.53|24802.25|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110681.53|24222.39|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110681.53|2550|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|110681.53|1226.01|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110681.53|69809.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110681.53|25875.03|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|Self-pay|Self-pay|110681.53|33204.46|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110681.53|22656.82|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110681.53|19722.14|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110681.53|19888.46|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110681.53|9572.43|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110681.53|11448.37|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110681.53|93211.33|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110681.53|1450|96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110681.53||96318.38|1226.01||||
MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110681.53|19072.08|96318.38|1226.01||||
MS332|DRG||Rectal Resection With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|GEHA [1415]|GEHA [141500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MULTIPLAN [1680]|HMA [168003]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MULTIPLAN [1680]|IHC HS [168011]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|Self-pay|Self-pay|366026.04|109807.81|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|TRUSTMARK [2030]|STARMARK [203000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|UMR [2035]|UMR OPTIONS [203501]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|366026.04|36586.04|109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|366026.04||109807.81|36586.04||||
MS332|DRG||Rectal Resection With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|366026.04||109807.81|36586.04||||
MS333|DRG||Rectal Resection With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114641.37|66569.35|66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|GEHA [1415]|GEHA [141500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114641.37|3400|66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MULTIPLAN [1680]|HMA [168003]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|Self-pay|Self-pay|114641.37|34392.41|66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|UMR [2035]|UMR OPTIONS [203501]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114641.37|13191|66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|114641.37||66569.35|3400||||
MS333|DRG||Rectal Resection With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|114641.37||66569.35|3400||||
MS334|DRG||Rectal Resection Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91915.34|53416.13|53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|GEHA [1415]|GEHA [141500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91915.34|1700|53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|Self-pay|Self-pay|91915.34|27574.6|53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91915.34|10022.34|53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91915.34||53416.13|1700||||
MS334|DRG||Rectal Resection Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91915.34||53416.13|1700||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|210087.02|212123.28|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|210087.02|189884.85|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|210087.02|182581.59|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|210087.02|237356.05|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|GEHA [1415]|GEHA [141500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|210087.02|49797.15|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|210087.02|189884.85|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|210087.02|339601.75|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|210087.02|164323.43|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|210087.02|164323.43|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MULTIPLAN [1680]|HMA [168003]|210087.02|4791.9|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|Self-pay|Self-pay|210087.02|63026.11|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|210087.02|182581.59|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|210087.02|58864.51|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|210087.02|45245.35|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|UMR [2035]|UMR OPTIONS [203501]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|210087.02|25905.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|210087.02|328646.86|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|210087.02|16675|339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|210087.02||339601.75|4791.9||||
MS335|DRG||Peritoneal Adhesiolysis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|210087.02|182581.59|339601.75|4791.9||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127671.98|74164.67|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127671.98|78725.74|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127671.98|66389.43|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|127671.98|25548|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127671.98|82986.79|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|GEHA [1415]|GEHA [141500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|127671.98|26973.32|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127671.98|66389.43|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|127671.98|118734.94|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127671.98|33223.85|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127671.98|32447.1|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127671.98|3400|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MULTIPLAN [1680]|HMA [168003]|127671.98|623.37|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|127671.98|143209.28|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|Self-pay|Self-pay|127671.98|38301.59|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127671.98|31632.74|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127671.98|34541.9|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127671.98|26550.13|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127671.98|13289.72|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127671.98|15259.96|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127671.98|114904.78|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|127671.98|2175|143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|127671.98||143209.28|623.37||||
MS336|DRG||Peritoneal Adhesiolysis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|127671.98|25548|143209.28|623.37||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124122.24|72102.62|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124122.24|50763.27|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124122.24|64543.56|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124122.24|18255.9|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124122.24|80679.45|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124122.24|24494.56|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124122.24|64543.56|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124122.24|115433.69|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124122.24|23740.85|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124122.24|23185.81|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124122.24|1700|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|124122.24|436.76|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|Self-pay|Self-pay|124122.24|37236.67|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124122.24|21878.06|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124122.24|75447.6|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124122.24|24702.4|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124122.24|18987.14|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124122.24|9511.49|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124122.24|10968|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124122.24|111710.02|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124122.24|2175|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124122.24|62873|115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124122.24||115433.69|436.76||||
MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124122.24|18255.9|115433.69|436.76||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91784.17|53317.4|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91784.17|24791.06|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91784.17|31189.9|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91784.17|59659.72|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|GEHA [1415]|GEHA [141500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91784.17|33228.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91784.17|24791.06|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91784.17|85359.27|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91784.17|40560.85|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91784.17|39612.57|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MULTIPLAN [1680]|HMA [168003]|91784.17|1059.88|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|Self-pay|Self-pay|91784.17|27535.25|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91784.17|37367.93|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91784.17|42347.83|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91784.17|32550.04|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|UMR [2035]|UMR OPTIONS [203501]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91784.17|18580.65|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91784.17|82605.76|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91784.17|3625|85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91784.17||85359.27|1059.88||||
MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91784.17|31189.9|85359.27|1059.88||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80529.71|45488.56|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80529.71|52825.37|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80529.71|14002.05|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|80529.71|18926.01|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80529.71|50899.57|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|GEHA [1415]|GEHA [141500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|80529.71|19520.1|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80529.71|14002.05|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|80529.71|72825.55|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80529.71|24612.3|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80529.71|24036.88|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80529.71|1700|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MULTIPLAN [1680]|HMA [168003]|80529.71|197.6|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|Self-pay|Self-pay|80529.71|24158.91|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80529.71|23052.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80529.71|21034.95|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80529.71|19712.85|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80529.71|8908.46|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80529.71|22845.5|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80529.71|70476.33|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|80529.71|1450|72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|80529.71||72825.55|197.6||||
MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|80529.71|18926.01|72825.55|197.6||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74844.48|38062.19|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74844.48|45128.48|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74844.48|9800.63|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74844.48|13695.55|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74844.48|42589.79|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74844.48||60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74844.48||60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74844.48|14125.45|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74844.48|9800.63|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74844.48|60936.17|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74844.48|17810.35|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74844.48|8296.79|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74844.48|17393.96|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74844.48|2550|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|74844.48|468.07|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74844.48||60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74844.48||60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|Self-pay|Self-pay|74844.48|22453.34|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74844.48|16221.3|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74844.48|50602.96|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74844.48|15656.18|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74844.48|14286.29|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74844.48|7226.03|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74844.48|8283.87|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74844.48|58970.49|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74844.48|2175|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74844.48|42169.14|60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74844.48||60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74844.48||60936.17|468.07||||
MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74844.48|13695.55|60936.17|468.07||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97476.68|58044.4|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97476.68|40800.34|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97476.68|18461.07|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|97476.68|25894.76|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97476.68|64948.97|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|GEHA [1415]|GEHA [141500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|97476.68|29052.6|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97476.68|18461.07|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|97476.68|92926.99|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97476.68|33674.8|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97476.68|32887.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97476.68|850|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MULTIPLAN [1680]|HMA [168003]|97476.68|498.21|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|97476.68|0|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|Self-pay|Self-pay|97476.68|29243|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97476.68|33637.76|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97476.68|31507.51|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97476.68|26937.41|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|UMR [2035]|UMR OPTIONS [203501]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97476.68|6789.48|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97476.68|89929.35|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|97476.68|2175|92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|97476.68||92926.99|498.21||||
MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|97476.68|25894.76|92926.99|498.21||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61309.35|36731.12|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61309.35|34851.44|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61309.35|10587.94|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61309.35|15976.84|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61309.35|41100.4|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|GEHA [1415]|GEHA [141500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61309.35|16478.35|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61309.35|10587.94|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61309.35|58805.19|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61309.35|20777.05|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61309.35|20291.3|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61309.35|850|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MULTIPLAN [1680]|HMA [168003]|61309.35|360.01|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|Self-pay|Self-pay|61309.35|18392.8|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61309.35|20120.46|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61309.35|41555.85|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61309.35|21683.82|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61309.35|16666.95|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61309.35|5188.47|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61309.35|9626.6|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61309.35|56908.24|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61309.35|725|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61309.35|34629.87|58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61309.35||58805.19|360.01||||
MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61309.35|15976.84|58805.19|360.01||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62309.37|34754.8|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62309.37|36860.92|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62309.37|7593.73|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62309.37|14139.5|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62309.37|12360.89|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62309.37|38889|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|62309.37||55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62309.37||55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62309.37|12748.9|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62309.37|7593.73|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|62309.37|55641.19|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62309.37|16074.7|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62309.37||55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62309.37|15698.88|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62309.37|850|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|62309.37|482.57|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62309.37||55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|62309.37|31762.91|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|Self-pay|Self-pay|62309.37|18692.81|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62309.37|14273.06|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62309.37|54758.89|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62309.37|16786.01|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62309.37|12902.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62309.37|4223.09|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62309.37|7498.32|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62309.37|53846.31|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62309.37|725|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62309.37|45684.14|55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62309.37||55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62309.37||55641.19|482.57||||
MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62309.37|12360.89|55641.19|482.57||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|GEHA [1415]|GEHA [141500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|Self-pay|Self-pay|46356.17|13906.85|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46356.17|18719.13|18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46356.17||18719.13|13906.85||||
MS344|DRG||Minor Small And Large Bowel Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46356.17||18719.13|13906.85||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70874.61|39947.78|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70874.61|45284.74|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70874.61|13813.9|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|70874.61|17603.62|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70874.61|44699.69|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|GEHA [1415]|GEHA [141500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|70874.61|18156.2|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70874.61|13813.9|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|70874.61|63954.95|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70874.61|22892.6|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70874.61|22357.39|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70874.61|1700|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|70874.61|384.53|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|Self-pay|Self-pay|70874.61|21262.38|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70874.61|21108.78|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70874.61|18233.15|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70874.61|18348.65|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70874.61|8220.14|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70874.61|10284.1|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70874.61|61891.88|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|70874.61|2175|63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|70874.61||63954.95|384.53||||
MS345|DRG||Minor Small And Large Bowel Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|70874.61|17603.62|63954.95|384.53||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62762.93|25870.57|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62762.93|14187.27|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62762.93|9682.73|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62762.93|14220.71|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62762.93|28947.95|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62762.93|14667.1|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62762.93|9682.73|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|62762.93|41417.84|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62762.93|18493.3|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62762.93|18060.94|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62762.93|1700|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|62762.93|240.68|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|Self-pay|Self-pay|62762.93|18828.88|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62762.93|14881.46|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62762.93|19291.66|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62762.93|14828.25|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62762.93|7939.82|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62762.93|40081.78|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62762.93|725|41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62762.93||41417.84|240.68||||
MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62762.93|14220.71|41417.84|240.68||||
MS347|DRG||Anal And Stomal Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93786.92|63091.86|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93786.92|287700.51|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93786.92|56477.47|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|93786.92|27481.41|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93786.92|70596.84|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|GEHA [1415]|GEHA [141500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|93786.92|30637.53|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93786.92|56477.47|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|93786.92|101007.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93786.92|35738.15|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93786.92|34902.62|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93786.92|9350|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|93786.92|2293.48|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|Self-pay|Self-pay|93786.92|28136.08|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93786.92|35552.19|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93786.92|37245.76|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93786.92|28628.41|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93786.92|10176.94|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93786.92|16397.92|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93786.92|97749.46|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|93786.92|2900|287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|93786.92||287700.51|2293.48||||
MS347|DRG||Anal And Stomal Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|93786.92|27481.41|287700.51|2293.48||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72839.03|42032.19|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72839.03|63679.11|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72839.03|11163.69|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72839.03|15031.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72839.03|47032.07|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|GEHA [1415]|GEHA [141500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72839.03|15503.15|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72839.03|11163.69|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72839.03|67292.04|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72839.03|19547.45|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72839.03|19090.44|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72839.03|4250|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|72839.03|485.45|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72839.03|44649.14|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|Self-pay|Self-pay|72839.03|21851.71|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72839.03|19094.3|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72839.03|20311.47|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72839.03|15612.11|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72839.03|6157.91|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72839.03|9070.09|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72839.03|65121.32|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72839.03|2900|67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72839.03||67292.04|485.45||||
MS348|DRG||Anal And Stomal Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72839.03|15031.32|67292.04|485.45||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58441.09|33335.65|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58441.09|7330.49|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58441.09|10919.2|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58441.09|37301.02|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58441.09|11949.32|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58441.09|7330.49|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58441.09|53369.16|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58441.09|14199.85|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58441.09|13867.87|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|58441.09|687.37|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|Self-pay|Self-pay|58441.09|17532.33|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58441.09|13720.1|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58441.09|14817.5|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58441.09|11389.26|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58441.09|7308.09|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58441.09|51647.57|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58441.09|1450|53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58441.09||53369.16|687.37||||
MS349|DRG||Anal And Stomal Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58441.09|10919.2|53369.16|687.37||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90971.57|49119.31|49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|GEHA [1415]|GEHA [141500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90971.57|2550|49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|Self-pay|Self-pay|90971.57|27291.47|49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90971.57|4193.34|49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90971.57||49119.31|2550||||
MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90971.57||49119.31|2550||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74001.53|42113.87|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74001.53|11324.38|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74001.53|16643.61|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74001.53|47123.44|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|GEHA [1415]|GEHA [141500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74001.53|17166.05|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74001.53|11324.38|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74001.53|67422.77|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74001.53|21644.15|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74001.53|21138.12|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|74001.53|192.12|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|Self-pay|Self-pay|74001.53|22200.46|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74001.53|20133.98|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74001.53|22550.81|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74001.53|17333.35|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74001.53|10019.02|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74001.53|65247.84|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74001.53|725|67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74001.53||67422.77|192.12||||
MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74001.53|16643.61|67422.77|192.12||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68728.71|37270.97|37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68728.71|1700|37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|Self-pay|Self-pay|68728.71|20618.61|37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68728.71|4903.47|37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68728.71||37270.97|1700||||
MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68728.71||37270.97|1700||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86649.73|35154.03|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|GEHA [1415]|GEHA [141500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86649.73|2550|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MULTIPLAN [1680]|HMA [168003]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MULTIPLAN [1680]|IHC HS [168011]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|Self-pay|Self-pay|86649.73|25994.92|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86649.73|64953.25|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|TRUSTMARK [2030]|STARMARK [203000]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|UMR [2035]|UMR OPTIONS [203501]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86649.73|11104.64|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86649.73|20824.11|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86649.73|54203.17|64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86649.73||64953.25|2550||||
MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86649.73||64953.25|2550||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109662.59|50402.83|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109662.59|102147.2|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109662.59|13658.86|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109662.59|19900.52|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109662.59|56398.42|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|GEHA [1415]|GEHA [141500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109662.59|21208.9|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109662.59|13658.86|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|109662.59|80693.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109662.59|25879.6|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109662.59|25274.55|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109662.59|3400|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MULTIPLAN [1680]|HMA [168003]|109662.59|354.76|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|109662.59|40280.63|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|Self-pay|Self-pay|109662.59|32898.78|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109662.59|23305.78|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109662.59|26978.06|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109662.59|20736.29|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|UMR [2035]|UMR OPTIONS [203501]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109662.59|5476.02|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109662.59|11935.99|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109662.59|78090.13|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109662.59|1450|102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109662.59||102147.2|354.76||||
MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109662.59|19900.52|102147.2|354.76||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82841.86|48122.84|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82841.86|35526.56|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82841.86|10110.71|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82841.86|15166.23|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82841.86|53847.22|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|GEHA [1415]|GEHA [141500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82841.86|15642.3|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82841.86|10110.71|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82841.86|77042.93|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82841.86|19722.9|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82841.86|19261.79|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82841.86|850|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|82841.86|471.19|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82841.86|64813.56|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|Self-pay|Self-pay|82841.86|24852.56|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82841.86|17854.51|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82841.86|20565.66|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82841.86|15807.5|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82841.86|4912.07|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82841.86|9149.49|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82841.86|74557.67|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82841.86|1450|77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82841.86||77042.93|471.19||||
MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82841.86|15166.23|77042.93|471.19||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158788.58|53811.19|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158788.58|92038.55|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158788.58|31147.7|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158788.58|48031.97|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158788.58|60212.2|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158788.58|50224.21|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158788.58|31147.7|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158788.58|86149.77|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158788.58|62463.1|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158788.58|61002.76|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158788.58|5100|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|158788.58|816.46|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|Self-pay|Self-pay|158788.58|47636.57|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158788.58|51458.47|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158788.58|49086.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158788.58|49908.98|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158788.58|22895.98|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158788.58|28493.51|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158788.58|83370.75|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158788.58|2900|92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158788.58||92038.55|816.46||||
MS356|DRG||Other Digestive System O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158788.58|48031.97|92038.55|816.46||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110257.15|31259.19|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110257.15|36611.89|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110257.15|17015.64|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110257.15|25293.78|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110257.15|34977.56|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110257.15|26087.75|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110257.15|17015.64|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110257.15|50044.81|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110257.15|32893.25|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110257.15|32124.23|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110257.15|850|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|110257.15|442.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|Self-pay|Self-pay|110257.15|33077.14|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110257.15|28392|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110257.15|34100.08|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110257.15|26210.53|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110257.15|12746.54|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110257.15|15110.33|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110257.15|48430.47|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110257.15|2175|50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110257.15||50044.81|442.33||||
MS357|DRG||Other Digestive System O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110257.15|25293.78|50044.81|442.33||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94497|51456.87|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94497|11092.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94497|15042.47|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94497|57577.85|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94497|15514.65|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94497|11092.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|94497|82380.62|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94497|19561.95|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94497|19104.61|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|94497|127.88|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|94497|28349.1|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94497|19042.92|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94497|80004.41|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94497|16973.6|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94497|15572.57|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94497|9076.63|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94497|79723.17|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94497|725|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94497|66718.66|82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94497||82380.62|127.88||||
MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94497|15042.47|82380.62|127.88||||
MS368|DRG||Major Esophageal Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71990.33|28184.94|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71990.33|33867.43|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71990.33|15052.61|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71990.33|21732.47|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71990.33|31537.65|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|GEHA [1415]|GEHA [141500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71990.33|22414.65|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71990.33|15052.61|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71990.33|45123.08|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71990.33|28261.95|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71990.33|13034.71|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71990.33|27601.21|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71990.33|3400|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|71990.33|197.03|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71990.33|36791.99|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|Self-pay|Self-pay|71990.33|21597.1|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71990.33|24838.94|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71990.33|20386.44|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71990.33|22588.95|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71990.33|6446.15|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71990.33|13014.22|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71990.33|43667.51|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71990.33|1450|45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71990.33||45123.08|197.03||||
MS368|DRG||Major Esophageal Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71990.33|21732.47|45123.08|197.03||||
MS369|DRG||Major Esophageal Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43639.66|21786.33|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43639.66|29509.12|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43639.66|8642.67|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43639.66|12010.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43639.66|24377.87|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|GEHA [1415]|GEHA [141500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43639.66|12387.8|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43639.66|8642.67|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43639.66|34879.1|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43639.66|15619.4|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43639.66|7303.6|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43639.66|15254.23|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43639.66|3400|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|43639.66|250.95|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43639.66|25350.28|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|Self-pay|Self-pay|43639.66|13091.9|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43639.66|14707.06|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43639.66|10759.78|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43639.66|12523.18|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43639.66|4634.65|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43639.66|7292.27|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43639.66|33753.97|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43639.66|1450|34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43639.66||34879.1|250.95||||
MS369|DRG||Major Esophageal Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43639.66|12010.78|34879.1|250.95||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41250.29|8943.01|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41250.29|850|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|Self-pay|Self-pay|41250.29|12375.09|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41250.29|3842.61|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41250.29|5744.4|12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41250.29||12375.09|850||||
MS370|DRG||Major Esophageal Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41250.29||12375.09|850||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74694.43|21824.24|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74694.43|50638.13|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74694.43|15046.15|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74694.43|19302.88|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74694.43|24420.32|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|GEHA [1415]|GEHA [141500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74694.43|20507.47|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74694.43|15046.15|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74694.43|34939.84|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74694.43|25102.4|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74694.43|24515.52|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74694.43|3400|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MULTIPLAN [1680]|HMA [168003]|74694.43|598.67|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MULTIPLAN [1680]|IHC HS [168011]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|Self-pay|Self-pay|74694.43|22408.33|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74694.43|23313.89|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74694.43|54938.44|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74694.43|16849.77|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|TRUSTMARK [2030]|STARMARK [203000]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74694.43|20100.13|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|UMR [2035]|UMR OPTIONS [203501]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74694.43|7215.55|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74694.43|11584.23|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74694.43|33812.75|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74694.43|2900|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74694.43|45782.03|54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74694.43||54938.44|598.67||||
MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74694.43|19302.88|54938.44|598.67||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47003.54|25622.45|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47003.54|26496.31|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47003.54|9159.47|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47003.54|11476.7|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47003.54|28670.35|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47003.54||50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47003.54||50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|GEHA [1415]|GEHA [141500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47003.54|11836.95|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47003.54|9159.47|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47003.54|41020.65|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47003.54|14924.85|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47003.54||50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47003.54|14575.92|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47003.54|1700|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MULTIPLAN [1680]|HMA [168003]|47003.54|357.72|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47003.54||50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47003.54|8809.35|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|Self-pay|Self-pay|47003.54|14101.06|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47003.54|14317.68|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47003.54|50235.35|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47003.54|15548.32|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47003.54|11950.99|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|UMR [2035]|UMR OPTIONS [203501]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47003.54|5969.3|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47003.54|6977.9|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47003.54|39697.39|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47003.54|2900|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47003.54|41862.79|50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47003.54||50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47003.54||50235.35|357.72||||
MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47003.54|11476.7|50235.35|357.72||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35141.28|19279.87|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35141.28|26806.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35141.28|6470.5|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35141.28|8302.29|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35141.28|21573.27|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|GEHA [1415]|GEHA [141500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35141.28|8562.9|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35141.28|6470.5|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35141.28|30866.37|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35141.28|10796.7|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35141.28|10544.28|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35141.28|4250|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|35141.28|103.6|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|Self-pay|Self-pay|35141.28|10542.38|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35141.28|10304.94|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35141.28|11249.68|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35141.28|8646.91|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35141.28|3136.4|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35141.28|5109.54|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35141.28|29870.67|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35141.28|725|30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35141.28||30866.37|103.6||||
MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35141.28|8302.29|30866.37|103.6||||
MS374|DRG||Digestive Malignancy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67704.47|49343.3|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67704.47|47193.68|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67704.47|16296.97|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67704.47|23121.76|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67704.47|55212.84|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|GEHA [1415]|GEHA [141500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67704.47|24841.99|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67704.47|16296.97|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67704.47|78996.85|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67704.47|30068.65|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67704.47|29365.67|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67704.47|6800|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MULTIPLAN [1680]|HMA [168003]|67704.47|994.44|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|Self-pay|Self-pay|67704.47|20311.34|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67704.47|27058.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67704.47|31288.8|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67704.47|24049.68|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|UMR [2035]|UMR OPTIONS [203501]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67704.47|10044.82|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67704.47|13831.93|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67704.47|76448.55|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67704.47|2900|78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67704.47||78996.85|994.44||||
MS374|DRG||Digestive Malignancy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67704.47|23121.76|78996.85|994.44||||
MS375|DRG||Digestive Malignancy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51183.37|30572.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51183.37|32006.87|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51183.37|10036.42|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51183.37|13464.74|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51183.37|34208.68|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|GEHA [1415]|GEHA [141500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51183.37|13887.4|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51183.37|10036.42|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51183.37|48944.72|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51183.37|17510.2|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51183.37|17100.82|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51183.37|1700|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MULTIPLAN [1680]|HMA [168003]|51183.37|331.92|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51183.37|43106.98|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|Self-pay|Self-pay|51183.37|15355.01|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51183.37|16693.14|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51183.37|18230.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51183.37|14012.99|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51183.37|7281.11|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51183.37|8148.04|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51183.37|47365.86|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51183.37|2175|48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51183.37||48944.72|331.92||||
MS375|DRG||Digestive Malignancy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51183.37|13464.74|48944.72|331.92||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33087.96|19220.8|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33087.96|7284.46|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|33087.96|10022.74|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33087.96|21507.18|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|33087.96|10337.35|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33087.96|7284.46|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|33087.96|30771.81|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33087.96|4204.53|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33087.96|12729.32|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|33087.96|176.75|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|Self-pay|Self-pay|33087.96|9926.39|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33087.96|12710.15|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33087.96|1539.21|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33087.96|10411.18|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33087.96|29779.16|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|33087.96|725|30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|33087.96||30771.81|176.75||||
MS376|DRG||Digestive Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|33087.96|10022.74|30771.81|176.75||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72172.52|33816.36|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72172.52|32639.46|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72172.52|14353.31|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72172.52|20083.38|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72172.52|37838.93|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72172.52||83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72172.52||83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|GEHA [1415]|GEHA [141500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72172.52|21647.97|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72172.52|14353.31|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72172.52|54138.77|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72172.52|26117.4|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72172.52|11679.66|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72172.52|12062.55|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72172.52|25506.79|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72172.52|4250|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MULTIPLAN [1680]|HMA [168003]|72172.52|934.17|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MULTIPLAN [1680]|IHC HS [168011]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72172.52||83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72172.52|44592.52|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|Self-pay|Self-pay|72172.52|21651.76|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72172.52|23173.28|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72172.52|83541.03|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72172.52|27218.63|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|TRUSTMARK [2030]|STARMARK [203000]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72172.52|20921.21|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|UMR [2035]|UMR OPTIONS [203501]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72172.52|7855.83|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72172.52|12043.61|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72172.52|52392.35|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72172.52|2175|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72172.52|69617.54|83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72172.52||83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72172.52||83541.03|934.17||||
MS377|DRG||Gastrointestinal Hemorrhage With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72172.52|20083.38|83541.03|934.17||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50639.11|32131.11|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50639.11|28317.39|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50639.11|8091.96|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50639.11|11077.53|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50639.11|35953.21|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50639.11||51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50639.11||51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|GEHA [1415]|GEHA [141500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50639.11|11425.25|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50639.11|8091.96|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50639.11|51440.75|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50639.11|14405.75|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50639.11|6753.42|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50639.11|14068.95|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50639.11|850|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MULTIPLAN [1680]|HMA [168003]|50639.11|132.87|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50639.11||51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50639.11|30789.65|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|Self-pay|Self-pay|50639.11|15191.73|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50639.11|13118.46|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50639.11|48351.34|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50639.11|15027.82|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50639.11|11550.92|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|UMR [2035]|UMR OPTIONS [203501]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50639.11|4465.69|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50639.11|6742.97|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50639.11|49781.37|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50639.11|2175|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50639.11|40334.88|51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50639.11||51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50639.11||51440.75|132.87||||
MS378|DRG||Gastrointestinal Hemorrhage With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50639.11|11077.53|51440.75|132.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36251.32|24784.42|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36251.32|19430.65|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36251.32|5471.62|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36251.32|7104.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36251.32|27732.6|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|GEHA [1415]|GEHA [141500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36251.32|7970.67|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36251.32|5471.62|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36251.32|39678.95|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36251.32|9239.4|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36251.32|9023.39|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36251.32|850|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|36251.32|642.87|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36251.32|22299.52|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|Self-pay|Self-pay|36251.32|10875.4|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36251.32|8714.99|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36251.32|4375.59|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36251.32|9639.78|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36251.32|7409.47|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36251.32|3442.87|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36251.32|4404.69|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36251.32|38398.97|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36251.32|1450|39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36251.32||39678.95|642.87||||
MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36251.32|7104.78|39678.95|642.87||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91672.69|52079.24|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91672.69|58018.05|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91672.69|15556.49|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91672.69|21035.59|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91672.69|58274.25|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|GEHA [1415]|GEHA [141500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91672.69|22626.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91672.69|15556.49|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91672.69|83377|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91672.69|27355.7|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91672.69|26716.14|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91672.69|5100|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MULTIPLAN [1680]|HMA [168003]|91672.69|930.55|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MULTIPLAN [1680]|IHC HS [168011]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91672.69|60662.77|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|Self-pay|Self-pay|91672.69|27501.81|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91672.69|25644.74|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91672.69|24000.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|TRUSTMARK [2030]|STARMARK [203000]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91672.69|21900.45|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|UMR [2035]|UMR OPTIONS [203501]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91672.69|9012.91|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91672.69|12604.06|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91672.69|80687.42|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91672.69|2900|83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91672.69||83377|930.55||||
MS380|DRG||Complicated Peptic Ulcer With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91672.69|21035.59|83377|930.55||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50015.55|27368.33|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50015.55|31937.34|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50015.55|8781.56|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50015.55|11811.2|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50015.55|30623.87|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50015.55||43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50015.55||43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|GEHA [1415]|GEHA [141500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50015.55|12784.3|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50015.55|8781.56|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50015.55|43815.7|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50015.55|15359.85|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50015.55||43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50015.55|15000.75|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50015.55|1700|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MULTIPLAN [1680]|HMA [168003]|50015.55|766.5|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50015.55||43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50015.55|29922.21|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|Self-pay|Self-pay|50015.55|15004.66|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50015.55|14575.91|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50015.55|34485.74|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50015.55|16034.01|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50015.55|12324.31|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|UMR [2035]|UMR OPTIONS [203501]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50015.55|5210.33|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50015.55|7174.79|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50015.55|42402.28|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50015.55|2175|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50015.55|28738.14|43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50015.55||43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50015.55||43815.7|766.5||||
MS381|DRG||Complicated Peptic Ulcer With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50015.55|11811.2|43815.7|766.5||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42822.11|24875.37|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42822.11|28541.76|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42822.11|6129.73|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42822.11|8569.89|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42822.11|27834.37|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|GEHA [1415]|GEHA [141500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42822.11|8838.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42822.11|6129.73|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42822.11|39824.56|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42822.11|11144.7|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42822.11|10884.14|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42822.11|1700|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|42822.11|226.45|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|Self-pay|Self-pay|42822.11|12846.63|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42822.11|10859.26|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42822.11|11624.92|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42822.11|8935.33|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42822.11|3981.14|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42822.11|5200.13|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42822.11|38539.9|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42822.11|1450|39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42822.11||39824.56|226.45||||
MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42822.11|8569.89|39824.56|226.45||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66548.36|40283.41|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|GEHA [1415]|GEHA [141500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66548.36|2550|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MULTIPLAN [1680]|HMA [168003]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MULTIPLAN [1680]|IHC HS [168011]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|Self-pay|Self-pay|66548.36|19964.51|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|TRUSTMARK [2030]|STARMARK [203000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|UMR [2035]|UMR OPTIONS [203501]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66548.36|5051.62|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66548.36|8837.1|40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66548.36||40283.41|2550||||
MS383|DRG||Uncomplicated Peptic Ulcer With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66548.36||40283.41|2550||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41682.26|23289.6|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41682.26|24176.29|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41682.26|6871.83|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41682.26|9954.72|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41682.26|26059.99|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|GEHA [1415]|GEHA [141500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41682.26|10267.2|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41682.26|6871.83|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41682.26|37285.83|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41682.26|12945.6|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41682.26|12642.94|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41682.26|2550|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MULTIPLAN [1680]|HMA [168003]|41682.26|284.1|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|Self-pay|Self-pay|41682.26|12504.68|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41682.26|11850.28|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41682.26|11373.8|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41682.26|10378.61|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|UMR [2035]|UMR OPTIONS [203501]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41682.26|3901.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41682.26|36083.06|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41682.26|1450|37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41682.26||37285.83|284.1||||
MS384|DRG||Uncomplicated Peptic Ulcer Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41682.26|9954.72|37285.83|284.1||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69653.32|44313.24|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69653.32|159576.31|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69653.32|14251.57|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|69653.32|18088.65|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69653.32|49584.43|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|GEHA [1415]|GEHA [141500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|69653.32|18656.45|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69653.32|14251.57|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|69653.32|70943.89|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69653.32|23523.35|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69653.32|22973.39|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69653.32|19550|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MULTIPLAN [1680]|HMA [168003]|69653.32|513.9|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MULTIPLAN [1680]|IHC HS [168011]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|Self-pay|Self-pay|69653.32|20896|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69653.32|22352.62|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69653.32|24498.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|TRUSTMARK [2030]|STARMARK [203000]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69653.32|18830.13|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|UMR [2035]|UMR OPTIONS [203501]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69653.32|6872.92|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69653.32|10869.55|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69653.32|68655.37|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|69653.32|5800|159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|69653.32||159576.31|513.9||||
MS385|DRG||Inflammatory Bowel Disease With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|69653.32|18088.65|159576.31|513.9||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47306.23|28487.7|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47306.23|8107.3|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|GEHA [1415]|GEHA [141500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47306.23|1700|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MULTIPLAN [1680]|HMA [168003]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|Self-pay|Self-pay|47306.23|14191.87|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|UMR [2035]|UMR OPTIONS [203501]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47306.23|5160.05|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47306.23|7414.94|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47306.23|15032.36|28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47306.23||28487.7|1700||||
MS386|DRG||Inflammatory Bowel Disease With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47306.23|15032.36|28487.7|1700||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37417.93|21736.09|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37417.93|5277.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37417.93|6015.07|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37417.93|7968.91|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37417.93|24321.65|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|GEHA [1415]|GEHA [141500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37417.93|8219.05|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37417.93|6015.07|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37417.93|34798.68|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37417.93|10363.15|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37417.93|10120.87|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37417.93|850|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|37417.93|31.5|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|Self-pay|Self-pay|37417.93|11225.38|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37417.93|9934.5|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37417.93|9093.69|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37417.93|8298.01|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37417.93|4196.38|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37417.93|33676.13|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37417.93|1450|34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37417.93||34798.68|31.5||||
MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37417.93|7968.91|34798.68|31.5||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59255.47|50390.77|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59255.47|26388.98|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59255.47|9881.25|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59255.47|13000.75|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|59255.47|16887.79|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59255.47|56384.9|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|GEHA [1415]|GEHA [141500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|59255.47|18218.68|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59255.47|13000.75|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|59255.47|80673.77|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59255.47|21961.7|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59255.47|10928.51|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59255.47|21448.25|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59255.47|1700|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MULTIPLAN [1680]|HMA [168003]|59255.47|800.78|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MULTIPLAN [1680]|IHC HS [168011]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|Self-pay|Self-pay|59255.47|17776.64|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59255.47|20603.13|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59255.47|10162.76|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59255.47|19268.16|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|TRUSTMARK [2030]|STARMARK [203000]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59255.47|17582.23|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|UMR [2035]|UMR OPTIONS [203501]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59255.47|6288.01|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59255.47|9881.25|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59255.47|78071.4|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|59255.47|2900|80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|59255.47||80673.77|800.78||||
MS388|DRG||Gastrointestinal Obstruction With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|59255.47|16887.79|80673.77|800.78||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38146.79|22688.88|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38146.79|19464.06|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38146.79|7038.98|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38146.79|9178.68|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38146.79|25387.79|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|GEHA [1415]|GEHA [141500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38146.79|10137.45|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38146.79|7038.98|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|38146.79|36324.07|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38146.79|11936.4|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38146.79|5634.01|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38146.79|11657.34|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38146.79|850|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MULTIPLAN [1680]|HMA [168003]|38146.79|670.65|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|38146.79|25476.83|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|Self-pay|Self-pay|38146.79|11444.04|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38146.79|11540.67|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38146.79|5625.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38146.79|12434.42|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38146.79|9557.53|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|UMR [2035]|UMR OPTIONS [203501]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38146.79|3996.35|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38146.79|5904.34|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38146.79|35152.33|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38146.79|3625|36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38146.79||36324.07|670.65||||
MS389|DRG||Gastrointestinal Obstruction With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38146.79|9178.68|36324.07|670.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26732.3|14015.7|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26732.3|13607.29|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26732.3|4872.46|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26732.3|6501.57|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26732.3|15682.89|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26732.3||26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26732.3||26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|GEHA [1415]|GEHA [141500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26732.3|6705.65|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26732.3|4872.46|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26732.3|22438.6|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26732.3|8454.95|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26732.3||26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26732.3|8257.28|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26732.3|850|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|26732.3|260.65|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26732.3||26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26732.3|14858.95|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|Self-pay|Self-pay|26732.3|8019.69|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26732.3|8066.03|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26732.3|26405.69|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26732.3|8815.15|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26732.3|6775.64|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26732.3|2975.88|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26732.3|4049.66|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26732.3|21714.78|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26732.3|725|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26732.3|22050.7|26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26732.3||26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26732.3||26405.69|260.65||||
MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26732.3|6501.57|26405.69|260.65||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|58551.92|15860.1|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58551.92|15860.1|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58551.92|29255.27|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58551.92|27992.29|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58551.92|18828.66|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58551.92|18828.66|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58551.92|9670.62|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58551.92|18828.66|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58551.92|13928.58|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58551.92|32735.29|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58551.92||46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58551.92||46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|GEHA [1415]|GEHA [141500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58551.92|16420.65|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58551.92|9670.62|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58551.92|46836.65|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58551.92|18113.4|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58551.92||46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58551.92|15860.1|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58551.92|17689.92|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58551.92|2550|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58551.92|15860.1|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|58551.92|2054.85|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58551.92||46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58551.92|26842.62|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58551.92|15860.1|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|Self-pay|Self-pay|58551.92|17565.58|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58551.92|16697.2|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58551.92|39955.24|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58551.92|15860.1|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58551.92|14472.37|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58551.92|3606.74|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58551.92|8421.03|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58551.92|45325.79|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58551.92|3625|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58551.92|33356.23|46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58551.92||46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58551.92||46836.65|2054.85||||
MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58551.92|13928.58|46836.65|2054.85||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37705.04|18902.81|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37705.04|19671.57|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37705.04|5965.81|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37705.04|9742.42|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37705.04|8538.67|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37705.04|21151.38|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37705.04||33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37705.04||33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|GEHA [1415]|GEHA [141500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37705.04|8806.7|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37705.04|5965.81|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37705.04|30262.74|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37705.04|11104.1|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37705.04|5256.69|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37705.04|10844.49|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37705.04|3400|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|37705.04|346.28|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37705.04||33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37705.04|15045.68|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37705.04|11565.91|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|Self-pay|Self-pay|37705.04|11311.51|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37705.04|10265.74|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37705.04|33287.28|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37705.04|9041.51|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37705.04|8889.97|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37705.04|3295.54|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37705.04|5248.64|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37705.04|29286.53|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37705.04|2900|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37705.04|27773.04|33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37705.04||33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37705.04||33287.28|346.28||||
MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37705.04|8538.67|33287.28|346.28||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64210.26|38444.52|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64210.26|35508.3|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64210.26|13641.1|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|64210.26|18522.38|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64210.26|43017.63|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|64210.26|19103.8|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64210.26|13641.1|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|64210.26|61548.3|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64210.26|24087.4|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64210.26|23524.25|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64210.26|3400|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|64210.26|257.48|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|64210.26|46954.2|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|Self-pay|Self-pay|64210.26|19263.08|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64210.26|22183.62|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64210.26|25020.14|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64210.26|19231.37|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64210.26|5432.44|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64210.26|11124.84|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64210.26|59562.88|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|64210.26|4350|61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|64210.26||61548.3|257.48||||
MS393|DRG||Other Digestive System Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|64210.26|18522.38|61548.3|257.48||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40161.14|21938|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40161.14|24184.4|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40161.14|7629.26|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40161.14|10491.04|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40161.14|24547.59|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40161.14||35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40161.14||35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40161.14|10820.35|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40161.14|7629.26|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40161.14|35121.93|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40161.14|13643.05|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40161.14||35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40161.14|13324.08|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40161.14|1700|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|40161.14|73.15|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40161.14||35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40161.14|11720.4|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|Self-pay|Self-pay|40161.14|12048.34|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40161.14|12750.71|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40161.14|6397.78|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40161.14|13906.24|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40161.14|14201.68|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40161.14|10915.92|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40161.14|4307.56|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40161.14|7048.37|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40161.14|33988.97|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40161.14|1450|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40161.14|11639.74|35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40161.14||35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40161.14||35121.93|73.15||||
MS394|DRG||Other Digestive System Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40161.14|10491.04|35121.93|73.15||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31795.12|11495.36|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31795.12|24425.64|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31795.12|5308.51|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31795.12|12862.76|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31795.12||24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31795.12||24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31795.12|7492.25|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31795.12|5308.51|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31795.12|18403.64|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31795.12|3633.37|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31795.12||24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31795.12|9225.89|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31795.12|850|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|31795.12|256.19|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31795.12||24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31795.12|20923.55|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|Self-pay|Self-pay|31795.12|9538.54|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31795.12|9120.59|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31795.12|16678.68|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31795.12|7264.23|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31795.12|7556.01|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31795.12|3769.28|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31795.12|4619.26|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31795.12|17809.97|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31795.12|725|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31795.12|13957.91|24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31795.12||24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31795.12||24425.64|256.19||||
MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31795.12|7264.23|24425.64|256.19||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198607.72|89167.67|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198607.72|115371.23|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198607.72|79819.57|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198607.72|63974.24|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198607.72|99774.47|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|GEHA [1415]|GEHA [141500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198607.72|75325.86|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198607.72|79819.57|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198607.72|142754.24|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198607.72|83195.2|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198607.72|81250.15|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198607.72|4250|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|198607.72|360.59|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198607.72|178691.59|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|Self-pay|Self-pay|198607.72|59582.32|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198607.72|71485.65|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198607.72|86706.53|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198607.72|66645.72|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198607.72|17269.01|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198607.72|138149.27|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198607.72|1450|178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198607.72||178691.59|360.59||||
MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198607.72|63974.24|178691.59|360.59||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102330.28|59443.67|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|GEHA [1415]|GEHA [141500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102330.28|19159.57|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102330.28|2550|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|Self-pay|Self-pay|102330.28|30699.08|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102330.28|12344.93|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102330.28|19129.28|59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102330.28||59443.67|2550||||
MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102330.28||59443.67|2550||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124455.21|68452.53|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124455.21|61276.14|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124455.21|41844.84|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124455.21|76595.17|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|GEHA [1415]|GEHA [141500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124455.21|44263.71|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124455.21|61276.14|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124455.21|109590.03|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124455.21|54417.05|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124455.21|53144.82|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MULTIPLAN [1680]|HMA [168003]|124455.21|1105.36|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MULTIPLAN [1680]|IHC HS [168011]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124455.21|72296.03|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|Self-pay|Self-pay|124455.21|37336.56|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124455.21|53362.09|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124455.21|56732.6|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|TRUSTMARK [2030]|STARMARK [203000]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124455.21|43606.69|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|UMR [2035]|UMR OPTIONS [203501]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124455.21|106054.85|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124455.21|3625|109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124455.21||109590.03|1105.36||||
MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124455.21|41844.84|109590.03|1105.36||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130021.18|64246.15|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130021.18|75529.3|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130021.18|57510.76|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|130021.18|23597.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130021.18|71888.45|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|GEHA [1415]|GEHA [141500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|130021.18|24338.6|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130021.18|57510.76|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|130021.18|102855.78|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130021.18|30687.8|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130021.18|29970.34|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130021.18|1700|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MULTIPLAN [1680]|HMA [168003]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|Self-pay|Self-pay|130021.18|39006.35|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130021.18|31508.36|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130021.18|26947.13|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130021.18|24589.31|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|UMR [2035]|UMR OPTIONS [203501]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130021.18|14041.23|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130021.18|99537.86|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|130021.18|2175|102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|130021.18||102855.78|1700||||
MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|130021.18|23597.86|102855.78|1700||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|121822.28|70771.95|70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|GEHA [1415]|GEHA [141500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|121822.28|2550|70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|Self-pay|Self-pay|121822.28|36546.68|70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|121822.28|11038.59|70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|121822.28||70771.95|2550||||
MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|121822.28||70771.95|2550||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112232.91|65013.11|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112232.91|58197.31|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|112232.91|25394.13|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112232.91|72746.64|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|GEHA [1415]|GEHA [141500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|112232.91|26191.25|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112232.91|58197.31|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|112232.91|104083.65|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112232.91|33023.75|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112232.91|32251.68|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MULTIPLAN [1680]|HMA [168003]|112232.91|488.83|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|Self-pay|Self-pay|112232.91|33669.87|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112232.91|32100.54|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112232.91|34432.96|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112232.91|26466.39|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|UMR [2035]|UMR OPTIONS [203501]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112232.91|100726.12|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|112232.91|1450|104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|112232.91||104083.65|488.83||||
MS412|DRG||Cholecystectomy With C.D.E. With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|112232.91|25394.13|104083.65|488.83||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|GEHA [1415]|GEHA [141500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MULTIPLAN [1680]|HMA [168003]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MULTIPLAN [1680]|IHC HS [168011]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|Self-pay|Self-pay|107134.44|32140.33|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|TRUSTMARK [2030]|STARMARK [203000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|UMR [2035]|UMR OPTIONS [203501]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107134.44|24154.91|32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107134.44||32140.33|24154.91||||
MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107134.44||32140.33|24154.91||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114618.87|55090.79|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114618.87|59510.11|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114618.87|16365.6|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|114618.87|22653.46|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114618.87|61644.03|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|GEHA [1415]|GEHA [141500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|114618.87|24234.8|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114618.87|16365.6|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|114618.87|88198.36|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114618.87|29459.65|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114618.87|28770.9|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114618.87|3400|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MULTIPLAN [1680]|HMA [168003]|114618.87|870.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|114618.87|115285.69|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|Self-pay|Self-pay|114618.87|34385.66|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114618.87|27323.92|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114618.87|24631.16|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114618.87|23631|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|UMR [2035]|UMR OPTIONS [203501]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114618.87|9058.48|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114618.87|13556.3|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114618.87|85353.25|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|114618.87|1450|115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|114618.87||115285.69|870.25||||
MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|114618.87|22653.46|115285.69|870.25||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90428.95|84773.36|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90428.95|75885.96|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|90428.95|15858.65|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90428.95|94857.45|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|GEHA [1415]|GEHA [141500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|90428.95|20032.83|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90428.95|75885.96|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|90428.95|135719.1|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90428.95|20623.35|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90428.95|20141.19|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|Self-pay|Self-pay|90428.95|27128.68|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90428.95|18959.1|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90428.95|12901.99|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90428.95|16540.19|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90428.95|131341.08|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|90428.95|3625|135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|90428.95||135719.1|3625||||
MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|90428.95|15858.65|135719.1|3625||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|129740.3|30887.94|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|129740.3|30887.94|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|129740.3|66947.26|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|129740.3|76060.64|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|129740.3|36669.28|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|129740.3|36669.28|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|129740.3|59928.69|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|129740.3|36669.28|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|129740.3|27030.95|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|129740.3|74910.87|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|GEHA [1415]|GEHA [141500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|129740.3|28506.66|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|129740.3|59928.69|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|129740.3|107180.17|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|129740.3|35152.35|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|129740.3|30887.94|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|129740.3|34330.51|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|129740.3|1700|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|129740.3|30887.94|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MULTIPLAN [1680]|HMA [168003]|129740.3|627.21|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MULTIPLAN [1680]|IHC HS [168011]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|129740.3|70195.16|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|129740.3|30887.94|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|Self-pay|Self-pay|129740.3|38922.09|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|129740.3|32329.02|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|129740.3|30887.94|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|TRUSTMARK [2030]|STARMARK [203000]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|129740.3|28185.31|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|UMR [2035]|UMR OPTIONS [203501]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|129740.3|8329.96|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|129740.3|16132.79|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|129740.3|103722.75|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|129740.3|2175|107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|129740.3||107180.17|627.21||||
MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|129740.3|27030.95|107180.17|627.21||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100098.27|52356.46|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100098.27|58160.39|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100098.27|13404.5|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100098.27|18832.35|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100098.27|58584.43|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100098.27||135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100098.27||135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|GEHA [1415]|GEHA [141500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100098.27|21028.08|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100098.27|13404.5|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100098.27|83820.79|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100098.27|24490.5|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100098.27||135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100098.27|23917.93|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100098.27|2550|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MULTIPLAN [1680]|HMA [168003]|100098.27|1604.58|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100098.27||135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100098.27|65418.16|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|Self-pay|Self-pay|100098.27|30029.48|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100098.27|22527.02|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100098.27|135665.26|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100098.27|25542.15|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100098.27|19632.6|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|UMR [2035]|UMR OPTIONS [203501]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100098.27|6487.37|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100098.27|11307.27|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100098.27|81116.89|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100098.27|2175|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100098.27|113107.97|135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100098.27||135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100098.27||135665.26|1604.58||||
MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100098.27|18832.35|135665.26|1604.58||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88680.85|47069.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88680.85|52275.31|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88680.85|9945.17|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|88680.85|16762.46|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|88680.85|14665.6|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88680.85|52668.92|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|GEHA [1415]|GEHA [141500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|88680.85|15125.95|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88680.85|9945.17|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|88680.85|75357.07|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88680.85|19071.85|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|88680.85|8868.65|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88680.85|18625.96|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88680.85|1700|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|88680.85|350.44|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|88680.85|38627.81|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88680.85|19899.91|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|Self-pay|Self-pay|88680.85|26604.25|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88680.85|17646.3|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88680.85|16577.88|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88680.85|15295.78|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88680.85|5989.31|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88680.85|8854.82|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88680.85|72926.21|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|88680.85|2175|75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|88680.85||75357.07|350.44||||
MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|88680.85|14665.6|75357.07|350.44||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|GEHA [1415]|GEHA [141500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|Self-pay|Self-pay|266285.44|79885.63|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|266285.44|23300.5|79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|266285.44||79885.63|23300.5||||
MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|266285.44||79885.63|23300.5||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107740.57|62586.48|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107740.57|56025.1|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107740.57|21268.63|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107740.57|70031.37|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|GEHA [1415]|GEHA [141500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107740.57|22880.52|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107740.57|56025.1|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107740.57|100198.73|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107740.57|27658.75|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107740.57|27012.11|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|107740.57|944.27|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|Self-pay|Self-pay|107740.57|32322.17|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107740.57|25468.98|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107740.57|28883.01|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107740.57|22200.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107740.57|96966.51|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107740.57|3625|100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107740.57||100198.73|944.27||||
MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107740.57|21268.63|100198.73|944.27||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124324.08|53269.97|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124324.08|68194.23|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124324.08|33883.51|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124324.08|46672.79|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124324.08|59606.6|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124324.08|49743.68|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124324.08|33883.51|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124324.08|85283.29|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124324.08|60695.55|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124324.08|59276.53|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124324.08|4250|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|124324.08|837.49|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|Self-pay|Self-pay|124324.08|37297.22|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124324.08|51200.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124324.08|63231.24|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124324.08|48601.77|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124324.08|19255.73|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124324.08|27693.52|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124324.08|82532.21|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124324.08|2900|85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124324.08||85283.29|837.49||||
MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124324.08|46672.79|85283.29|837.49||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63279.37|36758.99|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63279.37|18566.85|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63279.37|25467.72|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63279.37|41131.59|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63279.37|26267.15|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63279.37|18566.85|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63279.37|58849.83|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63279.37|33119.45|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63279.37|32345.14|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|63279.37|413.92|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|Self-pay|Self-pay|63279.37|18983.81|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63279.37|30222.61|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63279.37|29079.4|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63279.37|26535.01|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63279.37|56951.44|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63279.37|1450|58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63279.37||58849.83|413.92||||
MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63279.37|25467.72|58849.83|413.92||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|103156.03|30946.81|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103156.03|11118.55|30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|103156.03||30946.81|11118.55||||
MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|103156.03||30946.81|11118.55||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73614.95|53498.49|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73614.95|39150.3|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73614.95|13493.33|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73614.95|20970.92|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73614.95|59862.32|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|73614.95||85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73614.95||85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|GEHA [1415]|GEHA [141500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73614.95|28749.69|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73614.95|13493.33|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|73614.95|85649.15|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73614.95|27271.6|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73614.95|12585.78|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73614.95|26634.01|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73614.95|2550|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MULTIPLAN [1680]|HMA [168003]|73614.95|7120.49|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73614.95||85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|73614.95|41567.68|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|Self-pay|Self-pay|73614.95|22084.48|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73614.95|24341.41|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73614.95|36740.85|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73614.95|23987.7|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73614.95|21888.82|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73614.95|9698.79|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73614.95|12566|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73614.95|82886.28|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73614.95|5075|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73614.95|30617.38|85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73614.95||85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73614.95||85649.15|2550||||
MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73614.95|20970.92|85649.15|2550||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52015.84|33692.35|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52015.84|31398.83|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52015.84|7407.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52015.84|11483.39|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52015.84|37700.14|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|GEHA [1415]|GEHA [141500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52015.84|11843.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52015.84|7407.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52015.84|53940.21|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52015.84|14933.55|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52015.84|6992.68|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52015.84|14584.41|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52015.84|1700|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MULTIPLAN [1680]|HMA [168003]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52015.84|23635.68|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|Self-pay|Self-pay|52015.84|15604.75|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52015.84|13809.33|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52015.84|15561.94|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52015.84|11961.46|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52015.84|5380.4|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52015.84|6981.85|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52015.84|52200.2|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52015.84|1450|53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52015.84||53940.21|1450||||
MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52015.84|11483.39|53940.21|1450||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43994|27582.81|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43994|20424.34|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43994|5029.92|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43994|6920.81|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43994|30863.89|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43994|7138.05|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43994|5029.92|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43994|44159.1|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43994|9000.15|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43994|8789.73|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43994|1700|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|43994|642.95|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43994|16159.01|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|Self-pay|Self-pay|43994|13198.2|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43994|8493.26|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43994|9374.99|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43994|7205.95|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43994|3243.87|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43994|4296.41|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43994|42734.61|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43994|2175|44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43994||44159.1|642.95||||
MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43994|6920.81|44159.1|642.95||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91994.48|30631.49|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91994.48|79952.1|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91994.48|14150.63|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91994.48|19550.41|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91994.48|34275.21|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|GEHA [1415]|GEHA [141500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91994.48|21220.09|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91994.48|14150.63|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91994.48|49039.91|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91994.48|25424.3|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91994.48|24829.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91994.48|5950|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MULTIPLAN [1680]|HMA [168003]|91994.48|1055.99|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MULTIPLAN [1680]|IHC HS [168011]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91994.48|193818.62|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|Self-pay|Self-pay|91994.48|27598.34|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91994.48|22581.1|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91994.48|22339.75|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|TRUSTMARK [2030]|STARMARK [203000]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91994.48|20385.06|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|UMR [2035]|UMR OPTIONS [203501]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91994.48|8053.55|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91994.48|11729.9|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91994.48|47457.98|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91994.48|2175|193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91994.48||193818.62|1055.99||||
MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91994.48|19550.41|193818.62|1055.99||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43946.96|49063.73|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|GEHA [1415]|GEHA [141500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43946.96|2550|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MULTIPLAN [1680]|HMA [168003]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|Self-pay|Self-pay|43946.96|13184.09|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|UMR [2035]|UMR OPTIONS [203501]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43946.96|6182.59|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43946.96|5146.28|49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43946.96||49063.73|2550||||
MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43946.96||49063.73|2550||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|GEHA [1415]|GEHA [141500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|Self-pay|Self-pay|19718.03|5915.41|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19718.03|5733.95|5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19718.03||5915.41|5733.95||||
MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19718.03||5915.41|5733.95||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69075.7|34845.7|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69075.7|45960.54|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69075.7|13746.07|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|69075.7|17815.47|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69075.7|38990.7|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|GEHA [1415]|GEHA [141500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|69075.7|19747.42|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69075.7|13746.07|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|69075.7|55786.7|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69075.7|23168.1|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|69075.7|10403.33|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69075.7|22626.45|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69075.7|2550|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MULTIPLAN [1680]|HMA [168003]|69075.7|1372.72|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|69075.7|45342.83|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|Self-pay|Self-pay|69075.7|20722.71|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69075.7|22433.74|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69075.7|24153.15|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69075.7|18564.97|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|UMR [2035]|UMR OPTIONS [203501]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69075.7|8160.73|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69075.7|10708.77|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69075.7|53987.12|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|69075.7|4350|55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|69075.7||55786.7|1372.72||||
MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|69075.7|17815.47|55786.7|1372.72||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44065.94|24831.46|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44065.94|25919.85|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44065.94|7324.83|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44065.94|9423.98|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44065.94|27785.24|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44065.94||39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44065.94||39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|GEHA [1415]|GEHA [141500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44065.94|10353.42|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44065.94|7324.83|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44065.94|39754.28|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44065.94|12255.4|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44065.94||39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44065.94|11968.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44065.94|4250|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MULTIPLAN [1680]|HMA [168003]|44065.94|633.62|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44065.94||39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44065.94|25545.62|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|Self-pay|Self-pay|44065.94|13219.78|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44065.94|11817.83|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44065.94|28485.57|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44065.94|12776.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44065.94|9820.37|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44065.94|5824.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44065.94|5769.73|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44065.94|38471.88|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44065.94|2900|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44065.94|23781.55|39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44065.94||39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44065.94||39754.28|633.62||||
MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44065.94|9423.98|39754.28|633.62||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36911|21194.66|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36911|21302.56|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36911|5186.57|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36911|6760.25|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36911|23715.82|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36911|7530.56|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36911|5186.57|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36911|33931.87|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36911|8791.35|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36911|8585.81|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36911|1700|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|36911|798.91|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36911|13665.76|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|Self-pay|Self-pay|36911|11073.3|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36911|8627.11|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36911|9167.7|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36911|7046.62|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36911|4576.19|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36911|4181.69|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36911|32837.29|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36911|1450|33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36911||33931.87|798.91||||
MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36911|6760.25|33931.87|798.91||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|71332.22|21632.84|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71332.22|21632.84|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71332.22|29179.18|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71332.22|50838.3|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71332.22|27021.7|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71332.22|27021.7|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71332.22|15209.26|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71332.22|27021.7|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71332.22|20956.43|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71332.22|32650.13|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71332.22||72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71332.22||72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|GEHA [1415]|GEHA [141500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71332.22|22818.14|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71332.22|15209.26|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71332.22|46714.8|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71332.22|27252.75|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71332.22||72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71332.22|21632.84|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71332.22|26615.6|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71332.22|4250|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71332.22|21632.84|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MULTIPLAN [1680]|HMA [168003]|71332.22|1203.89|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71332.22||72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71332.22|39865.05|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71332.22|21632.84|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|Self-pay|Self-pay|71332.22|21399.67|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71332.22|24550.97|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71332.22|72306.46|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71332.22|21632.84|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71332.22|21907.43|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71332.22|6779.66|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71332.22|12557.47|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71332.22|45207.87|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71332.22|2175|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71332.22|60255.38|72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71332.22||72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71332.22||72306.46|1203.89||||
MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71332.22|20956.43|72306.46|1203.89||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44971.95|24906.76|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44971.95|27434.71|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44971.95|7482.3|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44971.95|10369.5|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44971.95|27869.5|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|GEHA [1415]|GEHA [141500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44971.95|10695|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44971.95|7482.3|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44971.95|39874.82|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44971.95|13485|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44971.95|13169.73|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44971.95|1700|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MULTIPLAN [1680]|HMA [168003]|44971.95|190.59|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44971.95|22995.38|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|Self-pay|Self-pay|44971.95|13491.58|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44971.95|12700.69|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44971.95|14095.77|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44971.95|10834.51|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44971.95|5176.98|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44971.95|6326.24|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44971.95|38588.54|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44971.95|1450|39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44971.95||39874.82|190.59||||
MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44971.95|10369.5|39874.82|190.59||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28344|16341.35|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28344|16465.01|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28344|5258.44|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28344|7394.68|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28344|18285.2|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28344|7626.8|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28344|5258.44|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28344|26161.89|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28344|9616.4|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28344|9391.58|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28344|1700|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|28344|492.09|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|Self-pay|Self-pay|28344|8503.2|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28344|9176.02|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28344|6956.77|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28344|7708.36|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28344|4337.48|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28344|4816.72|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28344|25317.96|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28344|725|26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28344||26161.89|492.09||||
MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28344|7394.68|26161.89|492.09||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|75651.9|23099.5|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75651.9|23099.5|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75651.9|32175.18|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75651.9|50226.82|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75651.9|25250.13|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75651.9|25250.13|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75651.9|13091.19|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75651.9|25250.13|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75651.9|18638.34|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75651.9|36002.49|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75651.9||51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75651.9||51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|GEHA [1415]|GEHA [141500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75651.9|20104.25|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75651.9|13091.19|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75651.9|51511.27|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75651.9|24238.2|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75651.9||51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75651.9|23099.5|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75651.9|23671.53|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75651.9|3400|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75651.9|23099.5|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MULTIPLAN [1680]|HMA [168003]|75651.9|1012.8|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MULTIPLAN [1680]|IHC HS [168011]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75651.9||51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75651.9|23979.13|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75651.9|23099.5|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|Self-pay|Self-pay|75651.9|22695.57|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75651.9|21627.94|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75651.9|11193.1|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75651.9|49777.34|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75651.9|23099.5|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|TRUSTMARK [2030]|STARMARK [203000]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75651.9|19408.14|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|UMR [2035]|UMR OPTIONS [203501]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75651.9|4975.25|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75651.9|7528.74|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75651.9|49849.61|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75651.9|2175|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75651.9|41481.12|51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75651.9||51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75651.9||51511.27|1012.8||||
MS444|DRG||Disorders Of The Biliary Tract With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75651.9|18638.34|51511.27|1012.8||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|60387.45|15713.84|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60387.45|15713.84|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60387.45|20153.68|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60387.45|22283.77|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60387.45|16292.75|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60387.45|16292.75|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60387.45|8603.11|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60387.45|16292.75|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60387.45|12014.13|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60387.45|22551.02|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60387.45||71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60387.45||71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|GEHA [1415]|GEHA [141500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60387.45|13350.37|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60387.45|8603.11|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60387.45|32265.31|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60387.45|15623.75|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60387.45||71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60387.45|15713.84|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60387.45|15258.48|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60387.45|1700|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60387.45|15713.84|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MULTIPLAN [1680]|HMA [168003]|60387.45|959.12|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60387.45||71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60387.45|23110|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60387.45|15713.84|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|Self-pay|Self-pay|60387.45|18116.23|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60387.45|14305.51|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60387.45|71674.25|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60387.45|15713.84|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60387.45|12523.18|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|UMR [2035]|UMR OPTIONS [203501]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60387.45|3878.66|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60387.45|7294.24|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60387.45|31224.5|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60387.45|2175|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60387.45|59728.55|71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60387.45||71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60387.45||71674.25|959.12||||
MS445|DRG||Disorders Of The Biliary Tract With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60387.45|12014.13|71674.25|959.12||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|53461.65|10738.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53461.65|10738.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53461.65|29180.37|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53461.65|21794.82|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53461.65|12349.69|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53461.65|12349.69|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53461.65|6111.97|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53461.65|12349.69|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53461.65|9105.09|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53461.65|32651.46|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|GEHA [1415]|GEHA [141500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53461.65|9390.9|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53461.65|6111.97|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53461.65|46716.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53461.65|11840.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53461.65|10738.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53461.65|11563.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53461.65|2550|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53461.65|10738.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|53461.65|203.82|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53461.65|26572.4|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53461.65|10738.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|Self-pay|Self-pay|53461.65|16038.49|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53461.65|10702.43|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53461.65|10738.87|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53461.65|9492.41|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53461.65|3267.15|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53461.65|6207.7|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53461.65|45209.72|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53461.65|1450|46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53461.65||46716.7|203.82||||
MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53461.65|9105.09|46716.7|203.82||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244664.82|142125.78|142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|GEHA [1415]|GEHA [141500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244664.82|4250|142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MULTIPLAN [1680]|HMA [168003]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MULTIPLAN [1680]|IHC HS [168011]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|Self-pay|Self-pay|244664.82|73399.45|142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|TRUSTMARK [2030]|STARMARK [203000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|UMR [2035]|UMR OPTIONS [203501]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244664.82|41856.08|142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|244664.82||142125.78|4250||||
MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|244664.82||142125.78|4250||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|241683.66|140913.32|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|241683.66|122445.72|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|GEHA [1415]|GEHA [141500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|241683.66|1700|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MULTIPLAN [1680]|HMA [168003]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|Self-pay|Self-pay|241683.66|72505.1|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|241683.66|160600.6|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|UMR [2035]|UMR OPTIONS [203501]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|241683.66|29638.26|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|241683.66|40209.78|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|241683.66|92268.58|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|241683.66|133833.84|160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|241683.66||160600.6|1700||||
MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|241683.66|92268.58|160600.6|1700||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200328.1|118104.68|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200328.1|124937.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200328.1|105722.9|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|200328.1|53311.5|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200328.1|132153.62|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|200328.1||189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|200328.1||189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|GEHA [1415]|GEHA [141500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|200328.1|78710.02|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200328.1|105722.9|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|200328.1|189081.35|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200328.1|69328.85|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|200328.1||189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200328.1|67707.99|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200328.1|1700|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|200328.1|313.72|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|200328.1||189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|200328.1|118365.64|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|Self-pay|Self-pay|200328.1|60098.43|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200328.1|68657.26|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|200328.1|148179.74|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200328.1|72491.23|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200328.1|55719.33|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200328.1|18599.86|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200328.1|31600.92|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200328.1|182981.95|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|200328.1|2175|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|200328.1|123483.12|189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|200328.1||189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|200328.1||189081.35|313.72||||
MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|200328.1|53311.5|189081.35|313.72||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267237.64|126047.64|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|GEHA [1415]|GEHA [141500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267237.64|8500|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MULTIPLAN [1680]|HMA [168003]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MULTIPLAN [1680]|IHC HS [168011]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|Self-pay|Self-pay|267237.64|80171.29|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|TRUSTMARK [2030]|STARMARK [203000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|UMR [2035]|UMR OPTIONS [203501]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267237.64|30019.1|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267237.64|56752.08|126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|267237.64||126047.64|8500||||
MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|267237.64||126047.64|8500||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350954.06|190566.02|190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|GEHA [1415]|GEHA [141500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350954.06|9350|190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MULTIPLAN [1680]|HMA [168003]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|Self-pay|Self-pay|350954.06|105286.22|190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|UMR [2035]|UMR OPTIONS [203501]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350954.06|23948.74|190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|350954.06||190566.02|9350||||
MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|350954.06||190566.02|9350||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|GEHA [1415]|GEHA [141500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|171353.61|99539.31|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|Self-pay|Self-pay|171353.61|51406.08|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|171353.61|0|99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|171353.61||99539.31|51406.08||||
MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|171353.61|0|99539.31|51406.08||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|GEHA [1415]|GEHA [141500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MULTIPLAN [1680]|HMA [168003]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MULTIPLAN [1680]|IHC HS [168011]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|Self-pay|Self-pay|234609.38|70382.81|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|TRUSTMARK [2030]|STARMARK [203000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|UMR [2035]|UMR OPTIONS [203501]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234609.38|44412.51|70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|234609.38||70382.81|44412.51||||
MS459|DRG||Spinal Fusion Except Cervical With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|234609.38||70382.81|44412.51||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172670.07|107242.14|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172670.07|91769.62|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172670.07|95999.14|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|172670.07|43827.31|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172670.07|119998.93|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|172670.07||199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|172670.07||199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|GEHA [1415]|GEHA [141500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|172670.07|63794.7|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172670.07|95999.14|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|172670.07|171690.76|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172670.07|56995.15|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|172670.07||199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172670.07|55662.64|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172670.07|850|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MULTIPLAN [1680]|HMA [168003]|172670.07|835.98|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|172670.07||199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|172670.07|59744.49|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|Self-pay|Self-pay|172670.07|51801.02|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172670.07|54281.45|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|172670.07|199030.38|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172670.07|59504.54|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172670.07|45737.3|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|UMR [2035]|UMR OPTIONS [203501]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172670.07|17276.25|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172670.07|26018.74|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172670.07|166152.36|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|172670.07|2175|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|172670.07|165858.66|199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|172670.07||199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|172670.07||199030.38|835.98||||
MS460|DRG||Spinal Fusion Except Cervical Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|172670.07|43827.31|199030.38|835.98||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161693.29|159345.17|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161693.29|142639.85|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|161693.29|137153.7|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161693.29|178299.81|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|GEHA [1415]|GEHA [141500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|161693.29|80345.99|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161693.29|142639.85|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|161693.29|255105.88|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161693.29|123438.33|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|161693.29|40198.93|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161693.29|123438.33|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MULTIPLAN [1680]|HMA [168003]|161693.29|2390.04|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MULTIPLAN [1680]|IHC HS [168011]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|Self-pay|Self-pay|161693.29|48507.99|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161693.29|137153.7|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161693.29|91937.22|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|TRUSTMARK [2030]|STARMARK [203000]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161693.29|70666.21|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|UMR [2035]|UMR OPTIONS [203501]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161693.29|246876.66|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|161693.29|6525|255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|161693.29||255105.88|2390.04||||
MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|161693.29|137153.7|255105.88|2390.04||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|148063.23|79260.17|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|148063.23|163016.42|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|148063.23|70950.76|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|148063.23|35026.61|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|148063.23|88688.45|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|GEHA [1415]|GEHA [141500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|148063.23|49629.25|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|148063.23|70950.76|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|148063.23|126892.7|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148063.23|45550.3|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|148063.23|44485.37|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|148063.23|5950|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MULTIPLAN [1680]|HMA [168003]|148063.23|368.25|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|Self-pay|Self-pay|148063.23|44418.97|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|148063.23|44129.28|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|148063.23|47573.98|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148063.23|36567.05|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|UMR [2035]|UMR OPTIONS [203501]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|148063.23|43645|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148063.23|21931.11|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|148063.23|122799.39|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|148063.23|1450|163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|148063.23||163016.42|368.25||||
MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|148063.23|35026.61|163016.42|368.25||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152764.73|137372.29|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|GEHA [1415]|GEHA [141500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152764.73|8500|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|Self-pay|Self-pay|152764.73|45829.42|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152764.73|29778.73|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152764.73|27602.82|137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|152764.73||137372.29|8500||||
MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|152764.73||137372.29|8500||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132610.24|100686.12|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132610.24|77075.06|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132610.24|90130.45|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|132610.24|33181.29|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132610.24|112663.07|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|GEHA [1415]|GEHA [141500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|132610.24|39343.44|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132610.24|90130.45|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|132610.24|161194.85|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132610.24|43150.55|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|132610.24|19784.02|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132610.24|42141.72|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132610.24|3400|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|132610.24|1655.26|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|Self-pay|Self-pay|132610.24|39783.07|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132610.24|38448.18|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132610.24|45006.3|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132610.24|34593.44|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132610.24|15836.51|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132610.24|19752.73|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132610.24|155995.01|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|132610.24|6525|161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|132610.24||161194.85|1655.26||||
MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|132610.24|33181.29|161194.85|1655.26||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67305.18|37849.97|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67305.18|15716.37|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67305.18|20561.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67305.18|42352.35|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67305.18|22047.15|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67305.18|15716.37|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67305.18|60596.44|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67305.18|26739.45|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67305.18|26114.3|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|67305.18|295.49|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67305.18|21401.23|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|Self-pay|Self-pay|67305.18|20191.55|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67305.18|25437.88|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67305.18|21232.61|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67305.18|21441.07|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67305.18|58641.72|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67305.18|725|60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67305.18||60596.44|295.49||||
MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67305.18|20561.72|60596.44|295.49||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234556.34|193735.32|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234556.34|182437.78|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234556.34|173424.63|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|234556.34|166754.46|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234556.34|216780.79|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|GEHA [1415]|GEHA [141500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|234556.34|107793.79|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234556.34|173424.63|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|234556.34|310163.29|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234556.34|150079.01|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234556.34|150079.01|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234556.34|8500|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MULTIPLAN [1680]|HMA [168003]|234556.34|2574.77|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MULTIPLAN [1680]|IHC HS [168011]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|Self-pay|Self-pay|234556.34|70366.9|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234556.34|166754.46|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234556.34|80873.64|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|TRUSTMARK [2030]|STARMARK [203000]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234556.34|62162.35|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|UMR [2035]|UMR OPTIONS [203501]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234556.34|31495.27|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234556.34|33921.28|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234556.34|300158.02|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|234556.34|5800|310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|234556.34||310163.29|2574.77||||
MS466|DRG||Revision Of Hip Or Knee Replacement With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|234556.34|166754.46|310163.29|2574.77||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|185793.54|98899.66|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|185793.54|105130.53|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|185793.54|88531.28|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|185793.54|39889.13|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|185793.54|110664.1|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|GEHA [1415]|GEHA [141500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|185793.54|60000.37|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|185793.54|88531.28|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|185793.54|158334.8|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|185793.54|51873.75|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|185793.54|23700.81|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|185793.54|50660.98|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|185793.54|5100|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MULTIPLAN [1680]|HMA [168003]|185793.54|393|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|Self-pay|Self-pay|185793.54|55738.06|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|185793.54|47019.86|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|185793.54|22825.88|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|185793.54|194717.78|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|185793.54|54110.45|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|185793.54|41591.21|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|UMR [2035]|UMR OPTIONS [203501]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|185793.54|24731.89|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|185793.54|21566.68|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|185793.54|153227.23|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|185793.54|1450|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|185793.54|162264.84|194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|185793.54||194717.78|393||||
MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|185793.54|39889.13|194717.78|393||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158888.16|84542.55|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158888.16|93999.64|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158888.16|75679.33|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|158888.16|31246.76|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158888.16|94599.16|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|GEHA [1415]|GEHA [141500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|158888.16|50175.56|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158888.16|75679.33|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|158888.16|135349.56|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158888.16|40634.8|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158888.16|39684.79|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158888.16|850|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|158888.16|318.93|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|Self-pay|Self-pay|158888.16|47666.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158888.16|38085.84|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|158888.16|90745.85|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158888.16|42426.51|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158888.16|32610.52|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158888.16|19622.24|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158888.16|18614.13|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158888.16|130983.45|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|158888.16|725|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158888.16|75621.55|135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|158888.16||135349.56|318.93||||
MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|158888.16|31246.76|135349.56|318.93||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|AETNA [1015]|AETNA ACO WILCO [101532]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|159969.99|68440.3|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|159969.99|98300.15|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|159969.99|61265.17|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|159969.99|34188.13|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|159969.99|76581.47|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|CORESOURCE [1315]|CORESOURCE [131500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|CORVEL CORP [2235]|CORVEL CORP [223500]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|GEHA [1415]|GEHA [141500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|159969.99|38554.1|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HEALTHNET [1495]|HEALTHNET [149500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|159969.99|61265.17|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HEALTHSMART [1505]|HEALTHSMART [150501]|159969.99|109570.41|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|159969.99|44459.9|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|159969.99|43420.46|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|159969.99|3400|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MULTIPLAN [1680]|HMA [168003]|159969.99|433.89|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MULTIPLAN [1680]|IHC HS [168011]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|Self-pay|Self-pay|159969.99|47991|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|159969.99|46669.16|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|TRUSTMARK [2030]|STARMARK [203000]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|159969.99|35871.57|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|UMR [2035]|UMR OPTIONS [203501]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|159969.99|24650.32|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|159969.99|20474.63|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|159969.99|106035.88|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|159969.99|3625|109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|159969.99||109570.41|433.89||||
MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|159969.99|34188.13|109570.41|433.89||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|96384.44|28746.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96384.44|28746.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96384.44|55450.85|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96384.44|56170.1|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96384.44|28746.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96384.44|19941.41|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96384.44|17068.13|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96384.44|24214.57|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96384.44|21188.35|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96384.44|62046.91|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96384.44||88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96384.44||88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|GEHA [1415]|GEHA [141500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96384.44|29976.61|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96384.44|17068.13|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96384.44|88774.82|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96384.44|27554.35|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96384.44|12713.95|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96384.44|28746.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96384.44|26910.15|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96384.44|850|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96384.44|28746.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MULTIPLAN [1680]|HMA [168003]|96384.44|583.66|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96384.44||88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96384.44|56590.4|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96384.44|28746.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|Self-pay|Self-pay|96384.44|28915.33|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96384.44|27774.14|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96384.44|88515.81|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96384.44|21867.99|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96384.44|22095.84|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|UMR [2035]|UMR OPTIONS [203501]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96384.44|14708.23|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96384.44|12693.97|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96384.44|85911.12|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96384.44|1450|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96384.44|73763.16|88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96384.44||88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96384.44||88774.82|583.66||||
MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96384.44|21188.35|88774.82|583.66||||
MS471|DRG||Cervical Spinal Fusion With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|271601.14|247763.27|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|271601.14|221788.44|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|271601.14|213258.12|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|271601.14|277235.56|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|GEHA [1415]|GEHA [141500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|271601.14|81737.68|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|271601.14|221788.44|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|271601.14|396660.11|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|271601.14|191932.31|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|271601.14|191932.31|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MULTIPLAN [1680]|HMA [168003]|271601.14|1986.77|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MULTIPLAN [1680]|IHC HS [168011]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|Self-pay|Self-pay|271601.14|81480.34|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|271601.14|213258.12|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|271601.14|75907.75|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|TRUSTMARK [2030]|STARMARK [203000]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|271601.14|58345.38|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|UMR [2035]|UMR OPTIONS [203501]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|271601.14|33165.46|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|271601.14|383864.61|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|271601.14|8700|396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|271601.14||396660.11|1986.77||||
MS471|DRG||Cervical Spinal Fusion With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|271601.14|213258.12|396660.11|1986.77||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163147.82|61291.73|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163147.82|90762.07|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163147.82|54866.06|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|163147.82|34048.76|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163147.82|68582.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|GEHA [1415]|GEHA [141500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|163147.82|40232.07|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163147.82|54866.06|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|163147.82|98125.85|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163147.82|44278.65|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163147.82|43243.45|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163147.82|5100|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MULTIPLAN [1680]|HMA [168003]|163147.82|163.34|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|Self-pay|Self-pay|163147.82|48944.35|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163147.82|38577.97|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|163147.82|163938.42|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163147.82|38913.58|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163147.82|35508.72|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|UMR [2035]|UMR OPTIONS [203501]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163147.82|11793.82|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163147.82|20263.3|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163147.82|94960.5|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|163147.82|725|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|163147.82|136615.35|163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|163147.82||163938.42|163.34||||
MS472|DRG||Cervical Spinal Fusion With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|163147.82|34048.76|163938.42|163.34||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111332.34|64475.78|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111332.34|72507.09|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111332.34|57716.31|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|111332.34|28309.85|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111332.34|72145.39|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|GEHA [1415]|GEHA [141500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|111332.34|36216.7|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111332.34|57716.31|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|111332.34|103223.4|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111332.34|36815.5|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111332.34|35954.78|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111332.34|850|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|111332.34|506.82|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|Self-pay|Self-pay|111332.34|33399.7|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111332.34|30982.43|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111332.34|29089.02|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111332.34|29542.53|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111332.34|8444.51|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111332.34|16885.52|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111332.34|99893.61|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111332.34|1450|103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|111332.34||103223.4|506.82||||
MS473|DRG||Cervical Spinal Fusion Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|111332.34|28309.85|103223.4|506.82||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141891.26|62942.15|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141891.26|67609.54|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141891.26|56343.46|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|141891.26|45448.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141891.26|70429.32|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|GEHA [1415]|GEHA [141500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|141891.26|49312.43|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141891.26|56343.46|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|141891.26|100768.1|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141891.26|59103.45|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141891.26|57721.65|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141891.26|2550|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|141891.26|2437.28|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|Self-pay|Self-pay|141891.26|42567.38|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141891.26|52227.76|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141891.26|61624.36|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141891.26|47366.66|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141891.26|20123.12|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141891.26|25833.4|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141891.26|97517.52|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|141891.26|4350|100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|141891.26||100768.1|2437.28||||
MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|141891.26|45448.52|100768.1|2437.28||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101370.58|48099.28|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101370.58|83923.23|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101370.58|16556.98|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|101370.58|24488.75|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101370.58|53820.84|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|GEHA [1415]|GEHA [141500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|101370.58|26622.31|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101370.58|16556.98|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|101370.58|77005.2|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101370.58|31846.35|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101370.58|31101.8|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101370.58|11900|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|101370.58|1364.86|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|Self-pay|Self-pay|101370.58|30411.17|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101370.58|29103.15|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101370.58|25214.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101370.58|25511.57|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101370.58|10384|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101370.58|14636.51|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101370.58|74521.16|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|101370.58|3625|83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|101370.58||83923.23|1364.86||||
MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|101370.58|24488.75|83923.23|1364.86||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86217.28|50083.62|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86217.28|9033.5|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86217.28|12937.35|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86217.28|56041.23|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86217.28|15389.13|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86217.28|9033.5|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86217.28|80182.06|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86217.28|16824.35|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86217.28|16431.01|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|86217.28|2045.68|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|Self-pay|Self-pay|86217.28|25865.18|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86217.28|15792.71|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86217.28|17548.6|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86217.28|13488.47|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86217.28|77595.56|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86217.28|3625|80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86217.28||80182.06|2045.68||||
MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86217.28|12937.35|80182.06|2045.68||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|GEHA [1415]|GEHA [141500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MULTIPLAN [1680]|HMA [168003]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MULTIPLAN [1680]|IHC HS [168011]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|144294.41|42398.07|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|Self-pay|Self-pay|144294.41|43288.32|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|TRUSTMARK [2030]|STARMARK [203000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|UMR [2035]|UMR OPTIONS [203501]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144294.41|22266.24|43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|144294.41||43288.32|22266.24||||
MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|144294.41||43288.32|22266.24||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133512.13|25708.99|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133512.13|73991.79|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133512.13|18121.11|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|133512.13|26296.16|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133512.13|28767.18|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|GEHA [1415]|GEHA [141500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|133512.13|27121.6|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133512.13|18121.11|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|133512.13|41159.2|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133512.13|34196.8|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|133512.13|15725.11|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133512.13|33397.3|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133512.13|10200|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MULTIPLAN [1680]|HMA [168003]|133512.13|466.27|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|Self-pay|Self-pay|133512.13|40053.64|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133512.13|30265.87|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133512.13|35661.57|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133512.13|27410.75|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|UMR [2035]|UMR OPTIONS [203501]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133512.13|9898.85|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133512.13|15700.31|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133512.13|39831.48|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|133512.13|1450|73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|133512.13||73991.79|466.27||||
MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|133512.13|26296.16|73991.79|466.27||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40586.69|23576.8|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40586.69|13979.44|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40586.69|20175.93|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40586.69|26381.35|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|GEHA [1415]|GEHA [141500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40586.69|20809.25|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40586.69|13979.44|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40586.69|37745.63|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40586.69|26237.75|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40586.69|25624.33|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|40586.69|112.7|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|Self-pay|Self-pay|40586.69|12176.01|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40586.69|23885.78|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40586.69|23059.85|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40586.69|21042.16|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40586.69|36528.02|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40586.69|725|37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40586.69||37745.63|112.7||||
MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40586.69|20175.93|37745.63|112.7||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142060.67|59914.29|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142060.67|79933.37|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142060.67|53633.01|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142060.67|33737.67|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142060.67|67041.27|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|GEHA [1415]|GEHA [141500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142060.67|38350.27|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142060.67|53633.01|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142060.67|95920.59|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142060.67|43874.1|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142060.67|42848.35|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142060.67|2550|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MULTIPLAN [1680]|HMA [168003]|142060.67|437.81|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MULTIPLAN [1680]|IHC HS [168011]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|Self-pay|Self-pay|142060.67|42618.2|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142060.67|40829.05|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142060.67|20080.22|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142060.67|81042.57|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142060.67|34041.91|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|TRUSTMARK [2030]|STARMARK [203000]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142060.67|35174.94|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|UMR [2035]|UMR OPTIONS [203501]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142060.67|14914.35|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142060.67|19168.31|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142060.67|92826.36|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142060.67|3625|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142060.67|67535.47|95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142060.67||95920.59|437.81||||
MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142060.67|33737.67|95920.59|437.81||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108748.26|74980.28|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108748.26|69576.32|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108748.26|67119.54|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|108748.26|23371.52|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108748.26|83899.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|GEHA [1415]|GEHA [141500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|108748.26|28389.05|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108748.26|67119.54|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|108748.26|120040.7|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108748.26|30393.45|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108748.26|29682.87|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108748.26|2550|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MULTIPLAN [1680]|HMA [168003]|108748.26|697.62|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|Self-pay|Self-pay|108748.26|32624.48|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108748.26|27717.35|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108748.26|13520.12|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|108748.26|77726.74|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108748.26|31706.4|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108748.26|24370.67|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|UMR [2035]|UMR OPTIONS [203501]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108748.26|11006.16|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108748.26|13978.93|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108748.26|116168.43|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|108748.26|4350|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|108748.26|64772.3|120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|108748.26||120040.7|697.62||||
MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|108748.26|23371.52|120040.7|697.62||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85620|48293.27|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85620|52856.79|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85620|13116.22|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|85620|18350.67|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85620|54037.93|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|GEHA [1415]|GEHA [141500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|85620|21667.33|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85620|13116.22|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|85620|77315.79|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85620|23864.1|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85620|11815.85|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85620|23306.17|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85620|2550|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|85620|285.81|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|Self-pay|Self-pay|85620|25686|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85620|22567.58|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85620|24917.25|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85620|19152.28|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85620|10620.28|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85620|10704.52|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85620|74821.73|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|85620|725|77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|85620||77315.79|285.81||||
MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|85620|18350.67|77315.79|285.81||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|AETNA [1015]|AETNA ACO WILCO [101532]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110170.93|65473.91|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110170.93|49806.61|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110170.93|15879.47|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110170.93|58609.78|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110170.93|26600.56|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110170.93|73262.23|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|CORESOURCE [1315]|CORESOURCE [131500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|GEHA [1415]|GEHA [141500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110170.93|36938.34|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HEALTHNET [1495]|HEALTHNET [149500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110170.93|58609.78|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110170.93|104821.34|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110170.93|34592.65|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110170.93|33783.9|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110170.93|850|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MULTIPLAN [1680]|HMA [168003]|110170.93|227.55|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MULTIPLAN [1680]|IHC HS [168011]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|Self-pay|Self-pay|110170.93|33051.28|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110170.93|32808.98|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110170.93|36106.41|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|TRUSTMARK [2030]|STARMARK [203000]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110170.93|27752.67|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|UMR [2035]|UMR OPTIONS [203501]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110170.93|8868.44|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110170.93|15347.38|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110170.93|101440.02|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110170.93|725|104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110170.93||104821.34|227.55||||
MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110170.93|26600.56|104821.34|227.55||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166849.99|76160.4|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|GEHA [1415]|GEHA [141500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166849.99|5100|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MULTIPLAN [1680]|HMA [168003]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MULTIPLAN [1680]|IHC HS [168011]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|Self-pay|Self-pay|166849.99|50055|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|166849.99|59711.9|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|TRUSTMARK [2030]|STARMARK [203000]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|UMR [2035]|UMR OPTIONS [203501]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166849.99|16667.48|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166849.99|22598.97|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|166849.99|49759.92|76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|166849.99||76160.4|5100||||
MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|166849.99||76160.4|5100||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111300.97|47495.01|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111300.97|68023.88|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111300.97|16679.72|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|111300.97|23965.81|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111300.97|53144.68|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|GEHA [1415]|GEHA [141500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|111300.97|24718.1|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111300.97|16679.72|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|111300.97|76037.76|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111300.97|31166.3|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111300.97|30437.65|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111300.97|2550|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MULTIPLAN [1680]|HMA [168003]|111300.97|319.18|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|Self-pay|Self-pay|111300.97|33390.29|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111300.97|30046.85|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111300.97|27381.74|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111300.97|24985.89|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|UMR [2035]|UMR OPTIONS [203501]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111300.97|11191.7|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111300.97|13864.6|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111300.97|73584.93|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111300.97|2175|76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|111300.97||76037.76|319.18||||
MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|111300.97|23965.81|76037.76|319.18||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57253.61|33249.32|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57253.61|12621.23|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57253.61|18288.23|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57253.61|37204.45|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|GEHA [1415]|GEHA [141500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57253.61|19712.1|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57253.61|12621.23|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|57253.61|53230.97|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57253.61|23782.9|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57253.61|23226.87|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|57253.61|849.8|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|Self-pay|Self-pay|57253.61|17176.08|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57253.61|22436.44|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57253.61|11447.29|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57253.61|19076.69|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57253.61|51513.85|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57253.61|3625|53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57253.61||53230.97|849.8||||
MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57253.61|18288.23|53230.97|849.8||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79299.4|63253.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79299.4|47490.29|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79299.4|56621.81|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79299.4|22029.06|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79299.4|70777.27|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79299.4|49519.08|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79299.4|28178.74|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|GEHA [1415]|GEHA [141500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79299.4|23874.78|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79299.4|56621.81|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79299.4|101265.93|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79299.4|28647.65|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79299.4||101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79299.4|27977.89|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79299.4|2550|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|79299.4|1154.23|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79299.4||101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79299.4|41907.54|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|Self-pay|Self-pay|79299.4|23789.82|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79299.4|26992.68|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79299.4||101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79299.4|29877.1|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79299.4|22964.6|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79299.4|9127.92|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79299.4|12774.64|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79299.4|97999.3|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79299.4|3625|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79299.4||101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79299.4|28178.74|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79299.4|229.12|101265.93|229.12||||
MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79299.4|22029.06|101265.93|229.12||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83150.17|48301.94|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83150.17|32636.5|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83150.17|10647.7|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83150.17|14474.93|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83150.17|54047.61|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|GEHA [1415]|GEHA [141500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83150.17|18556.7|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83150.17|10647.7|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83150.17|77329.66|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83150.17|18823.9|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83150.17|18383.81|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83150.17|850|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|83150.17|328.14|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|Self-pay|Self-pay|83150.17|24945.05|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83150.17|17408.35|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83150.17|16532.58|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83150.17|15098.07|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83150.17|9056.56|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83150.17|8742.6|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83150.17|74835.16|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83150.17|725|77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83150.17||77329.66|328.14||||
MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83150.17|14474.93|77329.66|328.14||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142756.57|82927.31|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142756.57|73949.06|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142756.57|74233.42|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142756.57|38690.5|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142756.57|92791.78|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|GEHA [1415]|GEHA [141500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142756.57|43232.69|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142756.57|74233.42|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142756.57|132763.61|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142756.57|50315|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142756.57|49138.67|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142756.57|4250|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MULTIPLAN [1680]|HMA [168003]|142756.57|1056.69|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MULTIPLAN [1680]|IHC HS [168011]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|Self-pay|Self-pay|142756.57|42826.97|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142756.57|44626.82|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142756.57|212742.49|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142756.57|52476.33|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|TRUSTMARK [2030]|STARMARK [203000]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142756.57|40335.17|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|UMR [2035]|UMR OPTIONS [203501]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142756.57|10455.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142756.57|22995.34|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142756.57|128480.91|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142756.57|4350|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142756.57|177285.41|212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142756.57||212742.49|1056.69||||
MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142756.57|38690.5|212742.49|1056.69||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106361.01|53258.99|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106361.01|51033.15|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106361.01|16435.86|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106361.01|25932.67|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106361.01|59594.32|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106361.01||91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106361.01||91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|GEHA [1415]|GEHA [141500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106361.01|30062.51|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106361.01|16435.86|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106361.01|85265.72|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106361.01|33724.1|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106361.01|14971.5|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106361.01|32935.65|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106361.01|2550|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MULTIPLAN [1680]|HMA [168003]|106361.01|511.89|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106361.01||91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106361.01|76545.44|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|Self-pay|Self-pay|106361.01|31908.3|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106361.01|29792.67|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106361.01|91552.92|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106361.01|79361.61|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106361.01|27042.08|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|UMR [2035]|UMR OPTIONS [203501]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106361.01|7130.4|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106361.01|15486.38|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106361.01|82515.23|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106361.01|725|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106361.01|76294.1|91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106361.01||91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106361.01||91552.92|511.89||||
MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106361.01|25932.67|91552.92|511.89||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103201.75|51636.52|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103201.75|46024.69|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103201.75|12433.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|103201.75|20646.46|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103201.75|57778.84|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|GEHA [1415]|GEHA [141500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|103201.75|26864.38|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103201.75|12433.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|103201.75|82668.16|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103201.75|26849.65|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103201.75|26221.92|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103201.75|1700|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|103201.75|209.39|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|103201.75|49491.81|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|Self-pay|Self-pay|103201.75|30960.52|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103201.75|23743.82|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103201.75|22982.08|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103201.75|21537.6|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103201.75|6172.06|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103201.75|12375.03|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103201.75|80001.45|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|103201.75|1450|82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|103201.75||82668.16|209.39||||
MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|103201.75|20646.46|82668.16|209.39||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166032.99|96448.62|96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|GEHA [1415]|GEHA [141500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166032.99|4250|96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MULTIPLAN [1680]|HMA [168003]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MULTIPLAN [1680]|IHC HS [168011]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|Self-pay|Self-pay|166032.99|49809.9|96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|TRUSTMARK [2030]|STARMARK [203000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|UMR [2035]|UMR OPTIONS [203501]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166032.99|16788.99|96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|166032.99||96448.62|4250||||
MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|166032.99||96448.62|4250||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75406.84|79076.52|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75406.84|54015.68|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75406.84|70786.35|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75406.84|22148.36|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75406.84|88482.95|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|GEHA [1415]|GEHA [141500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75406.84|25130.47|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75406.84|70786.35|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75406.84|126598.67|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75406.84|28802.8|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75406.84|28129.41|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75406.84|3400|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MULTIPLAN [1680]|HMA [168003]|75406.84|307.25|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|Self-pay|Self-pay|75406.84|22622.05|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75406.84|26696.59|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75406.84|30043.54|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75406.84|23092.53|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|UMR [2035]|UMR OPTIONS [203501]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75406.84|11559.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75406.84|13259.01|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75406.84|122514.84|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75406.84|2900|126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75406.84||126598.67|307.25||||
MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75406.84|22148.36|126598.67|307.25||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112661.02|65422.87|65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|GEHA [1415]|GEHA [141500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112661.02|1700|65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|Self-pay|Self-pay|112661.02|33798.31|65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112661.02|7053.82|65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|112661.02||65422.87|1700||||
MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|112661.02||65422.87|1700||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|GEHA [1415]|GEHA [141500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|Self-pay|Self-pay|196203.38|58861.01|58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|196203.38||58861.01|58861.01||||
MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|196203.38||58861.01|58861.01||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|GEHA [1415]|GEHA [141500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|Self-pay|Self-pay|53334.4|16000.32|16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53334.4||16000.32|16000.32||||
MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53334.4||16000.32|16000.32||||
MS500|DRG||Soft Tissue Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|GEHA [1415]|GEHA [141500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|Self-pay|Self-pay|129311.43|38793.43|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|129311.43|51048.38|51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|129311.43||51048.38|38793.43||||
MS500|DRG||Soft Tissue Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|129311.43||51048.38|38793.43||||
MS501|DRG||Soft Tissue Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82682.03|37858.39|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82682.03|37102.32|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82682.03|13302.76|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82682.03|19558.22|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82682.03|42361.78|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|GEHA [1415]|GEHA [141500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82682.03|20947.07|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82682.03|13302.76|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82682.03|60609.92|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82682.03|25434.45|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82682.03|24839.81|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82682.03|850|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|82682.03|774.92|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82682.03|45960.02|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|Self-pay|Self-pay|82682.03|24804.61|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82682.03|22839.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82682.03|14457.34|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82682.03|20294.35|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82682.03|5188.72|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82682.03|12548.33|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82682.03|58654.77|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82682.03|2900|60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82682.03||60609.92|774.92||||
MS501|DRG||Soft Tissue Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82682.03|19558.22|60609.92|774.92||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76400.24|55429.74|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76400.24|42835.37|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76400.24|9364.58|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76400.24|14860.72|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76400.24|62023.25|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76400.24|15327.2|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76400.24|9364.58|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76400.24|88740.97|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76400.24|19325.6|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76400.24|18873.78|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76400.24|2550|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|76400.24|477.23|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|Self-pay|Self-pay|76400.24|22920.07|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76400.24|17085.22|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76400.24|16961.29|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76400.24|15477.2|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76400.24|4264.71|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76400.24|85878.35|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76400.24|4350|88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76400.24||88740.97|477.23||||
MS502|DRG||Soft Tissue Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76400.24|14860.72|88740.97|477.23||||
MS503|DRG||Foot Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147497.42|73847.14|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147497.42|66105.21|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|147497.42|29442.69|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147497.42|82631.52|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|GEHA [1415]|GEHA [141500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|147497.42|32560.93|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147497.42|66105.21|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|147497.42|118226.63|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147497.42|38288.7|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147497.42|37393.54|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|147497.42|2194.03|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|Self-pay|Self-pay|147497.42|44249.23|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147497.42|33631|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147497.42|127125.41|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147497.42|30571.78|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147497.42|17552.3|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147497.42|114412.87|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|147497.42|5800|127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|147497.42||127125.41|2194.03||||
MS503|DRG||Foot Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|147497.42|29442.69|127125.41|2194.03||||
MS504|DRG||Foot Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145879.79|84741.58|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145879.79|75857.49|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|145879.79|19791.25|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145879.79|94821.87|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|GEHA [1415]|GEHA [141500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|145879.79|22988.75|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145879.79|75857.49|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|145879.79|135668.2|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145879.79|25737.5|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145879.79|25135.78|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|145879.79|2576.25|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|Self-pay|Self-pay|145879.79|43763.94|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145879.79|23309.83|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145879.79|26840.37|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145879.79|20630.46|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145879.79|11890.33|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145879.79|131291.82|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|145879.79|9425|135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|145879.79||135668.2|2576.25||||
MS504|DRG||Foot Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|145879.79|19791.25|135668.2|2576.25||||
MS505|DRG||Foot Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|Self-pay|Self-pay|60628.13|18188.44|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60628.13|121868.01|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60628.13|11871.67|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60628.13|101556.68|121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60628.13||121868.01|11871.67||||
MS505|DRG||Foot Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60628.13||121868.01|11871.67||||
MS506|DRG||Major Thumb Or Joint Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43281.61|25142.28|40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|GEHA [1415]|GEHA [141500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43281.61|1700|40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MULTIPLAN [1680]|HMA [168003]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43281.61|40828.08|40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|Self-pay|Self-pay|43281.61|12984.48|40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|UMR [2035]|UMR OPTIONS [203501]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43281.61|8590.67|40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43281.61||40828.08|1700||||
MS506|DRG||Major Thumb Or Joint Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43281.61||40828.08|1700||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89802.02|52176.78|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89802.02|3400|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|Self-pay|Self-pay|89802.02|26940.61|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89802.02|6995.91|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89802.02|13747.92|52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89802.02||52176.78|3400||||
MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89802.02||52176.78|3400||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|Self-pay|Self-pay|63300.5|18990.15|18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63300.5||18990.15|18990.15||||
MS508|DRG||Major Shoulder Or Elbow Joint Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63300.5||18990.15|18990.15||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137597.36|55526.55|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|GEHA [1415]|GEHA [141500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137597.36|2550|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|Self-pay|Self-pay|137597.36|41279.21|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137597.36|8622.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137597.36|18228.88|55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|137597.36||55526.55|2550||||
MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|137597.36||55526.55|2550||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|GEHA [1415]|GEHA [141500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|Self-pay|Self-pay|100934.27|30280.28|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100934.27|13134.31|30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100934.27||30280.28|13134.31||||
MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100934.27||30280.28|13134.31||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75935.24|44058.51|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75935.24|10467.62|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75935.24|17332.68|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75935.24|49299.41|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75935.24|19668.75|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75935.24|10467.62|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75935.24|70536.08|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75935.24|22540.25|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75935.24|22013.27|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|75935.24|342.67|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|Self-pay|Self-pay|75935.24|22780.57|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75935.24|20225.92|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75935.24|17426.37|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75935.24|18098.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75935.24|10131.61|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75935.24|68260.71|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75935.24|725|70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75935.24||70536.08|342.67||||
MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75935.24|17332.68|70536.08|342.67||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116460.83|43150.19|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116460.83|1700|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|Self-pay|Self-pay|116460.83|34938.25|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116460.83|4778.6|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116460.83|11316.72|43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|116460.83||43150.19|1700||||
MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|116460.83||43150.19|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67848.14|39901.29|39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67848.14|1700|39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|Self-pay|Self-pay|67848.14|20354.44|39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67848.14|5019.21|39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67848.14||39901.29|1700||||
MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67848.14||39901.29|1700||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105869.44|79209.58|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105869.44|70905.47|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|105869.44|35017.69|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105869.44|88631.84|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|105869.44|51243.87|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105869.44|70905.47|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|105869.44|126811.7|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105869.44|45538.7|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105869.44|44474.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|105869.44|929.8|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|Self-pay|Self-pay|105869.44|31760.83|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105869.44|39471.64|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105869.44|47465.04|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105869.44|36483.31|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105869.44|20833.59|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105869.44|122721.01|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|105869.44|4350|126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|105869.44||126811.7|929.8||||
MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|105869.44|35017.69|126811.7|929.8||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|92146.62|71290.36|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|Self-pay|Self-pay|92146.62|27643.99|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|92146.62|97716.94|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92146.62|13104.13|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92146.62|81430.78|97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|92146.62||97716.94|13104.13||||
MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|92146.62||97716.94|13104.13||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78853.08|90814.19|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78853.08|850|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|78853.08|23655.92|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|78853.08|48408.48|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78853.08|6624.9|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78853.08|9398.86|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78853.08|40340.4|90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|78853.08||90814.19|850||||
MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|78853.08||90814.19|850||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|AETNA [1015]|AETNA ACO WILCO [101532]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83227.26|48346.72|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83227.26|71865.01|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83227.26|24732.11|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83227.26|39993.94|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83227.26|54097.72|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|CORESOURCE [1315]|CORESOURCE [131500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|GEHA [1415]|GEHA [141500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83227.26|41781.59|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HEALTHNET [1495]|HEALTHNET [149500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83227.26|24732.11|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83227.26|77401.35|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83227.26|52010.05|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83227.26|50794.09|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83227.26|850|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MULTIPLAN [1680]|HMA [168003]|83227.26|532.24|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MULTIPLAN [1680]|IHC HS [168011]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|Self-pay|Self-pay|83227.26|24968.18|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83227.26|39113.36|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83227.26|40936.4|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|TRUSTMARK [2030]|STARMARK [203000]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83227.26|41685.41|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|UMR [2035]|UMR OPTIONS [203501]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83227.26|12960.87|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83227.26|20431.02|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83227.26|74904.53|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83227.26|725|77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83227.26||77401.35|532.24||||
MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83227.26|39993.94|77401.35|532.24||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114213.19|48664.9|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114213.19|13297.91|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|114213.19|21854|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114213.19|54453.75|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|GEHA [1415]|GEHA [141500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|114213.19|22540|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114213.19|13297.91|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|114213.19|77910.74|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114213.19|28420|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114213.19|27755.56|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MULTIPLAN [1680]|HMA [168003]|114213.19|421.41|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|Self-pay|Self-pay|114213.19|34263.96|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114213.19|24387.38|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114213.19|29621.39|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114213.19|22768.05|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|UMR [2035]|UMR OPTIONS [203501]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114213.19|13085.76|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114213.19|75397.5|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|114213.19|1450|77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|114213.19||77910.74|421.41||||
MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|114213.19|21854|77910.74|421.41||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99301.75|65900.76|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|GEHA [1415]|GEHA [141500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99301.75|2550|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|Self-pay|Self-pay|99301.75|29790.52|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|99301.75|104542.54|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99301.75|6284.96|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99301.75|9530.77|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|99301.75|21446.27|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|99301.75|87118.78|104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|99301.75||104542.54|2550||||
MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|99301.75|21446.27|104542.54|2550||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152227.76|68440.3|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152227.76|83860.1|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152227.76|61265.17|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|152227.76|34188.13|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152227.76|76581.47|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|GEHA [1415]|GEHA [141500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|152227.76|38554.1|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152227.76|61265.17|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|152227.76|109570.41|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152227.76|44459.9|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152227.76|43420.46|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152227.76|5100|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MULTIPLAN [1680]|HMA [168003]|152227.76|433.89|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MULTIPLAN [1680]|IHC HS [168011]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|Self-pay|Self-pay|152227.76|45668.33|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152227.76|46669.16|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|TRUSTMARK [2030]|STARMARK [203000]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152227.76|35871.57|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|UMR [2035]|UMR OPTIONS [203501]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152227.76|23543.73|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152227.76|20345.35|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152227.76|106035.88|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|152227.76|3625|109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|152227.76||109570.41|433.89||||
MS521|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|152227.76|34188.13|109570.41|433.89||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117719.4|79976.27|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117719.4|72231.98|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117719.4|14591.22|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117719.4|71591.78|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|117719.4|24411.81|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117719.4|89489.73|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|GEHA [1415]|GEHA [141500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|117719.4|31058.1|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117719.4|71591.78|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|117719.4|128039.14|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117719.4|31746.3|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117719.4|14591.22|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117719.4|31004.09|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117719.4|1700|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MULTIPLAN [1680]|HMA [168003]|117719.4|301.25|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|Self-pay|Self-pay|117719.4|35315.82|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117719.4|14236.28|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|117719.4|91784.6|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117719.4|33122.64|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117719.4|22095.84|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|UMR [2035]|UMR OPTIONS [203501]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117719.4|19983.36|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117719.4|13862.84|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117719.4|123908.85|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|117719.4|2175|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|117719.4|76487.17|128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|117719.4||128039.14|301.25||||
MS522|DRG||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|117719.4|24411.81|128039.14|301.25||||
MS533|DRG||Fractures Of Femur With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|GEHA [1415]|GEHA [141500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MULTIPLAN [1680]|HMA [168003]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MULTIPLAN [1680]|IHC HS [168011]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|Self-pay|Self-pay|27708.21|8312.46|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27708.21|24945.75|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|TRUSTMARK [2030]|STARMARK [203000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|UMR [2035]|UMR OPTIONS [203501]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27708.21|9263.79|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27708.21|20788.13|24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27708.21||24945.75|8312.46||||
MS533|DRG||Fractures Of Femur With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27708.21||24945.75|8312.46||||
MS534|DRG||Fractures Of Femur Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|GEHA [1415]|GEHA [141500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MULTIPLAN [1680]|HMA [168003]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|Self-pay|Self-pay|60343.95|18103.18|18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|UMR [2035]|UMR OPTIONS [203501]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60343.95||18103.18|18103.18||||
MS534|DRG||Fractures Of Femur Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60343.95||18103.18|18103.18||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74793.67|44408.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74793.67|70895.98|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74793.67|10021.08|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74793.67|13745.72|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74793.67|49691.54|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|GEHA [1415]|GEHA [141500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74793.67|14177.2|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74793.67|10021.08|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74793.67|71097.12|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74793.67|17875.6|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74793.67|17457.68|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74793.67|5950|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MULTIPLAN [1680]|HMA [168003]|74793.67|389.03|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|Self-pay|Self-pay|74793.67|22438.1|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74793.67|16991.94|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74793.67|18668.27|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74793.67|14349.09|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|UMR [2035]|UMR OPTIONS [203501]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74793.67|6702.28|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74793.67|8112.96|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74793.67|68803.67|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74793.67|4350|71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74793.67||71097.12|389.03||||
MS535|DRG||Fractures Of Hip And Pelvis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74793.67|13745.72|71097.12|389.03||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35442.96|53207.26|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35442.96|19076.9|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35442.96|5814.81|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35442.96|8604.46|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35442.96|59536.42|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|GEHA [1415]|GEHA [141500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35442.96|10486.12|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35442.96|5814.81|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35442.96|85182.89|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35442.96|11189.65|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35442.96|10928.04|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35442.96|1700|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MULTIPLAN [1680]|HMA [168003]|35442.96|1611.57|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35442.96|22941.53|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|Self-pay|Self-pay|35442.96|10632.89|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35442.96|10200.84|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35442.96|8098.74|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35442.96|8973.71|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|UMR [2035]|UMR OPTIONS [203501]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35442.96|3353.71|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35442.96|5287.38|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35442.96|82435.05|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35442.96|6525|85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35442.96||85182.89|1611.57||||
MS536|DRG||Fractures Of Hip And Pelvis Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35442.96|8604.46|85182.89|1611.57||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|GEHA [1415]|GEHA [141500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|Self-pay|Self-pay|65727.19|19718.16|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65727.19|6361.69|19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65727.19||19718.16|6361.69||||
MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65727.19||19718.16|6361.69||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|GEHA [1415]|GEHA [141500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|Self-pay|Self-pay|17238.01|5171.4|5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17238.01||5171.4|5171.4||||
MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17238.01||5171.4|5171.4||||
MS539|DRG||Osteomyelitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|GEHA [1415]|GEHA [141500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MULTIPLAN [1680]|HMA [168003]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|Self-pay|Self-pay|65392.07|19617.62|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65392.07|12598.93|19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65392.07||19617.62|12598.93||||
MS539|DRG||Osteomyelitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65392.07||19617.62|12598.93||||
MS540|DRG||Osteomyelitis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26590.57|12169.11|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|GEHA [1415]|GEHA [141500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26590.57|850|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MULTIPLAN [1680]|HMA [168003]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|Self-pay|Self-pay|26590.57|7977.17|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26590.57|7650.44|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26590.57|8438.78|12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26590.57||12169.11|850||||
MS540|DRG||Osteomyelitis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26590.57||12169.11|850||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55978.64|5420.94|16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|Self-pay|Self-pay|55978.64|16793.59|16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55978.64||16793.59|5420.94||||
MS541|DRG||Osteomyelitis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55978.64||16793.59|5420.94||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51302.98|25342.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51302.98|32121.35|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51302.98|15723.64|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51302.98|20172.58|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51302.98|28356.65|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|GEHA [1415]|GEHA [141500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51302.98|20805.8|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51302.98|15723.64|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51302.98|40571.81|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51302.98|26233.4|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51302.98|25620.08|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51302.98|3400|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MULTIPLAN [1680]|HMA [168003]|51302.98|246.68|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|Self-pay|Self-pay|51302.98|15390.89|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51302.98|24476.61|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51302.98|27315.47|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51302.98|20995.64|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|UMR [2035]|UMR OPTIONS [203501]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51302.98|9846.51|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51302.98|12096.11|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51302.98|39263.05|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51302.98|2900|40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51302.98||40571.81|246.68||||
MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51302.98|20172.58|40571.81|246.68||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39150.19|116376.87|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|GEHA [1415]|GEHA [141500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39150.19|12750|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MULTIPLAN [1680]|HMA [168003]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|Self-pay|Self-pay|39150.19|11745.06|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39150.19|7340.92|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39150.19|7082.26|116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|39150.19||116376.87|7082.26||||
MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|39150.19||116376.87|7082.26||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|Self-pay|Self-pay|47445.36|14233.61|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47445.36|5326.75|14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47445.36||14233.61|5326.75||||
MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47445.36||14233.61|5326.75||||
MS545|DRG||Connective Tissue Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124736.76|30627.67|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124736.76|20462.86|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124736.76|27909.57|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124736.76|34270.91|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|GEHA [1415]|GEHA [141500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124736.76|28785.65|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124736.76|20462.86|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124736.76|49033.75|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124736.76|36294.95|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124736.76|35446.4|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|124736.76|331.24|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|Self-pay|Self-pay|124736.76|37421.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124736.76|31953.17|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124736.76|37819.21|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124736.76|29069.19|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124736.76|16649.93|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124736.76|47452.03|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124736.76|1450|49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124736.76||49033.75|331.24||||
MS545|DRG||Connective Tissue Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124736.76|27909.57|49033.75|331.24||||
MS546|DRG||Connective Tissue Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50147.79|31840.58|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50147.79|19665|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50147.79|29357.99|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50147.79|38660.19|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50147.79|9456.63|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50147.79|13469.2|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50147.79|32850.21|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50147.79|38660.19|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50147.79|38660.19|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|GEHA [1415]|GEHA [141500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50147.79|14525.73|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50147.79|9456.63|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50147.79|47001.07|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50147.79|17516|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50147.79|38660.19|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50147.79|38660.19|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50147.79|17106.49|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50147.79|32477.39|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|50147.79|633.73|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50147.79|13867.83|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|Self-pay|Self-pay|50147.79|15044.34|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50147.79|15234.34|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50147.79|31840.58|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50147.79|18256.71|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50147.79|14032.76|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50147.79|31840.58|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50147.79|45484.92|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50147.79|3625|47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50147.79||47001.07|633.73||||
MS546|DRG||Connective Tissue Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50147.79|13469.2|47001.07|633.73||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23811.26|9833.79|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23811.26|3135|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23811.26|9639.18|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23811.26|11003.55|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23811.26|9941.75|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23811.26|3135|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23811.26|15743.54|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23811.26|12535.25|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23811.26|12242.18|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|Self-pay|Self-pay|23811.26|7143.38|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23811.26|10930.92|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23811.26|10043.67|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23811.26|5608|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23811.26|15235.69|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23811.26|10997.95|15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23811.26||15743.54|3135||||
MS547|DRG||Connective Tissue Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23811.26|9639.18|15743.54|3135||||
MS548|DRG||Septic Arthritis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|GEHA [1415]|GEHA [141500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MULTIPLAN [1680]|HMA [168003]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|Self-pay|Self-pay|40833.91|12250.17|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|UMR [2035]|UMR OPTIONS [203501]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40833.91|13681.64|13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40833.91||13681.64|12250.17||||
MS548|DRG||Septic Arthritis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40833.91||13681.64|12250.17||||
MS549|DRG||Septic Arthritis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|GEHA [1415]|GEHA [141500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MULTIPLAN [1680]|HMA [168003]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19347|58882.15|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|Self-pay|Self-pay|19347|5804.1|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19347|8438.78|58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19347||58882.15|5804.1||||
MS549|DRG||Septic Arthritis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19347||58882.15|5804.1||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26093.7|63944.93|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26093.7|4054.08|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26093.7|5950|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|Self-pay|Self-pay|26093.7|7828.11|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26093.7|5138.57|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26093.7|5892.24|63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26093.7||63944.93|4054.08||||
MS550|DRG||Septic Arthritis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26093.7||63944.93|4054.08||||
MS551|DRG||Medical Back Problems With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102740.89|21682.64|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102740.89|36578.7|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102740.89|12561.47|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102740.89|18145.51|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102740.89|24261.84|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102740.89||39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102740.89||39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|GEHA [1415]|GEHA [141500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102740.89|18715.1|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102740.89|12561.47|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102740.89|34713.09|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102740.89|12419.63|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102740.89||39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102740.89|23045.61|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102740.89|5950|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MULTIPLAN [1680]|HMA [168003]|102740.89|221.62|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MULTIPLAN [1680]|IHC HS [168011]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102740.89|39162.45|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102740.89||39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|Self-pay|Self-pay|102740.89|30822.27|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102740.89|21000.62|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102740.89|0|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102740.89|3391.26|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|TRUSTMARK [2030]|STARMARK [203000]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102740.89|18876.65|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|UMR [2035]|UMR OPTIONS [203501]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102740.89|5255.5|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102740.89|10923.16|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102740.89|33593.32|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102740.89|725|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102740.89|0|39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102740.89||39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102740.89||39162.45|221.62||||
MS551|DRG||Medical Back Problems With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102740.89|18145.51|39162.45|221.62||||
MS552|DRG||Medical Back Problems Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85853.64|27962.48|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85853.64|13505.47|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85853.64|49860.58|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85853.64|49654.3|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85853.64|24219.08|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85853.64|7023.64|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85853.64|36736.66|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85853.64|24218.21|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85853.64|24218.21|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|85853.64||52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|85853.64||52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|GEHA [1415]|GEHA [141500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|85853.64|10849.1|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85853.64|7023.64|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|85853.64|52561.68|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85853.64|13679.3|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85853.64|24218.21|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|85853.64||52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85853.64|24218.21|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85853.64|13359.49|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85853.64|10200|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85853.64|28540.65|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MULTIPLAN [1680]|HMA [168003]|85853.64|30.8|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|85853.64|16383.22|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|85853.64||52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|Self-pay|Self-pay|85853.64|25756.09|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85853.64|12084.18|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85853.64|27983.09|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|85853.64|20994.02|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85853.64|10518.91|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85853.64|10955.46|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|UMR [2035]|UMR OPTIONS [203501]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85853.64|16224|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85853.64|27981.03|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85853.64|50866.14|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|85853.64|2175|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|85853.64|21868.77|52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|85853.64||52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|85853.64||52561.68|30.8||||
MS552|DRG||Medical Back Problems Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|85853.64|10518.91|52561.68|30.8||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|GEHA [1415]|GEHA [141500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MULTIPLAN [1680]|HMA [168003]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MULTIPLAN [1680]|IHC HS [168011]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|Self-pay|Self-pay|55956.26|16786.88|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|TRUSTMARK [2030]|STARMARK [203000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|UMR [2035]|UMR OPTIONS [203501]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55956.26|8567.37|16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55956.26||16786.88|8567.37||||
MS553|DRG||Bone Diseases And Arthropathies With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55956.26||16786.88|8567.37||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87748.59|20412.32|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87748.59|50950.92|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87748.59|5873.76|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87748.59|8836.38|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87748.59|22840.43|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87748.59||50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87748.59||50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|GEHA [1415]|GEHA [141500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87748.59|9113.75|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87748.59|5873.76|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87748.59|32679.39|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87748.59|11491.25|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87748.59||50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87748.59|11222.59|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87748.59|1700|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MULTIPLAN [1680]|HMA [168003]|87748.59|109.73|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87748.59|22941.53|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87748.59||50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|Self-pay|Self-pay|87748.59|26324.58|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87748.59|10161.63|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87748.59|16490.53|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87748.59|11959.31|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87748.59|9192.35|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|UMR [2035]|UMR OPTIONS [203501]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87748.59|14708.23|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87748.59|5423.87|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87748.59|31625.21|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87748.59|1450|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87748.59|17177.64|50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87748.59||50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87748.59||50950.92|109.73||||
MS554|DRG||Bone Diseases And Arthropathies Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87748.59|8836.38|50950.92|109.73||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70690.64|14101.36|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70690.64|10203.57|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|70690.64|15258.78|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70690.64|15778.75|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|GEHA [1415]|GEHA [141500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|70690.64|15737.75|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70690.64|10203.57|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|70690.64|22575.75|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70690.64|19843.25|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70690.64|19379.33|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MULTIPLAN [1680]|HMA [168003]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MULTIPLAN [1680]|IHC HS [168011]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|Self-pay|Self-pay|70690.64|21207.19|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70690.64|17196.09|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70690.64|18806.64|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|TRUSTMARK [2030]|STARMARK [203000]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70690.64|15849.36|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|UMR [2035]|UMR OPTIONS [203501]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70690.64|10868.6|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70690.64|21847.5|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|70690.64|725|22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|70690.64||22575.75|725||||
MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|70690.64|15258.78|22575.75|725||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28801.1|21640.86|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28801.1|16730.56|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28801.1|5800.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28801.1|9017.01|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28801.1|24215.12|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|GEHA [1415]|GEHA [141500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28801.1|9300.05|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28801.1|5800.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28801.1|34646.25|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28801.1|11726.15|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28801.1|11452|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28801.1|850|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MULTIPLAN [1680]|HMA [168003]|28801.1|185.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28801.1|15762.76|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|Self-pay|Self-pay|28801.1|8640.33|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28801.1|10532.08|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28801.1|10305.85|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28801.1|9377.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|UMR [2035]|UMR OPTIONS [203501]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28801.1|2798.15|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28801.1|6154.27|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28801.1|33528.63|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28801.1|1450|34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28801.1||34646.25|185.85||||
MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28801.1|9017.01|34646.25|185.85||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68530.79|29402.47|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68530.79|39809.53|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68530.79|52337.27|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68530.79|15599.97|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68530.79|65421.59|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|GEHA [1415]|GEHA [141500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68530.79|17075.25|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68530.79|52337.27|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68530.79|93603.2|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68530.79|20286.95|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68530.79|19812.66|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68530.79|3400|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MULTIPLAN [1680]|HMA [168003]|68530.79|985.6|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68530.79|67119.48|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|Self-pay|Self-pay|68530.79|20559.24|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68530.79|19512.06|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68530.79|21090.7|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68530.79|16211.06|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68530.79|7949.64|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68530.79|4194.42|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68530.79|90583.74|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68530.79|5075|93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68530.79||93603.2|985.6||||
MS557|DRG||Tendonitis, Myositis And Bursitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68530.79|15599.97|93603.2|985.6||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33552|23739.27|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33552|13566.37|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33552|6881.52|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|33552|9604.61|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33552|26563.13|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|GEHA [1415]|GEHA [141500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|33552|11454.59|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33552|6881.52|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|33552|38005.7|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33552|12490.3|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33552|12198.29|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33552|850|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MULTIPLAN [1680]|HMA [168003]|33552|1548.49|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|33552|23009.18|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|33552|12282.63|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|Self-pay|Self-pay|33552|10065.6|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33552|11581.23|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33552|12986.69|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33552|9982.03|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|UMR [2035]|UMR OPTIONS [203501]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33552|3057.1|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33552|5782.44|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33552|36779.71|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|33552|2900|38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|33552||38005.7|850||||
MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|33552|9604.61|38005.7|850||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102543.91|25918.19|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102543.91|13455|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102543.91|28529.81|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102543.91|39566.46|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102543.91|24496.46|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102543.91|8118.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102543.91|5631.4|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102543.91|11400|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102543.91|6838.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102543.91|52548.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102543.91|24496.46|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102543.91|24496.46|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102543.91||75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102543.91||75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|GEHA [1415]|GEHA [141500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102543.91|21450.95|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102543.91|11400|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102543.91|75184.92|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102543.91|27046.85|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102543.91|24496.46|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102543.91||75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102543.91|24496.46|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102543.91|9570|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102543.91|5100|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102543.91|26436.55|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MULTIPLAN [1680]|HMA [168003]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MULTIPLAN [1680]|IHC HS [168011]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102543.91|26609.61|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102543.91||75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|Self-pay|Self-pay|102543.91|30763.17|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102543.91|22731.18|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102543.91|25918.19|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102543.91|24615.31|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102543.91|20798.1|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|TRUSTMARK [2030]|STARMARK [203000]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102543.91|21723.68|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|UMR [2035]|UMR OPTIONS [203501]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102543.91|8112|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102543.91|25918.19|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102543.91|72759.6|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102543.91|7250|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102543.91|25640.95|75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102543.91||75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102543.91||75184.92|5100||||
MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102543.91|20798.1|75184.92|5100||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91391.85|25075.45|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|91391.85|11365.34|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91391.85|22208.96|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91391.85|14490|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91391.85|50944.15|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91391.85|50786.56|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91391.85|23979.23|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91391.85|9741.72|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91391.85|30083.95|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91391.85|13680|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91391.85|8205.72|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91391.85|11997.4|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91391.85|55711|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91391.85|23979.23|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91391.85|23979.23|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91391.85||79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91391.85||79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|GEHA [1415]|GEHA [141500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91391.85|12374|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91391.85|13680|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91391.85|79709.58|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91391.85|15602|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91391.85|23979.23|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91391.85||79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91391.85|24429.86|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91391.85|23979.23|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91391.85|11484|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91391.85|9350|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91391.85|29982.1|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91391.85|25576.96|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MULTIPLAN [1680]|HMA [168003]|91391.85|39151.82|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91391.85|25075.45|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91391.85|57065.27|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91391.85|24429.86|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|Self-pay|Self-pay|91391.85|27417.55|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91391.85|14563.74|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91391.85|25075.45|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91391.85|23212.7|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91391.85|36200.61|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91391.85|12518.53|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|UMR [2035]|UMR OPTIONS [203501]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91391.85|14872|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91391.85|25075.45|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91391.85|77138.31|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91391.85|8700|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91391.85|24179.9|79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91391.85||79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91391.85||79709.58|8205.72||||
MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91391.85|11997.4|79709.58|8205.72||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79650.09|23359.04|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79650.09|13455|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79650.09|38561.97|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79650.09|38805.04|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79650.09|21302.17|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79650.09|6194.54|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79650.09|12540|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79650.09|7521.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79650.09|8835.26|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79650.09|48655.15|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79650.09|21302.17|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79650.09|21302.17|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79650.09||69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79650.09||69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|GEHA [1415]|GEHA [141500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79650.09|9112.6|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79650.09|12540|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79650.09|69614.3|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79650.09|11489.8|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79650.09|21302.17|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79650.09|18592.17|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79650.09|21302.17|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79650.09|10527|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79650.09|9350|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79650.09|23826.22|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|79650.09|157.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79650.09|20498.35|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79650.09|63482.18|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|Self-pay|Self-pay|79650.09|23895.03|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79650.09|10290.07|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79650.09|23359.04|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79650.09|19813.87|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79650.09|8929.91|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79650.09|9200.49|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79650.09|14872|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79650.09|23359.04|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79650.09|67368.67|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79650.09|7975|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79650.09|20639.45|69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79650.09||69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79650.09||69614.3|157.67||||
MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79650.09|8835.26|69614.3|157.67||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|GEHA [1415]|GEHA [141500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MULTIPLAN [1680]|HMA [168003]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MULTIPLAN [1680]|IHC HS [168011]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|Self-pay|Self-pay|45414.65|13624.39|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|TRUSTMARK [2030]|STARMARK [203000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|UMR [2035]|UMR OPTIONS [203501]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45414.65|9488.12|13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|45414.65||13624.39|9488.12||||
MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|45414.65||13624.39|9488.12||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43542.81|18721.17|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43542.81|26661.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43542.81|6262.97|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43542.81|9725.03|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43542.81|20948.08|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|GEHA [1415]|GEHA [141500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43542.81|10577.29|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43542.81|6262.97|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43542.81|29971.87|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43542.81|12646.9|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43542.81|12351.22|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43542.81|2550|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MULTIPLAN [1680]|HMA [168003]|43542.81|787.79|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|Self-pay|Self-pay|43542.81|13062.84|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43542.81|11133.72|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43542.81|10837.16|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43542.81|10127.4|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|UMR [2035]|UMR OPTIONS [203501]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43542.81|3169.83|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43542.81|5946.93|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43542.81|29005.04|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43542.81|725|29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43542.81||29971.87|725||||
MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43542.81|9725.03|29971.87|725||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68203.18|36439.71|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68203.18|2550|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|Self-pay|Self-pay|68203.18|20460.95|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68203.18|6054.85|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68203.18|10221.83|36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68203.18||36439.71|2550||||
MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68203.18||36439.71|2550||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32401.34|42542.15|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32401.34|7077.06|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32401.34|7588.89|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32401.34|11253.7|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32401.34|47602.7|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32401.34|11606.95|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32401.34|7588.89|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32401.34|68108.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32401.34|14634.85|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32401.34|0|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32401.34|14292.7|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32401.34|850|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|32401.34|470.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32401.34|18777.35|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|Self-pay|Self-pay|32401.34|9720.4|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32401.34|12880.5|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32401.34|12825.47|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32401.34|11703.27|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32401.34|4302.15|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32401.34|6846.66|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32401.34|65911.42|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32401.34|5075|68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32401.34||68108.47|470.47||||
MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32401.34|11253.7|68108.47|470.47||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|Self-pay|Self-pay|19055.63|5716.69|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19055.63|5095.33|5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19055.63||5716.69|5095.33||||
MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19055.63||5716.69|5095.33||||
MS570|DRG||Skin Debridement With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142333.06|50052.01|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142333.06|19341.24|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142333.06|31684.96|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142333.06|56005.85|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|GEHA [1415]|GEHA [141500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142333.06|33273.4|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142333.06|19341.24|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142333.06|80131.44|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142333.06|4337.33|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142333.06|40241.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MULTIPLAN [1680]|HMA [168003]|142333.06|593.85|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MULTIPLAN [1680]|IHC HS [168011]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|Self-pay|Self-pay|142333.06|42699.92|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142333.06|35081.7|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142333.06|5432.31|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|TRUSTMARK [2030]|STARMARK [203000]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142333.06|32986.17|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|UMR [2035]|UMR OPTIONS [203501]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142333.06|22364.53|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142333.06|77546.56|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142333.06|725|80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142333.06||80131.44|593.85||||
MS570|DRG||Skin Debridement With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142333.06|31684.96|80131.44|593.85||||
MS571|DRG||Skin Debridement With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92770.93|90874.81|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92770.93|44329.52|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92770.93|81347.72|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|92770.93|18234.71|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92770.93|101684.66|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|GEHA [1415]|GEHA [141500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|92770.93|21153.89|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92770.93|81347.72|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|92770.93|145487.28|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92770.93|23713.3|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92770.93|23158.9|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92770.93|3400|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MULTIPLAN [1680]|HMA [168003]|92770.93|2346.79|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|Self-pay|Self-pay|92770.93|27831.28|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92770.93|22020.02|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92770.93|24705.42|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92770.93|18989.46|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|UMR [2035]|UMR OPTIONS [203501]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92770.93|9230.87|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92770.93|10462.39|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92770.93|140794.14|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|92770.93|9425|145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|92770.93||145487.28|2346.79||||
MS571|DRG||Skin Debridement With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|92770.93|18234.71|145487.28|2346.79||||
MS572|DRG||Skin Debridement Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70319.96|40848.88|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70319.96|33237.1|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70319.96|8009.59|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|70319.96|12314.06|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70319.96|45707.98|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|GEHA [1415]|GEHA [141500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|70319.96|12700.6|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70319.96|8009.59|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|70319.96|65397.56|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70319.96|16013.8|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70319.96|15639.41|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70319.96|1700|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|70319.96|323.4|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|Self-pay|Self-pay|70319.96|21095.99|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70319.96|15894.11|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70319.96|12869.68|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70319.96|12823.24|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70319.96|5937.05|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70319.96|63287.97|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|70319.96|725|65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|70319.96||65397.56|323.4||||
MS572|DRG||Skin Debridement Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|70319.96|12314.06|65397.56|323.4||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137717.57|80000.13|80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|GEHA [1415]|GEHA [141500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137717.57|6800|80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MULTIPLAN [1680]|HMA [168003]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|Self-pay|Self-pay|137717.57|41315.27|80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137717.57|25563.38|80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|137717.57||80000.13|6800||||
MS573|DRG||Skin Graft For Skin Ulcer Or Cellulitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|137717.57||80000.13|6800||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95033.02|81924.14|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95033.02|73335.45|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95033.02|36198.48|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95033.02|91669.33|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|GEHA [1415]|GEHA [141500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95033.02|38049.19|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95033.02|73335.45|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95033.02|131157.63|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95033.02|47074.25|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95033.02|45973.69|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MULTIPLAN [1680]|HMA [168003]|95033.02|714.44|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|Self-pay|Self-pay|95033.02|28509.91|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95033.02|40011.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95033.02|49149.09|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95033.02|37756.8|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95033.02|21528.59|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95033.02|126926.75|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95033.02|4350|131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95033.02||131157.63|714.44||||
MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95033.02|36198.48|131157.63|714.44||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|GEHA [1415]|GEHA [141500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MULTIPLAN [1680]|HMA [168003]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|Self-pay|Self-pay|279926.81|83978.04|83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279926.81||83978.04|83978.04||||
MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279926.81||83978.04|83978.04||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83549.4|48533.85|48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|GEHA [1415]|GEHA [141500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83549.4|5950|48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MULTIPLAN [1680]|HMA [168003]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|Self-pay|Self-pay|83549.4|25064.82|48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83549.4|14530.83|48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83549.4||48533.85|5950||||
MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83549.4||48533.85|5950||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139802.37|81211.19|81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139802.37|9350|81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|Self-pay|Self-pay|139802.37|41940.71|81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139802.37|10250.94|81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|139802.37||81211.19|9350||||
MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|139802.37||81211.19|9350||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86506.14|12740.83|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86506.14|46578.94|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86506.14|16449.67|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86506.14|14256.38|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|GEHA [1415]|GEHA [141500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86506.14|20397.59|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86506.14|3400|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|86506.14|450.36|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|Self-pay|Self-pay|86506.14|25951.84|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86506.14|44299.69|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86506.14|21932.89|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86506.14|9898.17|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86506.14|20861.82|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86506.14|19739.61|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86506.14|725|46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86506.14||46578.94|450.36||||
MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86506.14|16449.67|46578.94|450.36||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81461.01|63335.86|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81461.01|28129.41|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81461.01|56695.9|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|81461.01|19276.12|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81461.01|70869.89|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|GEHA [1415]|GEHA [141500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|81461.01|21612.08|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81461.01|56695.9|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|81461.01|101398.44|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81461.01|25067.6|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81461.01|24481.54|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81461.01|1700|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|81461.01|1730.88|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|Self-pay|Self-pay|81461.01|24438.3|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81461.01|21034.42|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81461.01|24213.68|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81461.01|18644.05|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81461.01|6051.27|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81461.01|11568.48|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81461.01|98127.52|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|81461.01|4350|101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|81461.01||101398.44|1700||||
MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|81461.01|19276.12|101398.44|1700||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58899.58|24467.72|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58899.58|18964|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58899.58|9155.44|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58899.58|15351.32|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58899.58|27378.26|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58899.58|15833.2|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58899.58|9155.44|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58899.58|39171.96|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58899.58|19963.6|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58899.58|9272.91|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58899.58|19496.86|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58899.58|2550|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|58899.58|282.39|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58899.58|35773.59|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|Self-pay|Self-pay|58899.58|17669.87|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58899.58|16548.48|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58899.58|18945.16|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58899.58|14652.64|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58899.58|4489.11|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58899.58|9258.43|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58899.58|37908.36|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58899.58|725|39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58899.58||39171.96|282.39||||
MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58899.58|15351.32|39171.96|282.39||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|GEHA [1415]|GEHA [141500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|Self-pay|Self-pay|370337.26|111101.18|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370337.26|251829.33|251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|370337.26||251829.33|111101.18||||
MS582|DRG||Mastectomy For Malignancy With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|370337.26||251829.33|111101.18||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|Self-pay|Self-pay|108434.29|32530.29|32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|108434.29||32530.29|32530.29||||
MS583|DRG||Mastectomy For Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|108434.29||32530.29|32530.29||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50548.61|29363.69|29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50548.61|850|29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|Self-pay|Self-pay|50548.61|15164.58|29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50548.61|6105.18|29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50548.61||29363.69|850||||
MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50548.61||29363.69|850||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230893.81|134126.21|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230893.81|178069.51|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230893.81|120064.78|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|230893.81|19396.54|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230893.81|150080.98|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|230893.81|23206.71|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230893.81|120064.78|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|230893.81|214731.25|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230893.81|25224.2|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230893.81|24634.48|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230893.81|3400|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|230893.81|541.31|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|Self-pay|Self-pay|230893.81|69268.14|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230893.81|21526.54|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230893.81|26275.99|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230893.81|20262.95|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230893.81|208447.71|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230893.81|207804.43|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|230893.81|2900|214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|230893.81||214731.25|541.31||||
MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|230893.81|19396.54|214731.25|541.31||||
MS592|DRG||Skin Ulcers With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|GEHA [1415]|GEHA [141500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MULTIPLAN [1680]|HMA [168003]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MULTIPLAN [1680]|IHC HS [168011]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|Self-pay|Self-pay|144099.81|43229.94|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|TRUSTMARK [2030]|STARMARK [203000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|UMR [2035]|UMR OPTIONS [203501]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144099.81|11008.86|43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|144099.81||43229.94|11008.86||||
MS592|DRG||Skin Ulcers With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|144099.81||43229.94|11008.86||||
MS593|DRG||Skin Ulcers With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34871.26|14731.62|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|GEHA [1415]|GEHA [141500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34871.26|1700|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MULTIPLAN [1680]|HMA [168003]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|Self-pay|Self-pay|34871.26|10461.38|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|UMR [2035]|UMR OPTIONS [203501]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34871.26|3817.48|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34871.26|7534.4|14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34871.26||14731.62|1700||||
MS593|DRG||Skin Ulcers With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34871.26||14731.62|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19809.15|11507.13|11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|GEHA [1415]|GEHA [141500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19809.15|1700|11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|Self-pay|Self-pay|19809.15|5942.74|11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19809.15|2515.46|11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19809.15||11507.13|1700||||
MS594|DRG||Skin Ulcers Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19809.15||11507.13|1700||||
MS595|DRG||Major Skin Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|GEHA [1415]|GEHA [141500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|Self-pay|Self-pay|192933.68|57880.1|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192933.68|13456.55|57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192933.68||57880.1|13456.55||||
MS595|DRG||Major Skin Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192933.68||57880.1|13456.55||||
MS596|DRG||Major Skin Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27693.89|16087.4|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27693.89|22696.46|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27693.89|7693.05|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27693.89|11090.91|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27693.89|18001.02|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|GEHA [1415]|GEHA [141500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27693.89|12039.84|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27693.89|7693.05|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27693.89|25755.32|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27693.89|14423.15|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27693.89|14085.95|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27693.89|850|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|27693.89|600.79|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|Self-pay|Self-pay|27693.89|8308.17|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27693.89|13237.43|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27693.89|14967.3|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27693.89|11504.4|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27693.89|4869.15|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27693.89|24924.5|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27693.89|1450|25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27693.89||25755.32|600.79||||
MS596|DRG||Major Skin Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27693.89|11090.91|25755.32|600.79||||
MS597|DRG||Malignant Breast Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|GEHA [1415]|GEHA [141500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|Self-pay|Self-pay|96876.17|29062.85|29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96876.17||29062.85|29062.85||||
MS597|DRG||Malignant Breast Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96876.17||29062.85|29062.85||||
MS598|DRG||Malignant Breast Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65470.31|21468.99|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|GEHA [1415]|GEHA [141500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65470.31|2550|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|Self-pay|Self-pay|65470.31|19641.09|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65470.31|3159.21|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65470.31|7360.59|21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65470.31||21468.99|2550||||
MS598|DRG||Malignant Breast Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65470.31||21468.99|2550||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19533.81|11347.18|11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|GEHA [1415]|GEHA [141500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19533.81|1700|11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|Self-pay|Self-pay|19533.81|5860.14|11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19533.81|4233.78|11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|19533.81||11347.18|1700||||
MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|19533.81||11347.18|1700||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|Self-pay|Self-pay|32485.69|9745.71|9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32485.69||9745.71|9745.71||||
MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32485.69||9745.71|9745.71||||
MS602|DRG||Cellulitis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50642|33225.58|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50642|28266.29|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50642|11754.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50642|16167.5|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50642|37177.87|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|GEHA [1415]|GEHA [141500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50642|17951.71|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50642|11754.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50642|53192.96|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50642|21025|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50642|20533.45|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50642|2550|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MULTIPLAN [1680]|HMA [168003]|50642|1276.71|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|Self-pay|Self-pay|50642|15192.6|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50642|19555.33|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50642|21736.78|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50642|16707.66|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|UMR [2035]|UMR OPTIONS [203501]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50642|7270.22|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50642|9738.82|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50642|51477.06|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50642|2900|53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50642||53192.96|1276.71||||
MS602|DRG||Cellulitis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50642|16167.5|53192.96|1276.71||||
MS603|DRG||Cellulitis Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33763.11|18083.31|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33763.11|17413.28|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33763.11|6820.95|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|33763.11|9517.64|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33763.11|20234.37|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|33763.11||28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|33763.11||28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|GEHA [1415]|GEHA [141500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|33763.11|9816.4|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33763.11|6820.95|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|33763.11|28950.73|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33763.11|12377.2|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|33763.11||28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33763.11|12087.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33763.11|850|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MULTIPLAN [1680]|HMA [168003]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|33763.11||28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|33763.11|18291.66|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|Self-pay|Self-pay|33763.11|10128.93|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33763.11|11496.06|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|33763.11|21504.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33763.11|12782.42|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33763.11|9825.02|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|UMR [2035]|UMR OPTIONS [203501]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33763.11|3786.17|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33763.11|5824.86|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33763.11|28016.83|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|33763.11|1450|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33763.11|17981.68|28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|33763.11||28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|33763.11||28950.73|850||||
MS603|DRG||Cellulitis Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|33763.11|9517.64|28950.73|850||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118075.1|92497.13|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118075.1|82799.96|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118075.1|16478.59|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118075.1|103499.95|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|GEHA [1415]|GEHA [141500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118075.1|18759.69|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118075.1|82799.96|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118075.1|148084.54|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118075.1|21429.55|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118075.1|20928.54|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MULTIPLAN [1680]|HMA [168003]|118075.1|1763.84|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MULTIPLAN [1680]|IHC HS [168011]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|Self-pay|Self-pay|118075.1|35422.53|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118075.1|18813.08|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118075.1|22564.43|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|TRUSTMARK [2030]|STARMARK [203000]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118075.1|17343.82|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|UMR [2035]|UMR OPTIONS [203501]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118075.1|9921.9|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118075.1|143307.63|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118075.1|3625|148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118075.1||148084.54|1763.84||||
MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118075.1|16478.59|148084.54|1763.84||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34486.34|16087.95|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34486.34|20033.12|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34486.34|6188.68|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34486.34|10078.49|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34486.34|18001.65|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|GEHA [1415]|GEHA [141500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34486.34|10394.85|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34486.34|6188.68|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34486.34|25756.2|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34486.34|13106.55|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34486.34|12800.13|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34486.34|1700|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MULTIPLAN [1680]|HMA [168003]|34486.34|139.56|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|Self-pay|Self-pay|34486.34|10345.9|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34486.34|11436.57|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34486.34|6345.11|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34486.34|10574|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|UMR [2035]|UMR OPTIONS [203501]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34486.34|2957.12|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34486.34|6837.79|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34486.34|24925.36|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34486.34|2900|25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34486.34||25756.2|139.56||||
MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34486.34|10078.49|25756.2|139.56||||
MS606|DRG||Minor Skin Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|GEHA [1415]|GEHA [141500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|Self-pay|Self-pay|35631.33|10689.4|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35631.33|10162.24|10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35631.33||10689.4|10162.24||||
MS606|DRG||Minor Skin Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35631.33||10689.4|10162.24||||
MS607|DRG||Minor Skin Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46667.31|48526.16|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46667.31|12169.29|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46667.31|5891.52|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46667.31|9234.43|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46667.31|54298.5|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|GEHA [1415]|GEHA [141500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46667.31|11344.49|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46667.31|5891.52|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46667.31|77688.63|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46667.31|12008.9|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46667.31|11728.14|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46667.31|850|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|46667.31|1820.19|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46667.31|36055.45|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|Self-pay|Self-pay|46667.31|14000.19|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46667.31|10679.45|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46667.31|12491.91|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46667.31|9601.73|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46667.31|2706.88|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46667.31|5574.1|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46667.31|75182.55|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46667.31|5075|77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46667.31||77688.63|850||||
MS607|DRG||Minor Skin Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46667.31|9234.43|77688.63|850||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134927.42|90848.77|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134927.42|77415.81|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134927.42|81324.42|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|134927.42|26645.16|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134927.42|101655.52|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|134927.42|28036.64|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134927.42|81324.42|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|134927.42|145445.59|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134927.42|34650.65|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134927.42|33840.54|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134927.42|1700|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|134927.42|555.09|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|Self-pay|Self-pay|134927.42|40478.23|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134927.42|31758.48|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134927.42|36113.98|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134927.42|27758.48|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134927.42|10385.09|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134927.42|140753.79|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|134927.42|2900|145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|134927.42||145445.59|555.09||||
MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|134927.42|26645.16|145445.59|555.09||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76730|44456.29|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76730|11501.22|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76730|17561.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76730|49744.51|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76730|18735.06|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76730|11501.22|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76730|71172.9|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76730|22837.5|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76730|22303.58|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|76730|622.56|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|Self-pay|Self-pay|76730|23019|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76730|19940.65|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76730|23817.25|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76730|18306.78|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76730|10559.15|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76730|68877|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76730|725|71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76730||71172.9|622.56||||
MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76730|17561.25|71172.9|622.56||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122846.4|68873.29|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|GEHA [1415]|GEHA [141500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122846.4|6800|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|122846.4|88160.75|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|Self-pay|Self-pay|122846.4|36853.92|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122846.4|21127.18|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122846.4|25264.95|88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|122846.4||88160.75|6800||||
MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|122846.4||88160.75|6800||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109922.75|64345.77|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109922.75|63854.12|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109922.75|57599.95|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|109922.75|22632.27|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109922.75|71999.93|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|GEHA [1415]|GEHA [141500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|109922.75|26019.04|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109922.75|57599.95|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|109922.75|103015.29|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109922.75|29432.1|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109922.75|28744|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109922.75|5950|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|109922.75|2676.34|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|109922.75|49227.93|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|Self-pay|Self-pay|109922.75|32976.82|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109922.75|28364.96|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109922.75|23332.09|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109922.75|23656.58|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109922.75|10591.61|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109922.75|13543.83|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109922.75|99692.22|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|109922.75|4350|103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|109922.75||103015.29|2676.34||||
MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|109922.75|22632.27|103015.29|2676.34||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124931.48|72572.7|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124931.48|64964.37|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124931.48|34137.96|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124931.48|81205.46|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|GEHA [1415]|GEHA [141500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124931.48|36692.66|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124931.48|64964.37|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124931.48|116186.29|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124931.48|44394.65|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124931.48|43356.73|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MULTIPLAN [1680]|HMA [168003]|124931.48|785.91|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MULTIPLAN [1680]|IHC HS [168011]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|Self-pay|Self-pay|124931.48|37479.44|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124931.48|42140.49|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124931.48|124931.48|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|TRUSTMARK [2030]|STARMARK [203000]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124931.48|35600.59|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|UMR [2035]|UMR OPTIONS [203501]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124931.48|112438.32|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124931.48|2175|124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124931.48||124931.48|785.91||||
MS619|DRG||O.R. Procedures For Obesity With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124931.48|34137.96|124931.48|785.91||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79585.16|47218.57|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79585.16|48282.16|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79585.16|14914.53|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79585.16|19654.11|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79585.16|52835.38|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|GEHA [1415]|GEHA [141500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79585.16|20999.51|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79585.16|14914.53|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79585.16|75595.23|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79585.16|25559.15|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79585.16|24961.59|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79585.16|850|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MULTIPLAN [1680]|HMA [168003]|79585.16|728.46|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|Self-pay|Self-pay|79585.16|23875.55|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79585.16|24814.61|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79585.16|26646.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79585.16|20481.59|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|UMR [2035]|UMR OPTIONS [203501]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79585.16|9392.15|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79585.16|11438.05|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79585.16|73156.69|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79585.16|1450|75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79585.16||75595.23|728.46||||
MS620|DRG||O.R. Procedures For Obesity With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79585.16|19654.11|75595.23|728.46||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77845.66|45011.14|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77845.66|46965.57|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77845.66|12462.96|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|77845.66|20346.41|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|77845.66|17807.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77845.66|50365.37|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|77845.66||72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|77845.66||72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|GEHA [1415]|GEHA [141500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|77845.66|18923.48|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77845.66|12462.96|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|77845.66|72061.24|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77845.66|23157.95|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|77845.66||72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77845.66|22616.53|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77845.66|850|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|77845.66|556.83|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|77845.66||72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|77845.66|41060.5|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77845.66|24154.67|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|Self-pay|Self-pay|77845.66|23353.7|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77845.66|21396.75|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|77845.66|56133.11|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77845.66|17886.16|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77845.66|18566.13|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77845.66|7960|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77845.66|10398.93|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77845.66|69736.69|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|77845.66|725|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77845.66|46777.59|72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|77845.66||72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|77845.66||72061.24|556.83||||
MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|77845.66|17807.67|72061.24|556.83||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130917.54|109729|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|GEHA [1415]|GEHA [141500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130917.54|9350|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|Self-pay|Self-pay|130917.54|39275.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130917.54|17970.03|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130917.54|23946.26|109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|130917.54||109729|9350||||
MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|130917.54||109729|9350||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110178.65|64002.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110178.65|73883.04|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110178.65|57292.9|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110178.65|20867.23|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110178.65|71616.13|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|GEHA [1415]|GEHA [141500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110178.65|22620.82|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110178.65|57292.9|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110178.65|102466.15|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110178.65|27136.75|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110178.65|26502.31|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110178.65|5100|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|110178.65|1098.57|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110178.65|52797.03|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|Self-pay|Self-pay|110178.65|33053.59|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110178.65|25647.44|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110178.65|23851.38|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110178.65|21781.83|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110178.65|9209.76|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110178.65|12120.78|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110178.65|99160.79|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110178.65|5800|102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110178.65||102466.15|1098.57||||
MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110178.65|20867.23|102466.15|1098.57||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|Self-pay|Self-pay|60507.28|18152.18|18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60507.28||18152.18|18152.18||||
MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60507.28||18152.18|18152.18||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|GEHA [1415]|GEHA [141500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|Self-pay|Self-pay|76049.44|22814.83|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76049.44|18038.25|22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|76049.44||22814.83|18038.25||||
MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|76049.44||22814.83|18038.25||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142682.26|121644.06|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142682.26|108891.22|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142682.26|18429.84|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142682.26|136114.03|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|GEHA [1415]|GEHA [141500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142682.26|19008.35|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142682.26|108891.22|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142682.26|194747.75|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142682.26|23967.05|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142682.26|23406.72|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|Self-pay|Self-pay|142682.26|42804.68|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142682.26|20526.06|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142682.26|16016.21|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142682.26|19216.25|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142682.26|188465.57|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142682.26|1450|194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142682.26||194747.75|1450||||
MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142682.26|18429.84|194747.75|1450||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60748.69|31603.54|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60748.69|36729.33|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60748.69|6995.37|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60748.69|13188.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60748.69|35362.9|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60748.69|13602.2|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60748.69|6995.37|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60748.69|50596.15|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60748.69|17150.6|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60748.69|16749.63|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60748.69|2550|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|60748.69|350.69|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|Self-pay|Self-pay|60748.69|18224.61|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60748.69|14339.31|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60748.69|9791.22|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60748.69|13744.33|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60748.69|6879.75|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60748.69|7838.05|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60748.69|48964.01|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60748.69|1450|50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60748.69||50596.15|350.69||||
MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60748.69|13188.22|50596.15|350.69||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144216.67|71363.86|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144216.67|7650|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|Self-pay|Self-pay|144216.67|43265|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144216.67|15681.39|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144216.67|24369.55|71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|144216.67||71363.86|7650||||
MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|144216.67||71363.86|7650||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60781.31|23024.2|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60781.31|33238.17|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60781.31|18145.33|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60781.31|26150.1|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60781.31|25763.01|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60781.31|26970.95|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60781.31|18145.33|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60781.31|36860.92|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60781.31|34006.85|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60781.31|33211.79|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60781.31|1700|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|60781.31|250.95|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|Self-pay|Self-pay|60781.31|18234.39|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60781.31|31308.26|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60781.31|21079.36|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60781.31|27293.28|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60781.31|10536.26|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60781.31|15614.34|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60781.31|35671.86|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60781.31|1450|36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60781.31||36860.92|250.95||||
MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60781.31|26150.1|36860.92|250.95||||
MS637|DRG||Diabetes With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65066.38|35938.8|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65066.38|37977.8|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65066.38|9015.3|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65066.38|11259.78|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65066.38|15349.09|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65066.38|40213.85|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|GEHA [1415]|GEHA [141500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65066.38|15830.9|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65066.38|11259.78|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65066.38|57536.75|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65066.38|19960.7|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65066.38|19494.03|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65066.38|1700|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MULTIPLAN [1680]|HMA [168003]|65066.38|348.17|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MULTIPLAN [1680]|IHC HS [168011]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65066.38|49041.76|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|Self-pay|Self-pay|65066.38|19519.91|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65066.38|18045.14|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65066.38|9257.12|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65066.38|20800.19|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|TRUSTMARK [2030]|STARMARK [203000]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65066.38|15987.76|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|UMR [2035]|UMR OPTIONS [203501]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65066.38|5629.78|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65066.38|9995.16|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65066.38|55680.72|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65066.38|2175|57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65066.38||57536.75|348.17||||
MS637|DRG||Diabetes With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65066.38|15349.09|57536.75|348.17||||
MS638|DRG||Diabetes With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47120.01|30551.53|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47120.01|27314.89|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47120.01|6670.76|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47120.01|9805.31|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47120.01|34185.76|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47120.01||48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47120.01||48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|GEHA [1415]|GEHA [141500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47120.01|10113.1|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47120.01|6670.76|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47120.01|48911.93|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47120.01|12751.3|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47120.01|6003.43|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47120.01|12453.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47120.01|1700|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MULTIPLAN [1680]|HMA [168003]|47120.01|382.47|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47120.01||48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47120.01|19913.41|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47120.01|13305.95|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|Self-pay|Self-pay|47120.01|14136|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47120.01|11508.22|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47120.01|29790.7|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47120.01|10325.9|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47120.01|10227.42|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|UMR [2035]|UMR OPTIONS [203501]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47120.01|4174.38|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47120.01|5994.18|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47120.01|47334.12|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47120.01|1450|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47120.01|24825.59|48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47120.01||48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47120.01||48911.93|382.47||||
MS638|DRG||Diabetes With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47120.01|9805.31|48911.93|382.47||||
MS639|DRG||Diabetes Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38389.22|24840.66|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38389.22|27173.42|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38389.22|8501.36|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|38389.22|11443.25|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38389.22|27795.52|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|38389.22||39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|38389.22||39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|GEHA [1415]|GEHA [141500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|38389.22|11802.45|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38389.22|8501.36|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|38389.22|39768.98|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38389.22|14881.35|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38389.22|14533.43|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38389.22|2550|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|38389.22|217.37|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|38389.22||39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|38389.22|15914.79|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|Self-pay|Self-pay|38389.22|11516.77|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38389.22|14258.19|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|38389.22|27047.58|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38389.22|15457.53|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38389.22|11881.21|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38389.22|3267.83|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38389.22|4202.4|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38389.22|38486.1|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|38389.22|1450|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|38389.22|22603.23|39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|38389.22||39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|38389.22||39768.98|217.37||||
MS639|DRG||Diabetes Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|38389.22|11443.25|39768.98|217.37||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51304.99|33573.76|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51304.99|26400.86|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51304.99|8918.03|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|51304.99|13723.42|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51304.99|37567.48|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|51304.99||53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|51304.99||53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|GEHA [1415]|GEHA [141500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|51304.99|14154.2|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51304.99|8918.03|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|51304.99|53750.4|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51304.99|17846.6|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|51304.99||53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51304.99|17429.36|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51304.99|850|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MULTIPLAN [1680]|HMA [168003]|51304.99|332.72|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MULTIPLAN [1680]|IHC HS [168011]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|51304.99||53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|51304.99|23694.04|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|Self-pay|Self-pay|51304.99|15391.5|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51304.99|15850.85|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51304.99|8313.23|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|51304.99|40010.38|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51304.99|18577.49|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|TRUSTMARK [2030]|STARMARK [203000]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51304.99|14279.31|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|UMR [2035]|UMR OPTIONS [203501]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51304.99|8190.15|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51304.99|8300.29|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51304.99|52016.51|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|51304.99|2900|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|51304.99|33341.99|53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|51304.99||53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|51304.99||53750.4|332.72||||
MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|51304.99|13723.42|53750.4|332.72||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41289.19|27049.68|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41289.19|24826.47|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41289.19|5693.68|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41289.19|8409.33|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41289.19|30267.34|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41289.19||43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41289.19||43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|GEHA [1415]|GEHA [141500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41289.19|9351|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41289.19|5693.68|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41289.19|43305.58|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41289.19|10935.9|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41289.19||43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41289.19|10680.23|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41289.19|1700|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MULTIPLAN [1680]|HMA [168003]|41289.19|677.7|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41289.19||43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41289.19|30503.64|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|Self-pay|Self-pay|41289.19|12386.76|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41289.19|10087.27|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41289.19|19254.34|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41289.19|9597.12|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41289.19|8757.39|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|UMR [2035]|UMR OPTIONS [203501]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41289.19|4357.46|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41289.19|5172.52|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41289.19|41908.62|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41289.19|2175|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41289.19|16045.28|43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41289.19||43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41289.19||43305.58|677.7||||
MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41289.19|8409.33|43305.58|677.7||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|AETNA [1015]|AETNA ACO WILCO [101532]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|CORESOURCE [1315]|CORESOURCE [131500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|CORVEL CORP [2235]|CORVEL CORP [223500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|GEHA [1415]|GEHA [141500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HEALTHNET [1495]|HEALTHNET [149500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HEALTHSMART [1505]|HEALTHSMART [150501]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MULTIPLAN [1680]|HMA [168003]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MULTIPLAN [1680]|IHC HS [168011]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|Self-pay|Self-pay|97484.04|29245.21|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|TRUSTMARK [2030]|STARMARK [203000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|UMR [2035]|UMR OPTIONS [203501]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97484.04|8687.48|29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|97484.04||29245.21|8687.48||||
MS642|DRG||Inborn And Other Disorders Of Metabolism|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|97484.04||29245.21|8687.48||||
MS643|DRG||Endocrine Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91912.89|57173.54|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91912.89|72618.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91912.89|13291.45|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|91912.89|18594.86|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91912.89|63974.51|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|GEHA [1415]|GEHA [141500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|91912.89|20245.17|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91912.89|13291.45|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|91912.89|91532.76|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91912.89|24181.65|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91912.89|23616.3|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91912.89|1700|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|91912.89|1066.62|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|Self-pay|Self-pay|91912.89|27573.87|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91912.89|21515.73|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|91912.89|216262.23|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91912.89|21182.13|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91912.89|19344.18|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91912.89|6534.34|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91912.89|11167.49|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91912.89|88580.09|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|91912.89|3625|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|91912.89|180300.33|216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|91912.89||216262.23|1066.62||||
MS643|DRG||Endocrine Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|91912.89|18594.86|216262.23|1066.62||||
MS644|DRG||Endocrine Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55595.3|14509.19|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55595.3|27437.64|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55595.3|8235.69|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|55595.3|11370.77|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55595.3|16235.12|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|GEHA [1415]|GEHA [141500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|55595.3|11727.7|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55595.3|8235.69|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|55595.3|23228.7|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55595.3|14787.1|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55595.3|14441.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55595.3|2550|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|55595.3|240.8|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|Self-pay|Self-pay|55595.3|16678.59|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55595.3|13551.1|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55595.3|11913.24|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55595.3|11842.83|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55595.3|4821.51|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55595.3|6776.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55595.3|22479.39|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|55595.3|1450|27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|55595.3||27437.64|240.8||||
MS644|DRG||Endocrine Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|55595.3|11370.77|27437.64|240.8||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28257.7|16414.91|21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28257.7|850|21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|28257.7|21680.37|21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|Self-pay|Self-pay|28257.7|8477.31|21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28257.7|3763.15|21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|28257.7||21680.37|850||||
MS645|DRG||Endocrine Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|28257.7||21680.37|850||||
MS653|DRG||Major Bladder Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|GEHA [1415]|GEHA [141500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|Self-pay|Self-pay|180281.4|54084.42|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180281.4|24810.89|54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|180281.4||54084.42|24810.89||||
MS653|DRG||Major Bladder Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|180281.4||54084.42|24810.89||||
MS654|DRG||Major Bladder Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|212188.54|123260.33|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|212188.54|110338.04|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|212188.54|32366.22|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|212188.54|137922.55|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|GEHA [1415]|GEHA [141500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|212188.54|34217.12|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|212188.54|110338.04|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|212188.54|197335.34|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|212188.54|42090.6|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|212188.54|41106.55|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|212188.54|834.92|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|Self-pay|Self-pay|212188.54|63656.56|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|212188.54|37485.55|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|212188.54|43882.09|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|212188.54|33729.33|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|212188.54|190969.69|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|212188.54|2175|197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|212188.54||197335.34|834.92||||
MS654|DRG||Major Bladder Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|212188.54|32366.22|197335.34|834.92||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|Self-pay|Self-pay|127183.09|38154.93|38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|127183.09||38154.93|38154.93||||
MS655|DRG||Major Bladder Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|127183.09||38154.93|38154.93||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|402190.33|233632.35|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|402190.33|209138.97|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|402190.33|201095.17|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|402190.33|261423.72|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|GEHA [1415]|GEHA [141500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|402190.33|42019.06|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|402190.33|209138.97|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|402190.33|374037|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|402190.33|180985.65|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|402190.33|180985.65|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MULTIPLAN [1680]|HMA [168003]|402190.33|2997.19|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MULTIPLAN [1680]|IHC HS [168011]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|Self-pay|Self-pay|402190.33|120657.1|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|402190.33|201095.17|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|402190.33|49654.45|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|TRUSTMARK [2030]|STARMARK [203000]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|402190.33|38166.17|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|UMR [2035]|UMR OPTIONS [203501]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|402190.33|22902.33|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|402190.33|361971.32|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|402190.33|5800|374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|402190.33||374037|2997.19||||
MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|402190.33|201095.17|374037|2997.19||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112362.15|73658.15|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112362.15|74338.38|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112362.15|65936.03|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|112362.15|21571.91|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112362.15|82420.03|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|GEHA [1415]|GEHA [141500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|112362.15|22249.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112362.15|65936.03|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|112362.15|117924.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112362.15|28053.15|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112362.15|27397.29|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112362.15|850|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MULTIPLAN [1680]|HMA [168003]|112362.15|424.63|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|Self-pay|Self-pay|112362.15|33708.64|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112362.15|26743.91|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|112362.15|92321.55|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112362.15|23830.05|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112362.15|22493.58|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|UMR [2035]|UMR OPTIONS [203501]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112362.15|10130.66|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112362.15|12919.73|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112362.15|114120.04|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|112362.15|725|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|112362.15|76934.63|117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|112362.15||117924.04|424.63||||
MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|112362.15|21571.91|117924.04|424.63||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|122234.1|20386.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122234.1|20386.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122234.1|66478.51|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122234.1|75225.46|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|122234.1|23892.9|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122234.1|23892.9|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122234.1|59509.07|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|122234.1|23892.9|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|122234.1|17593.59|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122234.1|74386.34|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|122234.1||143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|122234.1||143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|GEHA [1415]|GEHA [141500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|122234.1|18145.85|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122234.1|59509.07|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|122234.1|106429.67|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122234.1|22879.55|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|122234.1|11425.87|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122234.1|20386.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122234.1|22344.64|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122234.1|2550|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122234.1|20386.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|122234.1|221.91|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|122234.1||143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|122234.1||143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122234.1|20386.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|Self-pay|Self-pay|122234.1|36670.23|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122234.1|21131.76|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|122234.1|143886.9|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122234.1|20386.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122234.1|18364.93|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122234.1|8185.25|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122234.1|10578.18|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122234.1|102996.47|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|122234.1|725|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|122234.1|119905.75|143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|122234.1||143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|122234.1||143886.9|221.91||||
MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|122234.1|17593.59|143886.9|221.91||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96927.52|57234.46|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96927.52|31155.72|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96927.52|27304|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96927.52|29730.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96927.52|64042.71|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96927.52||91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96927.52||91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|GEHA [1415]|GEHA [141500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96927.52|31463.32|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96927.52|27304|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96927.52|91630.32|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96927.52|38662.8|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96927.52||91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96927.52|37758.89|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96927.52|850|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MULTIPLAN [1680]|HMA [168003]|96927.52|799.72|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MULTIPLAN [1680]|IHC HS [168011]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96927.52||91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96927.52|32783.74|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|Self-pay|Self-pay|96927.52|29078.26|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96927.52|46142.41|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96927.52|57040.06|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96927.52|33963.36|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|TRUSTMARK [2030]|STARMARK [203000]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96927.52|30991.62|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|UMR [2035]|UMR OPTIONS [203501]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96927.52|12681.41|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96927.52|17749.65|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96927.52|88674.51|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96927.52|5075|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96927.52|47580.59|91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96927.52||91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96927.52||91630.32|799.72||||
MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96927.52|29730.36|91630.32|799.72||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56877.83|31173.61|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56877.83|36119.97|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56877.83|15252.06|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|56877.83|16090.57|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56877.83|34881.8|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|56877.83||49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|56877.83||49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|GEHA [1415]|GEHA [141500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|56877.83|16595.65|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56877.83|15252.06|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|56877.83|49907.78|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56877.83|20924.95|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|56877.83|10508.27|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56877.83|20435.74|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56877.83|1700|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MULTIPLAN [1680]|HMA [168003]|56877.83|447.44|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|56877.83||49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|56877.83|31696.21|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|Self-pay|Self-pay|56877.83|17063.35|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56877.83|24240.01|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56877.83|9693.52|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|56877.83|37411.01|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56877.83|21839.67|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56877.83|16786.74|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|UMR [2035]|UMR OPTIONS [203501]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56877.83|8571.84|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56877.83|10444.94|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56877.83|48297.86|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|56877.83|725|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|56877.83|31175.85|49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|56877.83||49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|56877.83||49907.78|447.44||||
MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|56877.83|16090.57|49907.78|447.44||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54895.85|31663.39|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54895.85|32044.54|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54895.85|10896.41|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54895.85|13565.97|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54895.85|11860.26|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54895.85|35429.84|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|54895.85||50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54895.85||50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|GEHA [1415]|GEHA [141500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54895.85|12232.55|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54895.85|10896.41|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|54895.85|50691.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54895.85|15423.65|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54895.85||50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54895.85|15063.06|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54895.85|850|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|54895.85|154.35|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54895.85||50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|54895.85|29627.27|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54895.85|16105.13|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|Self-pay|Self-pay|54895.85|16468.75|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54895.85|19658.08|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54895.85|47363.04|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54895.85|13632.03|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54895.85|12378.97|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54895.85|6694.84|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54895.85|7878.92|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54895.85|49056.7|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54895.85|725|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54895.85|39469.21|50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54895.85||50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54895.85||50691.92|154.35||||
MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54895.85|11860.26|50691.92|154.35||||
MS662|DRG||Minor Bladder Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59192.67|13675.62|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|59192.67|17656.61|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59192.67|15302.39|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|GEHA [1415]|GEHA [141500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|59192.67|21894.19|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|59192.67|300.9|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|Self-pay|Self-pay|59192.67|17757.8|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59192.67|30751.27|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59192.67|23542.14|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59192.67|19499.41|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59192.67|21187.93|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|59192.67|1450|30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|59192.67||30751.27|300.9||||
MS662|DRG||Minor Bladder Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|59192.67|17656.61|30751.27|300.9||||
MS663|DRG||Minor Bladder Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63522.23|31989.67|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63522.23|12342.64|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63522.23|17834.43|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63522.23|35794.98|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|GEHA [1415]|GEHA [141500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63522.23|18394.25|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63522.23|12342.64|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63522.23|51214.35|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63522.23|23192.75|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63522.23|22650.52|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|63522.23|352.05|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|Self-pay|Self-pay|63522.23|19056.67|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63522.23|24073.71|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63522.23|24131.97|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63522.23|18548.69|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63522.23|11502.73|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63522.23|49562.27|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63522.23|1450|51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63522.23||51214.35|352.05||||
MS663|DRG||Minor Bladder Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63522.23|17834.43|51214.35|352.05||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53341.98|84874.82|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53341.98|75976.76|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53341.98|13199.37|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53341.98|94970.95|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53341.98|34809.41|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53341.98|75976.76|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53341.98|135881.51|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53341.98|17165.1|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53341.98|16763.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|53341.98|227.08|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|Self-pay|Self-pay|53341.98|16002.59|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53341.98|17396.18|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53341.98|17917.79|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53341.98|13772.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53341.98|8691.17|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53341.98|131498.25|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53341.98|725|135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53341.98||135881.51|227.08||||
MS664|DRG||Minor Bladder Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53341.98|13199.37|135881.51|227.08||||
MS665|DRG||Prostatectomy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|681371.22|395808.56|395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|GEHA [1415]|GEHA [141500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|681371.22|33150|395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MULTIPLAN [1680]|HMA [168003]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|Self-pay|Self-pay|681371.22|204411.37|395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|UMR [2035]|UMR OPTIONS [203501]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|681371.22|8325.26|395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|681371.22||395808.56|8325.26||||
MS665|DRG||Prostatectomy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|681371.22||395808.56|8325.26||||
MS666|DRG||Prostatectomy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59024.87|31574.2|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59024.87|14140.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|59024.87|19397.66|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59024.87|35330.06|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|GEHA [1415]|GEHA [141500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|59024.87|20006.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59024.87|14140.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|59024.87|50549.16|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59024.87|25225.65|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59024.87|24635.89|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MULTIPLAN [1680]|HMA [168003]|59024.87|92.4|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|Self-pay|Self-pay|59024.87|17707.46|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59024.87|23518.04|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|59024.87|51393.37|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59024.87|26241.19|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59024.87|20169.91|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59024.87|12450.94|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59024.87|48918.55|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|59024.87|725|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|59024.87|42827.81|51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|59024.87||51393.37|92.4||||
MS666|DRG||Prostatectomy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|59024.87|19397.66|51393.37|92.4||||
MS667|DRG||Prostatectomy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|Self-pay|Self-pay|42953.34|12886|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42953.34|6208.55|12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42953.34||12886|6208.55||||
MS667|DRG||Prostatectomy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42953.34||12886|6208.55||||
MS668|DRG||Transurethral Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|GEHA [1415]|GEHA [141500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|Self-pay|Self-pay|93820.66|28146.2|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|93820.66|182690.75|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93820.66|17649.36|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|93820.66|152242.29|182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|93820.66||182690.75|17649.36||||
MS668|DRG||Transurethral Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|93820.66||182690.75|17649.36||||
MS669|DRG||Transurethral Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86752.54|36878.76|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86752.54|41652.8|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86752.54|10224.57|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86752.54|17433.03|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86752.54|41265.61|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|GEHA [1415]|GEHA [141500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86752.54|17980.25|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86752.54|10224.57|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86752.54|59041.57|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86752.54|22670.75|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86752.54|22140.72|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86752.54|850|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|86752.54|253.65|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|Self-pay|Self-pay|86752.54|26025.76|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86752.54|18695.46|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86752.54|12691.81|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86752.54|17816|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86752.54|4782.65|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86752.54|11259.24|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86752.54|57137.01|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86752.54|725|59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86752.54||59041.57|253.65||||
MS669|DRG||Transurethral Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86752.54|17433.03|59041.57|253.65||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44263.3|30282.42|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44263.3|7232.78|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44263.3|10910.28|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44263.3|33884.62|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44263.3|11252.75|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44263.3|7232.78|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44263.3|48481.06|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44263.3|14188.25|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44263.3|13856.54|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|44263.3|184.8|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44263.3|23968.16|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|Self-pay|Self-pay|44263.3|13278.99|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44263.3|13298.27|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44263.3|14775.14|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44263.3|11356.7|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44263.3|46917.15|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44263.3|725|48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44263.3||48481.06|184.8||||
MS670|DRG||Transurethral Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44263.3|10910.28|48481.06|184.8||||
MS671|DRG||Urethral Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111300.47|64602.18|64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111300.47|5100|64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|Self-pay|Self-pay|111300.47|33390.14|64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111300.47|4814.51|64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|111300.47||64602.18|4814.51||||
MS671|DRG||Urethral Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|111300.47||64602.18|4814.51||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|Self-pay|Self-pay|96181.54|28854.46|28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96181.54||28854.46|28854.46||||
MS672|DRG||Urethral Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96181.54||28854.46|28854.46||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163809.89|74331.63|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163809.89|97754.34|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163809.89|66538.89|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|163809.89|38671.55|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163809.89|83173.61|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|GEHA [1415]|GEHA [141500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|163809.89|40807.23|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163809.89|66538.89|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|163809.89|119002.25|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163809.89|50290.35|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163809.89|49114.6|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163809.89|11050|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|163809.89|151.35|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|163809.89|76620.8|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|Self-pay|Self-pay|163809.89|49142.97|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163809.89|47647.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163809.89|44102.58|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163809.89|40275.85|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163809.89|11017.96|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163809.89|22984.18|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163809.89|115163.48|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|163809.89|5075|119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|163809.89||119002.25|151.35||||
MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|163809.89|38671.55|119002.25|151.35||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123484.02|81083.34|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123484.02|75295.17|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123484.02|72582.78|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123484.02|26572.68|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123484.02|90728.47|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|GEHA [1415]|GEHA [141500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123484.02|28181.4|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123484.02|72582.78|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|123484.02|129811.51|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123484.02|34556.4|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123484.02|33748.5|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123484.02|7650|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|123484.02|774.6|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|123484.02|128740.18|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|Self-pay|Self-pay|123484.02|37045.21|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123484.02|31319.08|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123484.02|36017.14|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123484.02|27684.05|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123484.02|7401.74|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123484.02|15863.07|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123484.02|125624.04|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123484.02|5075|129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123484.02||129811.51|774.6||||
MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123484.02|26572.68|129811.51|774.6||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|Self-pay|Self-pay|125474.31|37642.29|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125474.31|11973.21|37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|125474.31||37642.29|11973.21||||
MS675|DRG||Other Kidney And Urinary Tract Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|125474.31||37642.29|11973.21||||
MS682|DRG||Renal Failure With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70116|39400.62|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70116|43345.74|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70116|12269.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|70116|16420.61|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70116|44087.45|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|70116||86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|70116||86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|GEHA [1415]|GEHA [141500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|70116|16936.05|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70116|12269.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|70116|63078.96|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70116|21354.15|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|70116||86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70116|20854.9|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70116|5100|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MULTIPLAN [1680]|HMA [168003]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MULTIPLAN [1680]|IHC HS [168011]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|70116||86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|70116|86446.88|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|Self-pay|Self-pay|70116|21034.8|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70116|20067.74|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|70116|58598.74|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70116|22245.17|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|TRUSTMARK [2030]|STARMARK [203000]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70116|17098.43|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|UMR [2035]|UMR OPTIONS [203501]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70116|14306.8|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70116|9887.78|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70116|61044.16|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|70116|2900|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|70116|48832.28|86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|70116||86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|70116||86446.88|2900||||
MS682|DRG||Renal Failure With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|70116|16420.61|86446.88|2900||||
MS683|DRG||Renal Failure With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41964.91|24000.96|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41964.91|24142.98|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41964.91|7680.94|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41964.91|9804.2|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41964.91|26855.95|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41964.91||38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41964.91||38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|GEHA [1415]|GEHA [141500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41964.91|10729.65|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41964.91|7680.94|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41964.91|38424.67|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41964.91|12749.85|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41964.91||38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41964.91|12451.77|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41964.91|2550|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MULTIPLAN [1680]|HMA [168003]|41964.91|617.7|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41964.91||38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41964.91|36390.26|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|Self-pay|Self-pay|41964.91|12589.47|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41964.91|12562.78|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41964.91|6002.77|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41964.91|26757.9|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41964.91|13286.28|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41964.91|10212.3|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|UMR [2035]|UMR OPTIONS [203501]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41964.91|9729.94|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41964.91|5993.52|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41964.91|37185.17|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41964.91|2900|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41964.91|22298.25|38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41964.91||38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41964.91||38424.67|617.7||||
MS683|DRG||Renal Failure With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41964.91|9804.2|38424.67|617.7||||
MS684|DRG||Renal Failure Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32596|21995.07|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|GEHA [1415]|GEHA [141500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32596|2550|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|Self-pay|Self-pay|32596|9778.8|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32596|6177.44|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32596|4796.19|21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32596||21995.07|2550||||
MS684|DRG||Renal Failure Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32596||21995.07|2550||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37228.31|117846.35|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37228.31|105491.65|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37228.31|20909.6|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37228.31|131864.56|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|GEHA [1415]|GEHA [141500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37228.31|31993.49|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37228.31|105491.65|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37228.31|188667.76|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37228.31|27191.85|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37228.31|26556.12|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MULTIPLAN [1680]|HMA [168003]|37228.31|10427.54|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MULTIPLAN [1680]|IHC HS [168011]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|Self-pay|Self-pay|37228.31|11168.49|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37228.31|23355.8|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37228.31|21585.36|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|TRUSTMARK [2030]|STARMARK [203000]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37228.31|21785.32|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|UMR [2035]|UMR OPTIONS [203501]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37228.31|12529.91|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37228.31|182581.7|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37228.31|10150|188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37228.31||188667.76|10150||||
MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37228.31|20909.6|188667.76|10150||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|GEHA [1415]|GEHA [141500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MULTIPLAN [1680]|HMA [168003]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|Self-pay|Self-pay|72194.14|21658.24|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|UMR [2035]|UMR OPTIONS [203501]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72194.14|7114.42|21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72194.14||21658.24|7114.42||||
MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72194.14||21658.24|7114.42||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21782.19|12653.27|12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|GEHA [1415]|GEHA [141500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21782.19|1700|12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|Self-pay|Self-pay|21782.19|6534.66|12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21782.19|7159.51|12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21782.19||12653.27|1700||||
MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21782.19||12653.27|1700||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48813.56|23317.71|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48813.56|22290.33|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48813.56|9021.39|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48813.56|12423.33|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48813.56|26091.42|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|GEHA [1415]|GEHA [141500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48813.56|12813.3|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48813.56|9021.39|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48813.56|37330.8|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48813.56|16155.9|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48813.56|15778.19|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48813.56|850|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MULTIPLAN [1680]|HMA [168003]|48813.56|239.28|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MULTIPLAN [1680]|IHC HS [168011]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|Self-pay|Self-pay|48813.56|14644.07|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48813.56|14592.14|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48813.56|7546.81|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48813.56|16814.76|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|TRUSTMARK [2030]|STARMARK [203000]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48813.56|12924.42|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|UMR [2035]|UMR OPTIONS [203501]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48813.56|6817.26|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48813.56|7535.09|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48813.56|36126.59|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48813.56|2175|37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48813.56||37330.8|239.28||||
MS689|DRG||Kidney And Urinary Tract Infections With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48813.56|12423.33|37330.8|239.28||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|35449.76|10096.73|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35449.76|10096.73|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35449.76|17794.89|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35449.76|19244.62|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35449.76|11986.55|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35449.76|11986.55|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35449.76|6293.66|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35449.76|11986.55|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35449.76|8853.1|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35449.76|19911.64|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|GEHA [1415]|GEHA [141500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35449.76|9131|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35449.76|6293.66|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35449.76|28488.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35449.76|11513|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35449.76|5442.07|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35449.76|10096.73|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35449.76|11243.83|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35449.76|2550|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35449.76|10096.73|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MULTIPLAN [1680]|HMA [168003]|35449.76|284.59|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35449.76|26427.85|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35449.76|10096.73|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|Self-pay|Self-pay|35449.76|10634.93|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35449.76|10741.64|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35449.76|10096.73|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35449.76|9213.29|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|UMR [2035]|UMR OPTIONS [203501]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35449.76|4141.5|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35449.76|5433.72|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35449.76|27569.97|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35449.76|2175|28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35449.76||28488.97|284.59||||
MS690|DRG||Kidney And Urinary Tract Infections Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35449.76|8853.1|28488.97|284.59||||
MS693|DRG||Urinary Stones With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72105.54|53254.57|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|GEHA [1415]|GEHA [141500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72105.54|4250|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MULTIPLAN [1680]|HMA [168003]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MULTIPLAN [1680]|IHC HS [168011]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|Self-pay|Self-pay|72105.54|21631.66|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|TRUSTMARK [2030]|STARMARK [203000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|UMR [2035]|UMR OPTIONS [203501]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72105.54|4673.17|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72105.54|10348.76|53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72105.54||53254.57|4250||||
MS693|DRG||Urinary Stones With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72105.54||53254.57|4250||||
MS694|DRG||Urinary Stones Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|30726.45|10207.31|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30726.45|10207.31|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30726.45|15823.21|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30726.45|12621.63|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30726.45|11034.83|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30726.45|11034.83|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30726.45|5538.64|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30726.45|11034.83|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30726.45|8598.88|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30726.45|17705.44|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|GEHA [1415]|GEHA [141500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30726.45|8868.8|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30726.45|5538.64|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30726.45|25332.4|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30726.45|11182.4|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30726.45|10207.31|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30726.45|10920.96|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30726.45|850|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30726.45|10207.31|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MULTIPLAN [1680]|HMA [168003]|30726.45|186.2|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30726.45|10207.31|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|Self-pay|Self-pay|30726.45|9217.93|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30726.45|11007.98|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30726.45|10207.31|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30726.45|8481.76|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|UMR [2035]|UMR OPTIONS [203501]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30726.45|3347.96|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30726.45|5284.09|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30726.45|24515.23|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30726.45|1450|25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30726.45||25332.4|186.2||||
MS694|DRG||Urinary Stones Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30726.45|8598.88|25332.4|186.2||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|GEHA [1415]|GEHA [141500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MULTIPLAN [1680]|HMA [168003]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MULTIPLAN [1680]|IHC HS [168011]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|Self-pay|Self-pay|36413.18|10923.95|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|TRUSTMARK [2030]|STARMARK [203000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|UMR [2035]|UMR OPTIONS [203501]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36413.18|7689.3|10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36413.18||10923.95|7689.3||||
MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36413.18||10923.95|7689.3||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37597.32|23556.13|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37597.32|21840.31|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37597.32|5344.84|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37597.32|7714.69|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37597.32|26358.21|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|GEHA [1415]|GEHA [141500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37597.32|7956.85|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37597.32|5344.84|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37597.32|37712.5|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37597.32|10032.55|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37597.32|9798|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37597.32|1700|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MULTIPLAN [1680]|HMA [168003]|37597.32|30.45|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|Self-pay|Self-pay|37597.32|11279.2|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37597.32|9412.62|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37597.32|19025.05|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37597.32|7241.81|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37597.32|8021.21|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|UMR [2035]|UMR OPTIONS [203501]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37597.32|3455.03|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37597.32|4763.68|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37597.32|36495.97|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37597.32|2900|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37597.32|15854.21|37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37597.32||37712.5|30.45||||
MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37597.32|7714.69|37712.5|30.45||||
MS697|DRG||Urethral Stricture|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|AETNA [1015]|AETNA ACO WILCO [101532]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|CORESOURCE [1315]|CORESOURCE [131500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|GEHA [1415]|GEHA [141500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HEALTHNET [1495]|HEALTHNET [149500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MULTIPLAN [1680]|HMA [168003]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MULTIPLAN [1680]|IHC HS [168011]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|Self-pay|Self-pay|47556.32|14266.9|39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47556.32|39845.84|39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|TRUSTMARK [2030]|STARMARK [203000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|UMR [2035]|UMR OPTIONS [203501]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47556.32|33238.52|39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47556.32||39845.84|14266.9||||
MS697|DRG||Urethral Stricture|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47556.32||39845.84|14266.9||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66062.69|33546.69|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66062.69|35021.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66062.69|10483.65|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66062.69|12617.19|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66062.69|17958.19|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66062.69|37537.15|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66062.69||76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66062.69||76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66062.69|18521.9|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66062.69|12617.19|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66062.69|53706.99|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66062.69|23353.7|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66062.69|10809.71|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66062.69|22807.71|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66062.69|5100|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|66062.69|253.13|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66062.69||76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66062.69|33238.79|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|Self-pay|Self-pay|66062.69|19818.81|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66062.69|21468.41|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66062.69|10792.77|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66062.69|76216.93|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66062.69|24310.51|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66062.69|18685.92|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66062.69|7718.36|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66062.69|10483.65|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66062.69|51974.52|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66062.69|2900|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66062.69|63514.1|76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66062.69||76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66062.69||76216.93|253.13||||
MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66062.69|17958.19|76216.93|253.13||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52932.04|31519.89|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52932.04|36434.12|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52932.04|8212.28|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52932.04|11451.05|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52932.04|35269.26|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52932.04|11810.5|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52932.04|8212.28|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52932.04|50462.17|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52932.04|14891.5|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52932.04|14543.35|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52932.04|2550|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|52932.04|339.64|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52932.04|27527.94|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|Self-pay|Self-pay|52932.04|15879.61|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52932.04|14148.68|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52932.04|15512|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52932.04|11923.08|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52932.04|5790.27|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52932.04|6973.62|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52932.04|48834.36|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52932.04|3625|50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52932.04||50462.17|339.64||||
MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52932.04|11451.05|50462.17|339.64||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22967.7|11444.47|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22967.7|5741.33|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|22967.7|8323.48|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22967.7|12805.82|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|22967.7|8584.75|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22967.7|5741.33|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|22967.7|18322.18|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22967.7|10824.25|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22967.7|10571.19|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|Self-pay|Self-pay|22967.7|6890.31|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22967.7|10498.28|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22967.7|11269.35|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22967.7|8662.02|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22967.7|5242.7|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22967.7|17731.13|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|22967.7|725|18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|22967.7||18322.18|725||||
MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|22967.7|8323.48|18322.18|725||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84102.34|48855.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84102.34|45037.2|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84102.34|14660.16|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84102.34|21432.53|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84102.34|54666.53|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84102.34|22105.3|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84102.34|14660.16|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84102.34|78215.18|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84102.34|27871.9|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84102.34|27220.27|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84102.34|1700|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|84102.34|303.7|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|Self-pay|Self-pay|84102.34|25230.7|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84102.34|24364.39|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84102.34|29060.04|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84102.34|22336.58|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84102.34|11180.62|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84102.34|12837.68|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84102.34|75692.11|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84102.34|1450|78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84102.34||78215.18|303.7||||
MS707|DRG||Major Male Pelvic Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84102.34|21432.53|78215.18|303.7||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|124978.67|19008.16|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124978.67|19008.16|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124978.67|72600.11|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124978.67|61502.87|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|124978.67|22565.94|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124978.67|22565.94|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124978.67|64988.91|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|124978.67|22565.94|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|124978.67|16626.88|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124978.67|81236.13|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|124978.67|17148.8|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124978.67|64988.91|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|124978.67|116230.17|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124978.67|21622.4|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124978.67|19008.16|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124978.67|21116.88|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124978.67|850|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124978.67|19008.16|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|124978.67|135.42|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124978.67|19008.16|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|Self-pay|Self-pay|124978.67|37493.6|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124978.67|18719.79|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124978.67|19008.16|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124978.67|17344.98|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124978.67|8817.61|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124978.67|10594.1|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124978.67|112480.81|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|124978.67|725|116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|124978.67||116230.17|135.42||||
MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|124978.67|16626.88|116230.17|135.42||||
MS709|DRG||Penis Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|568762.55|330394.14|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|568762.55|568762.55|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|568762.55|369695.65|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|568762.55|56851.53|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|568762.55|568762.55|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|568762.55|528949.18|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|568762.55|568762.55|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|568762.55|568762.55|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|568762.55|3585.83|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|Self-pay|Self-pay|568762.55|170628.76|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|568762.55|568762.55|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|568762.55|199282.49|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|568762.55|568762.55|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|568762.55|511886.31|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|568762.55|37700|568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|568762.55||568762.55|3585.83||||
MS709|DRG||Penis Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|568762.55|199282.49|568762.55|3585.83||||
MS710|DRG||Penis Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23309.16|13297.48|13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23309.16|1700|13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|Self-pay|Self-pay|23309.16|6992.75|13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23309.16|5567.36|13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23309.16||13297.48|1700||||
MS710|DRG||Penis Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23309.16||13297.48|1700||||
MS711|DRG||Testes Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|Self-pay|Self-pay|57281.05|17184.31|17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57281.05||17184.31|17184.31||||
MS711|DRG||Testes Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57281.05||17184.31|17184.31||||
MS712|DRG||Testes Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44467.37|25831.1|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44467.37|8585.34|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44467.37|11819|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44467.37|28903.79|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44467.37|12190|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44467.37|8585.34|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44467.37|41354.65|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44467.37|15370|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44467.37|15010.66|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|44467.37|122.85|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|Self-pay|Self-pay|44467.37|13340.21|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44467.37|12572.25|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44467.37|13478.03|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44467.37|12298.73|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44467.37|40020.63|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44467.37|725|41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44467.37||41354.65|122.85||||
MS712|DRG||Testes Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44467.37|11819|41354.65|122.85||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82755.71|45653.98|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82755.71|11973.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82755.71|16651.41|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82755.71|51084.67|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|GEHA [1415]|GEHA [141500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82755.71|17174.1|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82755.71|11973.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82755.71|73090.37|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82755.71|21654.3|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82755.71|21148.04|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|82755.71|316.91|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|Self-pay|Self-pay|82755.71|24826.71|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82755.71|19253.83|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82755.71|22568.97|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82755.71|17347.31|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82755.71|10023.63|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82755.71|70732.61|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82755.71|1450|73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82755.71||73090.37|316.91||||
MS713|DRG||Transurethral Prostatectomy With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82755.71|16651.41|73090.37|316.91||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|Self-pay|Self-pay|66307.27|19892.18|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66307.27|6966.53|19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|66307.27||19892.18|6966.53||||
MS714|DRG||Transurethral Prostatectomy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|66307.27||19892.18|6966.53||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|GEHA [1415]|GEHA [141500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|Self-pay|Self-pay|58490.42|17547.13|17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58490.42||17547.13|17547.13||||
MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58490.42||17547.13|17547.13||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|Self-pay|Self-pay|57913.15|17373.94|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57913.15|9313.42|17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57913.15||17373.94|9313.42||||
MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57913.15||17373.94|9313.42||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71115.43|54920.69|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71115.43|34572.57|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71115.43|14306.48|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|71115.43|20076.69|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71115.43|61453.69|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|GEHA [1415]|GEHA [141500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|71115.43|22136.87|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71115.43|14306.48|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|71115.43|87926.05|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71115.43|26108.7|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71115.43|25498.3|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71115.43|850|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|71115.43|1429.97|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|Self-pay|Self-pay|71115.43|21334.63|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71115.43|26082.78|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71115.43|22922.21|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71115.43|20916.56|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71115.43|5048.2|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71115.43|12862.82|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71115.43|85089.73|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|71115.43|2900|87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|71115.43||87926.05|850||||
MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|71115.43|20076.69|87926.05|850||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67005.13|29632.07|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67005.13|8154.94|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67005.13|13765.79|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67005.13|33156.91|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67005.13|15163.05|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67005.13|8154.94|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67005.13|47439.88|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67005.13|17901.7|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67005.13|17483.17|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|67005.13|965.15|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|Self-pay|Self-pay|67005.13|20101.54|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67005.13|16849.98|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67005.13|18704.58|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67005.13|14377.01|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67005.13|9034.77|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67005.13|45909.56|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67005.13|2175|47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67005.13||47439.88|965.15||||
MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67005.13|13765.79|47439.88|965.15||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|GEHA [1415]|GEHA [141500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MULTIPLAN [1680]|HMA [168003]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|Self-pay|Self-pay|47750.38|14325.11|14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|UMR [2035]|UMR OPTIONS [203501]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47750.38||14325.11|14325.11||||
MS722|DRG||Malignancy, Male Reproductive System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47750.38||14325.11|14325.11||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|GEHA [1415]|GEHA [141500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|Self-pay|Self-pay|20972.87|6291.86|6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20972.87||6291.86|6291.86||||
MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20972.87||6291.86|6291.86||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|GEHA [1415]|GEHA [141500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MULTIPLAN [1680]|HMA [168003]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|Self-pay|Self-pay|54048.91|16214.67|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|UMR [2035]|UMR OPTIONS [203501]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54048.91|8659.25|16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54048.91||16214.67|8659.25||||
MS725|DRG||Benign Prostatic Hypertrophy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54048.91||16214.67|8659.25||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31524.87|30563.73|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31524.87|5675.92|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31524.87|8303.41|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31524.87|34199.39|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|GEHA [1415]|GEHA [141500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31524.87|8564.05|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31524.87|5675.92|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31524.87|48931.43|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31524.87|10798.15|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31524.87|10545.7|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MULTIPLAN [1680]|HMA [168003]|31524.87|423.75|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|Self-pay|Self-pay|31524.87|9457.46|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31524.87|9969.65|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31524.87|11246.66|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31524.87|8644.58|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|UMR [2035]|UMR OPTIONS [203501]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31524.87|5110.18|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31524.87|47353|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31524.87|1450|48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31524.87||48931.43|423.75||||
MS726|DRG||Benign Prostatic Hypertrophy Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31524.87|8303.41|48931.43|423.75||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|GEHA [1415]|GEHA [141500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MULTIPLAN [1680]|HMA [168003]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|70113.74|40729.07|40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|Self-pay|Self-pay|70113.74|21034.12|40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|UMR [2035]|UMR OPTIONS [203501]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|70113.74||40729.07|21034.12||||
MS727|DRG||Inflammation Of The Male Reproductive System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|70113.74||40729.07|21034.12||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48581.95|44103.17|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48581.95|25862.41|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48581.95|6464.85|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48581.95|8983.56|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48581.95|49349.39|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|GEHA [1415]|GEHA [141500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48581.95|10770.61|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48581.95|6464.85|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48581.95|70607.59|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48581.95|11682.65|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48581.95|11409.52|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48581.95|850|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MULTIPLAN [1680]|HMA [168003]|48581.95|1505.06|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|Self-pay|Self-pay|48581.95|14574.58|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48581.95|10972.83|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48581.95|10611.25|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48581.95|9344.71|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|UMR [2035]|UMR OPTIONS [203501]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48581.95|3155.08|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48581.95|5432.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48581.95|68329.93|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48581.95|4350|70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48581.95||70607.59|850||||
MS728|DRG||Inflammation Of The Male Reproductive System Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48581.95|8983.56|70607.59|850||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|GEHA [1415]|GEHA [141500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|Self-pay|Self-pay|110508.71|33152.61|33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110508.71||33152.61|33152.61||||
MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110508.71||33152.61|33152.61||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87207.48|49838.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87207.48|5377.95|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87207.48|6343.24|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87207.48|55766.41|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87207.48|8233.41|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87207.48|5377.95|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87207.48|79788.87|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87207.48|8249.05|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87207.48|8056.19|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|87207.48|1691.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|Self-pay|Self-pay|87207.48|26162.24|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87207.48|8628.46|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87207.48|10724.06|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87207.48|6579.09|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87207.48|77215.03|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87207.48|725|79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87207.48||79788.87|725||||
MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87207.48|6343.24|79788.87|725||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118348.76|181668.5|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118348.76|162622.87|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|118348.76|156368.14|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118348.76|203278.59|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|GEHA [1415]|GEHA [141500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|118348.76|27091.07|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118348.76|162622.87|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|118348.76|290844.75|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118348.76|140731.33|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118348.76|140731.33|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|118348.76|1511.62|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|Self-pay|Self-pay|118348.76|35504.63|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118348.76|156368.14|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118348.76|33632.54|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118348.76|25851.16|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118348.76|14843.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118348.76|281462.65|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|118348.76|7250|290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|118348.76||290844.75|1511.62||||
MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|118348.76|156368.14|290844.75|1511.62||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107986.37|62729.28|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107986.37|56152.91|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107986.37|15761.64|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107986.37|70191.13|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107986.37|17628.95|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107986.37|56152.91|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107986.37|100427.32|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107986.37|20497.2|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107986.37|20017.99|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|107986.37|1372.55|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|Self-pay|Self-pay|107986.37|32395.91|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107986.37|17686.86|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107986.37|21387.26|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107986.37|16439.01|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107986.37|97187.73|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107986.37|1450|100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107986.37||100427.32|1372.55||||
MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107986.37|15761.64|100427.32|1372.55||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170570.75|99084.54|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170570.75|88696.79|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|170570.75|47506.81|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170570.75|110871|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|GEHA [1415]|GEHA [141500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|170570.75|50782.99|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170570.75|88696.79|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|170570.75|158630.8|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170570.75|61780.15|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170570.75|60335.77|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MULTIPLAN [1680]|HMA [168003]|170570.75|1784.94|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|Self-pay|Self-pay|170570.75|51171.22|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170570.75|53102.5|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170570.75|44694.19|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170570.75|49522.87|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|UMR [2035]|UMR OPTIONS [203501]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170570.75|153513.68|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|170570.75|5800|158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|170570.75||158630.8|1784.94||||
MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|170570.75|47506.81|158630.8|1784.94||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119491.89|72359.96|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119491.89|80522.2|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119491.89|64773.93|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119491.89|22947.82|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119491.89|80967.42|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|GEHA [1415]|GEHA [141500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119491.89|23668.15|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119491.89|64773.93|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119491.89|115845.68|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119491.89|29842.45|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119491.89|29144.75|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119491.89|2550|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MULTIPLAN [1680]|HMA [168003]|119491.89|477.16|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|Self-pay|Self-pay|119491.89|35847.57|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119491.89|26495.14|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119491.89|31142.03|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119491.89|23936.87|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119491.89|10688.57|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119491.89|14604.38|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119491.89|112108.74|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119491.89|5800|115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119491.89||115845.68|477.16||||
MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119491.89|22947.82|115845.68|477.16||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100881.19|52764.8|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100881.19|66057.51|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100881.19|10292.4|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100881.19|16456.29|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100881.19|59041.34|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100881.19|16972.85|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100881.19|10292.4|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100881.19|84474.53|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100881.19|21400.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100881.19|20900.22|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100881.19|3400|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|100881.19|309|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|Self-pay|Self-pay|100881.19|30264.36|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100881.19|18841.47|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100881.19|22342.01|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100881.19|17172.86|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100881.19|8492.23|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100881.19|7673.3|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100881.19|81749.55|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100881.19|725|84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100881.19||84474.53|309||||
MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100881.19|16456.29|84474.53|309||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218452.22|71907.41|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218452.22|76481.86|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218452.22|64368.84|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|218452.22|42637.6|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218452.22|80461.05|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|GEHA [1415]|GEHA [141500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|218452.22|44732.01|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218452.22|64368.84|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|218452.22|115121.2|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218452.22|55448|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218452.22|54151.66|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218452.22|2550|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MULTIPLAN [1680]|HMA [168003]|218452.22|756.01|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|Self-pay|Self-pay|218452.22|65535.67|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218452.22|47878.38|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218452.22|48708.25|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218452.22|44446.37|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|UMR [2035]|UMR OPTIONS [203501]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218452.22|8438.43|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218452.22|111407.62|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|218452.22|2900|115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|218452.22||115121.2|756.01||||
MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|218452.22|42637.6|115121.2|756.01||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126766.08|102546.7|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126766.08|53785.11|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126766.08|91795.96|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|126766.08|20087.84|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126766.08|114744.95|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|GEHA [1415]|GEHA [141500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|126766.08|20718.4|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126766.08|91795.96|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|126766.08|164173.54|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126766.08|26123.2|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126766.08|25512.46|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126766.08|1700|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MULTIPLAN [1680]|HMA [168003]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|Self-pay|Self-pay|126766.08|38029.82|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126766.08|23273.33|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126766.08|22271.66|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126766.08|20934|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|UMR [2035]|UMR OPTIONS [203501]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126766.08|6535.16|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126766.08|12046.24|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126766.08|158877.63|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|126766.08|7250|164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|126766.08||164173.54|1700||||
MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|126766.08|20087.84|164173.54|1700||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82449.64|46483.08|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82449.64|83087.06|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82449.64|9565.65|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82449.64|14270.89|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82449.64|52012.4|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82449.64|14718.85|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82449.64|9565.65|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82449.64|74417.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82449.64|18558.55|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82449.64|18124.66|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82449.64|1700|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|82449.64|164.5|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|Self-pay|Self-pay|82449.64|24734.89|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82449.64|17094.69|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82449.64|19359.74|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82449.64|14880.59|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82449.64|5203.63|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82449.64|9341.14|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82449.64|72017.17|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82449.64|2175|83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82449.64||83087.06|164.5||||
MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82449.64|14270.89|83087.06|164.5||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75997.38|41747.77|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75997.38|37052.15|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75997.38|12464.57|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75997.38|19156.82|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75997.38|46713.8|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|GEHA [1415]|GEHA [141500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75997.38|19758.15|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75997.38|12464.57|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75997.38|66836.67|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75997.38|24912.45|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75997.38|24330.01|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75997.38|1700|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|75997.38|259.73|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75997.38|42993.4|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|Self-pay|Self-pay|75997.38|22799.21|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75997.38|22157.93|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75997.38|25979.43|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75997.38|19968.71|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75997.38|6418.42|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75997.38|12304.83|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75997.38|64680.64|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75997.38|1450|66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75997.38||66836.67|259.73||||
MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75997.38|19156.82|66836.67|259.73||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|68839.31|14441.05|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68839.31|14441.05|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68839.31|39851.29|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68839.31|38846.08|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68839.31|17132.5|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68839.31|17132.5|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68839.31|8037.86|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68839.31|17132.5|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68839.31|12630.72|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68839.31|44591.73|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68839.31|13027.2|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68839.31|8037.86|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68839.31|63800.47|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68839.31|16425.6|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68839.31|14441.05|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68839.31|16041.58|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68839.31|2550|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68839.31|14441.05|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|68839.31|363.03|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68839.31|39593.38|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68839.31|14441.05|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|Self-pay|Self-pay|68839.31|20651.79|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68839.31|14527.24|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68839.31|14441.05|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68839.31|13168.65|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68839.31|5609.55|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68839.31|7657.14|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68839.31|61742.4|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68839.31|2175|63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68839.31||63800.47|363.03||||
MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68839.31|12630.72|63800.47|363.03||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96234.71|31291.05|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|GEHA [1415]|GEHA [141500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96234.71|2550|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|Self-pay|Self-pay|96234.71|28870.41|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96234.71|5365.5|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96234.71|12005.56|31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|96234.71||31291.05|2550||||
MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|96234.71||31291.05|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73724.51|42826.55|42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|GEHA [1415]|GEHA [141500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73724.51|2550|42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|Self-pay|Self-pay|73724.51|22117.35|42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73724.51|5894.78|42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|73724.51||42826.55|2550||||
MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|73724.51||42826.55|2550||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|Self-pay|Self-pay|89590.41|26877.12|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89590.41|10798.68|26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89590.41||26877.12|10798.68||||
MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89590.41||26877.12|10798.68||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43510.52|25275.25|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43510.52|850|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|Self-pay|Self-pay|43510.52|13053.16|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43510.52|4119.28|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43510.52|7036.19|25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43510.52||25275.25|850||||
MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43510.52||25275.25|850||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|GEHA [1415]|GEHA [141500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MULTIPLAN [1680]|HMA [168003]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|Self-pay|Self-pay|62689.5|18806.85|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|UMR [2035]|UMR OPTIONS [203501]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62689.5|9799.02|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62689.5|0|18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62689.5||18806.85|9799.02||||
MS748|DRG||Female Reproductive System Reconstructive Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62689.5|0|18806.85|9799.02||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119160.78|24604.25|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119160.78|45570.52|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119160.78|20624.36|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|119160.78|30258.87|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119160.78|27531|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|119160.78|31208.7|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119160.78|20624.36|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|119160.78|39390.51|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119160.78|39350.1|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119160.78|38430.12|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119160.78|1700|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|119160.78|51.8|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|Self-pay|Self-pay|119160.78|35748.23|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119160.78|34842.39|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119160.78|31065.28|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119160.78|31487.06|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119160.78|8909.63|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119160.78|18032.67|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119160.78|38119.84|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|119160.78|1450|45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|119160.78||45570.52|51.8||||
MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|119160.78|30258.87|45570.52|51.8||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52154.58|53370.74|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52154.58|30296.59|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52154.58|9612.48|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52154.58|16321.37|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52154.58|59719.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52154.58|17916.62|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52154.58|9612.48|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52154.58|85444.66|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52154.58|21225.1|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52154.58|20728.87|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52154.58|1700|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|52154.58|1082.92|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|52154.58|15646.37|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52154.58|17573.3|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52154.58|22180.11|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52154.58|17048.42|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52154.58|6326.35|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52154.58|82688.38|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52154.58|2175|85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52154.58||85444.66|1082.92||||
MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52154.58|16321.37|85444.66|1082.92||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59005.37|49573.4|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59005.37|18953.76|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59005.37|15848|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|59005.37|20362.13|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59005.37|55470.31|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|GEHA [1415]|GEHA [141500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|59005.37|22629.94|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59005.37|15848|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|59005.37|79365.22|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59005.37|26479.9|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59005.37|25860.82|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59005.37|1700|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MULTIPLAN [1680]|HMA [168003]|59005.37|1628.64|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|Self-pay|Self-pay|59005.37|17701.61|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59005.37|24207.56|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59005.37|27553.02|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59005.37|21178.23|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|UMR [2035]|UMR OPTIONS [203501]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59005.37|7999.27|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59005.37|76805.06|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|59005.37|5075|79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|59005.37||79365.22|1628.64||||
MS754|DRG||Malignancy, Female Reproductive System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|59005.37|20362.13|79365.22|1628.64||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52975.15|77160.37|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52975.15|16503.97|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52975.15|69071.11|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52975.15|12591.7|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52975.15|86338.88|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|GEHA [1415]|GEHA [141500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52975.15|12986.95|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52975.15|69071.11|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52975.15|123531.01|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52975.15|16374.85|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52975.15|15992.02|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52975.15|2550|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MULTIPLAN [1680]|HMA [168003]|52975.15|193.9|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|Self-pay|Self-pay|52975.15|15892.54|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52975.15|14839.55|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52975.15|17061.39|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52975.15|13113.99|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|UMR [2035]|UMR OPTIONS [203501]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52975.15|4722.5|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52975.15|8322.59|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52975.15|119546.15|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52975.15|9425|123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52975.15||123531.01|193.9||||
MS755|DRG||Malignancy, Female Reproductive System With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52975.15|12591.7|123531.01|193.9||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36604|21263.26|21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|GEHA [1415]|GEHA [141500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36604|2550|21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|Self-pay|Self-pay|36604|10981.2|21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36604|3308.43|21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36604||21263.26|2550||||
MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36604||21263.26|2550||||
MS757|DRG||Infections, Female Reproductive System With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79503.67|26819.06|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79503.67|46183.7|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79503.67|12433.08|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79503.67|17000.41|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79503.67|30009.28|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|GEHA [1415]|GEHA [141500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79503.67|18387.71|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79503.67|12433.08|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79503.67|42936.36|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79503.67|22108.15|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79503.67|21591.28|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79503.67|3400|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MULTIPLAN [1680]|HMA [168003]|79503.67|853.66|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MULTIPLAN [1680]|IHC HS [168011]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|Self-pay|Self-pay|79503.67|23851.1|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79503.67|19813.56|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|TRUSTMARK [2030]|STARMARK [203000]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79503.67|17702.02|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|UMR [2035]|UMR OPTIONS [203501]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79503.67|4501.37|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79503.67|10996.81|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79503.67|41551.31|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79503.67|2900|46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79503.67||46183.7|853.66||||
MS757|DRG||Infections, Female Reproductive System With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79503.67|17000.41|46183.7|853.66||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11063.58|6426.84|6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|GEHA [1415]|GEHA [141500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11063.58|1700|6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MULTIPLAN [1680]|HMA [168003]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|Self-pay|Self-pay|11063.58|3319.07|6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|UMR [2035]|UMR OPTIONS [203501]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11063.58|3001.38|6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11063.58||6426.84|1700||||
MS758|DRG||Infections, Female Reproductive System With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11063.58||6426.84|1700||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32064.45|30487.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32064.45|15237.98|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32064.45|5596.78|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32064.45|7619.91|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32064.45|34113.87|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|GEHA [1415]|GEHA [141500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32064.45|8977.06|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32064.45|5596.78|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32064.45|48809.08|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32064.45|9909.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32064.45|9677.63|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32064.45|850|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|32064.45|1117.96|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|Self-pay|Self-pay|32064.45|9619.33|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32064.45|9674.91|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32064.45|10337.3|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32064.45|7945.62|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32064.45|2743.01|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32064.45|4707.9|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32064.45|47234.59|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32064.45|4350|48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32064.45||48809.08|850||||
MS759|DRG||Infections, Female Reproductive System Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32064.45|7619.91|48809.08|850||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20085.2|9256.65|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20085.2|19148.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20085.2|6782.19|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20085.2|10259.12|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20085.2|10357.75|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|GEHA [1415]|GEHA [141500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20085.2|10581.15|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20085.2|6782.19|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|20085.2|14819.55|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20085.2|13341.45|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20085.2|13029.54|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20085.2|1700|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|20085.2|31.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|Self-pay|Self-pay|20085.2|6025.56|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20085.2|11608.27|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20085.2|5757.53|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20085.2|11758.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20085.2|10729.84|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20085.2|3425.7|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20085.2|6150.77|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20085.2|14341.5|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20085.2|725|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20085.2|4813.14|19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20085.2||19148.5|31.5||||
MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20085.2|10259.12|19148.5|31.5||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23213.25|3730.54|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23213.25|4027.81|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23213.25|4816.5|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23213.25|4174.3|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23213.25|6422|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23213.25|4027.81|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23213.25|5972.46|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23213.25|6422|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23213.25|6422|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|23213.25|123.9|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|Self-pay|Self-pay|23213.25|6963.97|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23213.25|6422|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23213.25|6318.72|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23213.25|6422|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23213.25|5779.8|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23213.25|725|6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23213.25||6963.97|123.9||||
MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23213.25|4816.5|6963.97|123.9||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|AETNA [1015]|AETNA ACO WILCO [101532]|30091.89|14922.06|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30091.89|14922.06|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30091.89|17176.38|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30091.89|17883.03|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30091.89|17715.04|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30091.89|17715.04|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30091.89|9031.08|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30091.89|14922.06|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30091.89|13041.04|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30091.89|19219.55|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|CORESOURCE [1315]|CORESOURCE [131500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|GEHA [1415]|GEHA [141500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30091.89|10216.8|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HEALTHNET [1495]|HEALTHNET [149500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30091.89|9031.08|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30091.89|27498.73|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30091.89|16959.2|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30091.89|14922.06|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30091.89|16562.71|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30091.89|2550|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30091.89|14922.06|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MULTIPLAN [1680]|HMA [168003]|30091.89|608.4|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MULTIPLAN [1680]|IHC HS [168011]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30091.89|17829.5|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30091.89|14922.06|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|Self-pay|Self-pay|30091.89|9027.57|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30091.89|15327.62|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30091.89|29028.84|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30091.89|14871.91|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|TRUSTMARK [2030]|STARMARK [203000]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30091.89|13616.4|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|UMR [2035]|UMR OPTIONS [203501]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30091.89|3933.08|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30091.89|26611.67|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30091.89|2175|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30091.89|24190.7|29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30091.89||29028.84|608.4||||
MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30091.89|13041.04|29028.84|608.4||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82594.61|47979.22|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82594.61|55559.92|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82594.61|15285.98|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82594.61|18036.24|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82594.61|53686.5|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|GEHA [1415]|GEHA [141500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82594.61|19507.19|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82594.61|15285.98|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82594.61|76812.98|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82594.61|23455.2|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82594.61|22906.83|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82594.61|2550|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MULTIPLAN [1680]|HMA [168003]|82594.61|904.79|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82594.61|30940.71|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|Self-pay|Self-pay|82594.61|24778.38|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82594.61|23307.13|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82594.61|54178.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82594.61|20117.31|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82594.61|18845.25|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|UMR [2035]|UMR OPTIONS [203501]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82594.61|4556.68|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82594.61|74335.14|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82594.61|2175|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82594.61|45195.1|76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82594.61||76812.98|904.79||||
MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82594.61|18036.24|76812.98|904.79||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|AETNA [1015]|AETNA ACO WILCO [101532]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43327.49|24737.03|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43327.49|25168.94|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43327.49|6483.42|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|43327.49|9921.27|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43327.49|27679.56|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|CORESOURCE [1315]|CORESOURCE [131500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|CORVEL CORP [2235]|CORVEL CORP [223500]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|GEHA [1415]|GEHA [141500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|43327.49|10232.7|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HEALTHNET [1495]|HEALTHNET [149500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43327.49|6483.42|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HEALTHSMART [1505]|HEALTHSMART [150501]|43327.49|39603.07|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43327.49|12902.1|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43327.49|12600.46|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43327.49|850|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MULTIPLAN [1680]|HMA [168003]|43327.49|91.71|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MULTIPLAN [1680]|IHC HS [168011]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|Self-pay|Self-pay|43327.49|12998.25|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43327.49|10651.06|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|43327.49|47520.6|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43327.49|13437.58|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|TRUSTMARK [2030]|STARMARK [203000]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43327.49|10328.6|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|UMR [2035]|UMR OPTIONS [203501]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43327.49|2785.05|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43327.49|38325.55|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|43327.49|725|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|43327.49|39600.51|47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|43327.49||47520.6|91.71||||
MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|43327.49|9921.27|47520.6|91.71||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|AETNA [1015]|AETNA ACO WILCO [101532]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24029.83|14510.93|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24029.83|13372.36|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24029.83|6554.48|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|24029.83|8635.68|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24029.83|16237.04|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|CORESOURCE [1315]|CORESOURCE [131500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|CORVEL CORP [2235]|CORVEL CORP [223500]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|GEHA [1415]|GEHA [141500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|24029.83|8906.75|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HEALTHNET [1495]|HEALTHNET [149500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24029.83|6554.48|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HEALTHSMART [1505]|HEALTHSMART [150501]|24029.83|23231.46|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24029.83|11230.25|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24029.83|10967.69|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24029.83|2550|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MULTIPLAN [1680]|HMA [168003]|24029.83|146.66|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MULTIPLAN [1680]|IHC HS [168011]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|24029.83|17834.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|Self-pay|Self-pay|24029.83|7208.95|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24029.83|10914.7|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|24029.83|16978.76|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24029.83|11632.49|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|TRUSTMARK [2030]|STARMARK [203000]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24029.83|8941.14|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|UMR [2035]|UMR OPTIONS [203501]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24029.83|2622.42|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24029.83|22482.06|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|24029.83|1450|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24029.83|14197.04|23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|24029.83||23231.46|146.66||||
MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|24029.83|8635.68|23231.46|146.66||||
MS779|DRG||Abortion Without D&C|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|AETNA [1015]|AETNA ACO WILCO [101532]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27235.33|13751.27|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27235.33|13251.56|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27235.33|5159.12|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27235.33|11807.85|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27235.33|15387.02|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|CORESOURCE [1315]|CORESOURCE [131500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|GEHA [1415]|GEHA [141500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27235.33|12888.33|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HEALTHNET [1495]|HEALTHNET [149500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27235.33|5159.12|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27235.33|22015.26|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27235.33|15355.5|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27235.33|14996.5|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27235.33|850|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MULTIPLAN [1680]|HMA [168003]|27235.33|709.83|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MULTIPLAN [1680]|IHC HS [168011]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|Self-pay|Self-pay|27235.33|8170.6|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27235.33|9105.72|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27235.33|10593.63|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|TRUSTMARK [2030]|STARMARK [203000]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27235.33|12099.85|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|UMR [2035]|UMR OPTIONS [203501]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27235.33|0|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27235.33|21305.1|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27235.33|725|22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27235.33||22015.26|709.83||||
MS779|DRG||Abortion Without D&C|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27235.33|11807.85|22015.26|709.83||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63047.59|103876.07|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63047.59|36641.46|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63047.59|20905.14|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63047.59|116232.47|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|GEHA [1415]|GEHA [141500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63047.59|17125.08|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63047.59|92985.98|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63047.59|166301.85|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63047.59|27186.05|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63047.59|26550.46|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63047.59|4250|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MULTIPLAN [1680]|HMA [168003]|63047.59|1062.54|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|Self-pay|Self-pay|63047.59|18914.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63047.59|49536.19|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63047.59|28335.28|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63047.59|21779.5|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|UMR [2035]|UMR OPTIONS [203501]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63047.59|6072.32|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63047.59|160937.27|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63047.59|4350|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63047.59|41280.16|166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63047.59||166301.85|1062.54||||
MS783|DRG||Cesarean Section With Sterilization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63047.59|20905.14|166301.85|1062.54||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52326.24|28744.08|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52326.24|31529.07|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52326.24|12219.29|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52326.24|32163.27|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|GEHA [1415]|GEHA [141500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52326.24|9000|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52326.24|8439.99|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52326.24|46018.22|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52326.24|15890.55|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52326.24|15519.04|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52326.24|1700|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MULTIPLAN [1680]|HMA [168003]|52326.24|232.47|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52326.24|40190.55|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|Self-pay|Self-pay|52326.24|15697.87|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52326.24|50717.88|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52326.24|16566.61|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52326.24|12733.69|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|UMR [2035]|UMR OPTIONS [203501]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52326.24|4152.15|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52326.24|44533.76|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52326.24|1450|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52326.24|42264.9|50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52326.24||50717.88|232.47||||
MS784|DRG||Cesarean Section With Sterilization With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52326.24|12219.29|50717.88|232.47||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46137.18|26120.9|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46137.18|27352.97|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|46137.18|7583.27|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|46137.18|10222.32|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46137.18|29228.06|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|GEHA [1415]|GEHA [141500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|46137.18|9000|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46137.18|6931.58|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|46137.18|41818.6|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46137.18|13293.6|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46137.18|12982.8|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46137.18|1700|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|46137.18|170.35|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|Self-pay|Self-pay|46137.18|13841.15|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|46137.18|44430.6|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46137.18|11665.66|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46137.18|10644.94|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46137.18|4222.38|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46137.18|40469.62|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|46137.18|725|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46137.18|37025.5|44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|46137.18||44430.6|170.35||||
MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|46137.18|10222.32|44430.6|170.35||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63070.11|35217.33|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63070.11|36380.65|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63070.11|17777.56|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63070.11|39406.51|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63070.11||58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63070.11||58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|GEHA [1415]|GEHA [141500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63070.11|12264.5|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63070.11|13844.59|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63070.11|56381.62|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63070.11|23118.8|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63070.11||58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63070.11|22578.3|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63070.11|3400|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MULTIPLAN [1680]|HMA [168003]|63070.11|632.25|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MULTIPLAN [1680]|IHC HS [168011]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63070.11||58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63070.11|35337.5|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|Self-pay|Self-pay|63070.11|18921.03|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63070.11|58911.38|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63070.11|24074.47|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|TRUSTMARK [2030]|STARMARK [203000]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63070.11|18504.49|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|UMR [2035]|UMR OPTIONS [203501]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63070.11|6564.78|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63070.11|11468.23|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63070.11|54562.87|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63070.11|2900|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63070.11|49092.83|58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63070.11||58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63070.11||58911.38|632.25||||
MS786|DRG||Cesarean Section Without Sterilization With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63070.11|17777.56|58911.38|632.25||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|53084.72|13719.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53084.72|13719.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53084.72|30778.01|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53084.72|30061.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53084.72|16079.41|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53084.72|16079.41|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53084.72|13544.3|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53084.72|13544.3|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53084.72|11868.06|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53084.72|34439.17|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53084.72||49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53084.72||49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|GEHA [1415]|GEHA [141500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53084.72|9000|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53084.72|8442.41|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53084.72|49274.49|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53084.72|15433.8|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53084.72||49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53084.72|13719.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53084.72|15072.97|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53084.72|2550|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53084.72|13719.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MULTIPLAN [1680]|HMA [168003]|53084.72|347.45|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53084.72||49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53084.72|36273.52|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53084.72|13719.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|Self-pay|Self-pay|53084.72|15925.42|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53084.72|13719.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53084.72|47294.95|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53084.72|13640.2|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53084.72|12359.2|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|UMR [2035]|UMR OPTIONS [203501]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53084.72|4316.56|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53084.72|7883.64|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53084.72|47685|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53084.72|2175|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53084.72|39412.46|49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53084.72||49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53084.72||49274.49|347.45||||
MS787|DRG||Cesarean Section Without Sterilization With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53084.72|11868.06|49274.49|347.45||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48691.89|28117.13|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48691.89|28262.13|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48691.89|7349.63|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48691.89|7349.63|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48691.89|9894.51|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48691.89|31461.75|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|48691.89||45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48691.89||45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|GEHA [1415]|GEHA [141500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48691.89|9000|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48691.89|7317.57|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|48691.89|45014.5|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48691.89|12867.3|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48691.89||45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48691.89|12566.47|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48691.89|2550|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|48691.89|207.84|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48691.89||45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|48691.89|28850.07|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48691.89|4119.59|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|Self-pay|Self-pay|48691.89|14607.57|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48691.89|11306.25|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48691.89|42985.57|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48691.89|11567.81|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48691.89|10316.97|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48691.89|4414.87|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48691.89|6686.53|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48691.89|43562.42|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|48691.89|2175|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48691.89|35821.31|45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48691.89||45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48691.89||45014.5|207.84||||
MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48691.89|9894.51|45014.5|207.84||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|AETNA [1015]|AETNA ACO WILCO [101532]|67385|3917.52|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67385|3917.52|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67385|60760.79|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67385|22949.93|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|67385|1885.8|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67385|3583.59|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67385|54390.8|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|67385|3583.59|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|67385|19178|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67385|67988.49|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|CORESOURCE [1315]|CORESOURCE [131500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|CORVEL CORP [2235]|CORVEL CORP [223500]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|GEHA [1415]|GEHA [141500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|67385|9091.96|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HEALTHNET [1495]|HEALTHNET [149500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67385|54390.8|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HEALTHSMART [1505]|HEALTHSMART [150501]|67385|97275.85|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67385|24940|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67385|3917.52|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67385|24356.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67385|850|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67385|3917.52|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MULTIPLAN [1680]|HMA [168003]|67385|545.98|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MULTIPLAN [1680]|IHC HS [168011]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|67385|46173.41|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67385|3917.52|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|Self-pay|Self-pay|67385|20215.5|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67385|22189.02|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67385|3917.52|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|TRUSTMARK [2030]|STARMARK [203000]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67385|19986.16|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|UMR [2035]|UMR OPTIONS [203501]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67385|10896.93|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67385|94137.92|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|67385|1450|97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|67385||97275.85|545.98||||
MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|67385|19178|97275.85|545.98||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|AETNA [1015]|AETNA ACO WILCO [101532]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|846482.33|509682.17|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|846482.33|440691.62|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|846482.33|456248.44|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|846482.33|72228.21|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|846482.33|438700.43|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|846482.33|570310.55|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|CORESOURCE [1315]|CORESOURCE [131500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|CORVEL CORP [2235]|CORVEL CORP [223500]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|GEHA [1415]|GEHA [141500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|846482.33|146840.74|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HEALTHNET [1495]|HEALTHNET [149500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|846482.33|456248.44|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HEALTHSMART [1505]|HEALTHSMART [150501]|846482.33|815982.79|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|846482.33|394830.38|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|846482.33|394830.38|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|846482.33|29750|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MULTIPLAN [1680]|HMA [168003]|846482.33|1420.37|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MULTIPLAN [1680]|IHC HS [168011]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|846482.33|418832.76|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|Self-pay|Self-pay|846482.33|253944.7|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|846482.33|438700.43|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|846482.33|202440.72|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|846482.33|85747.25|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|TRUSTMARK [2030]|STARMARK [203000]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|846482.33|65908.37|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|UMR [2035]|UMR OPTIONS [203501]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|846482.33|143869.45|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|846482.33|789660.77|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|846482.33|26100|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|846482.33|168700.6|815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|846482.33||815982.79|1420.37||||
MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|846482.33|438700.43|815982.79|1420.37||||
MS791|DRG||Prematurity With Major Problems|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|AETNA [1015]|AETNA ACO WILCO [101532]|364373.55|49966.86|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|364373.55|49966.86|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|364373.55|137223.87|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|364373.55|219019.63|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|364373.55|58561.9|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|364373.55|49328.94|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|364373.55|122837.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|364373.55|49328.94|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|364373.55|43192.87|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|364373.55|153547.11|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|CORESOURCE [1315]|CORESOURCE [131500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|CORVEL CORP [2235]|CORVEL CORP [223500]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|GEHA [1415]|GEHA [141500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|364373.55|60000|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HEALTHNET [1495]|HEALTHNET [149500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|364373.55|122837.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HEALTHSMART [1505]|HEALTHSMART [150501]|364373.55|219690.48|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|364373.55|56170.1|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|364373.55|49966.86|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|364373.55|54856.88|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|364373.55|11900|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|364373.55|49966.86|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MULTIPLAN [1680]|HMA [168003]|364373.55|35.92|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MULTIPLAN [1680]|IHC HS [168011]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|364373.55|190495.67|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|364373.55|49966.86|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|Self-pay|Self-pay|364373.55|109312.06|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|364373.55|49973.98|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|364373.55|837765.87|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|364373.55|46533.89|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|TRUSTMARK [2030]|STARMARK [203000]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|364373.55|45012.75|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|UMR [2035]|UMR OPTIONS [203501]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|364373.55|62362.5|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|364373.55|212603.69|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|364373.55|10875|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|364373.55|698138.23|837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|364373.55||837765.87|35.92||||
MS791|DRG||Prematurity With Major Problems|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|364373.55|43192.87|837765.87|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|AETNA [1015]|AETNA ACO WILCO [101532]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49297.33|26797.51|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49297.33|28629.49|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49297.33|19347.98|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49297.33|17060.05|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49297.33|26062.01|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49297.33|29985.16|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|CORESOURCE [1315]|CORESOURCE [131500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|GEHA [1415]|GEHA [141500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49297.33|8000|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HEALTHNET [1495]|HEALTHNET [149500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49297.33|17060.05|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49297.33|42901.84|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49297.33|33892.3|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49297.33|33099.92|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49297.33|3400|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MULTIPLAN [1680]|HMA [168003]|49297.33|35.92|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MULTIPLAN [1680]|IHC HS [168011]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49297.33|29609.37|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|Self-pay|Self-pay|49297.33|14789.2|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49297.33|30152.3|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49297.33|73112.39|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49297.33|29763.82|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|TRUSTMARK [2030]|STARMARK [203000]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49297.33|27159.54|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|UMR [2035]|UMR OPTIONS [203501]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49297.33|3089.81|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49297.33|41517.91|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49297.33|1450|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49297.33|60926.99|73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49297.33||73112.39|35.92||||
MS792|DRG||Prematurity Without Major Problems|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49297.33|26062.01|73112.39|35.92||||
MS793|DRG||Full Term Neonate With Major Problems|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|AETNA [1015]|AETNA ACO WILCO [101532]|79113.17|50671.01|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79113.17|50671.01|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79113.17|35058.67|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79113.17|51920.9|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|79113.17|60155.16|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79113.17|60155.16|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79113.17|29044.16|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|79113.17|50671.01|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|79113.17|44368.08|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79113.17|39229.02|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|CORESOURCE [1315]|CORESOURCE [131500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|CORVEL CORP [2235]|CORVEL CORP [223500]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|GEHA [1415]|GEHA [141500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|79113.17|12000|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HEALTHNET [1495]|HEALTHNET [149500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79113.17|29044.16|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HEALTHSMART [1505]|HEALTHSMART [150501]|79113.17|56127.67|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79113.17|57698.4|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79113.17|50671.01|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79113.17|56349.45|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79113.17|2550|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79113.17|50671.01|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MULTIPLAN [1680]|HMA [168003]|79113.17|108.02|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MULTIPLAN [1680]|IHC HS [168011]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|79113.17|54577.82|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79113.17|50671.01|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|Self-pay|Self-pay|79113.17|23733.95|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79113.17|51334.09|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|79113.17|99043.41|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79113.17|47767.96|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|TRUSTMARK [2030]|STARMARK [203000]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79113.17|46237.39|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|UMR [2035]|UMR OPTIONS [203501]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79113.17|5121.42|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79113.17|54317.1|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|79113.17|2175|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|79113.17|82536.18|99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|79113.17||99043.41|108.02||||
MS793|DRG||Full Term Neonate With Major Problems|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|79113.17|44368.08|99043.41|108.02||||
MS794|DRG||Neonate With Other Significant Problems|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|AETNA [1015]|AETNA ACO WILCO [101532]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14491.26|8277.44|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14491.26|8817.94|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14491.26|10280.28|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|14491.26|10687|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14491.26|9262.07|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|CORESOURCE [1315]|CORESOURCE [131500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|CORVEL CORP [2235]|CORVEL CORP [223500]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|GEHA [1415]|GEHA [141500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|14491.26|3000|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HEALTHNET [1495]|HEALTHNET [149500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14491.26|10280.28|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HEALTHSMART [1505]|HEALTHSMART [150501]|14491.26|13251.88|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14491.26|14249.33|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14491.26|14249.33|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14491.26|1700|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MULTIPLAN [1680]|HMA [168003]|14491.26|35.92|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MULTIPLAN [1680]|IHC HS [168011]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|14491.26|7473.1|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|Self-pay|Self-pay|14491.26|4347.38|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14491.26|14249.33|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|14491.26|12952.58|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14491.26|17935.02|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|TRUSTMARK [2030]|STARMARK [203000]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14491.26|14249.33|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|UMR [2035]|UMR OPTIONS [203501]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14491.26|1092.65|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14491.26|12824.4|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|14491.26|1450|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14491.26|10793.82|17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|14491.26||17935.02|35.92||||
MS794|DRG||Neonate With Other Significant Problems|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|14491.26|10687|17935.02|35.92||||
MS795|DRG||Normal Newborn|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|AETNA [1015]|AETNA ACO WILCO [101532]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5828.33|3518.71|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5828.33|3538.88|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5828.33|1392.13|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5828.33|2126.31|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5828.33|3937.27|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|CORESOURCE [1315]|CORESOURCE [131500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|GEHA [1415]|GEHA [141500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5828.33|3000|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HEALTHNET [1495]|HEALTHNET [149500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5828.33|1392.13|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5828.33|5633.32|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5828.33|2765.15|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5828.33|2700.5|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5828.33|1700|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MULTIPLAN [1680]|HMA [168003]|5828.33|35.92|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MULTIPLAN [1680]|IHC HS [168011]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5828.33|3631.83|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|Self-pay|Self-pay|5828.33|1748.5|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5828.33|2459.29|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5828.33|7883.17|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5828.33|2427.96|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|TRUSTMARK [2030]|STARMARK [203000]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5828.33|2215.52|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|UMR [2035]|UMR OPTIONS [203501]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5828.33|648.61|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5828.33|5451.6|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|5828.33|1450|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5828.33|6569.31|7883.17|35.92||||
MS795|DRG||Normal Newborn|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5828.33||7883.17|35.92||||
MS795|DRG||Normal Newborn|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5828.33|2126.31|7883.17|35.92||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34375.73|19968.86|19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|GEHA [1415]|GEHA [141500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34375.73|2550|19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MULTIPLAN [1680]|HMA [168003]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MULTIPLAN [1680]|IHC HS [168011]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|Self-pay|Self-pay|34375.73|10312.72|19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|TRUSTMARK [2030]|STARMARK [203000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|UMR [2035]|UMR OPTIONS [203501]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34375.73|3590.09|19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34375.73||19968.86|2550||||
MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34375.73||19968.86|2550||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24878.36|15350.71|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24878.36|14389.02|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|24878.36|10251.31|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24878.36|17176.73|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|GEHA [1415]|GEHA [141500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|24878.36|7000|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24878.36|6967.11|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|24878.36|24575.94|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24878.36|13331.3|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24878.36|13019.62|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24878.36|1700|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MULTIPLAN [1680]|HMA [168003]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|Self-pay|Self-pay|24878.36|7463.51|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24878.36|8948.52|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24878.36|10698.44|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|UMR [2035]|UMR OPTIONS [203501]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24878.36|3060.81|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24878.36|23783.17|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|24878.36|1450|24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|24878.36||24575.94|1450||||
MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|24878.36|10251.31|24575.94|1450||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49498.09|28693.94|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49498.09|28746.79|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49498.09|9226.63|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49498.09|32107.16|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|GEHA [1415]|GEHA [141500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49498.09|7000|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49498.09|6967.11|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49498.09|45937.92|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49498.09|11998.75|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49498.09|11718.23|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49498.09|1700|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|49498.09|171.37|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|Self-pay|Self-pay|49498.09|14849.43|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49498.09|12517.64|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49498.09|9621.5|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49498.09|2821.19|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49498.09|44456.05|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49498.09|1450|45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49498.09||45937.92|171.37||||
MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49498.09|9226.63|45937.92|171.37||||
MS799|DRG||Splenectomy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|GEHA [1415]|GEHA [141500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MULTIPLAN [1680]|HMA [168003]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|75768.66|44014.01|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|Self-pay|Self-pay|75768.66|22730.6|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|UMR [2035]|UMR OPTIONS [203501]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75768.66|151150.03|151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|75768.66||151150.03|22730.6||||
MS799|DRG||Splenectomy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|75768.66||151150.03|22730.6||||
MS801|DRG||Splenectomy Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63726.64|36000.51|36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|GEHA [1415]|GEHA [141500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63726.64|850|36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|Self-pay|Self-pay|63726.64|19117.99|36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63726.64|10127.8|36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|63726.64||36000.51|850||||
MS801|DRG||Splenectomy Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|63726.64||36000.51|850||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154082.01|86213.14|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|GEHA [1415]|GEHA [141500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154082.01|2550|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MULTIPLAN [1680]|HMA [168003]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MULTIPLAN [1680]|IHC HS [168011]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|Self-pay|Self-pay|154082.01|46224.6|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|TRUSTMARK [2030]|STARMARK [203000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|UMR [2035]|UMR OPTIONS [203501]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154082.01|16788.03|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154082.01|24581.52|86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|154082.01||86213.14|2550||||
MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|154082.01||86213.14|2550||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|115665.42|67190.04|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|115665.42|60146.02|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|115665.42|21034.48|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|115665.42|75182.53|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|GEHA [1415]|GEHA [141500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|115665.42|23874.87|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|115665.42|60146.02|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|115665.42|107568.84|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|115665.42|27354.25|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|115665.42|26714.73|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MULTIPLAN [1680]|HMA [168003]|115665.42|2180.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|Self-pay|Self-pay|115665.42|34699.63|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|115665.42|25151.26|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|115665.42|24022.12|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|115665.42|21920.22|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|UMR [2035]|UMR OPTIONS [203501]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|115665.42|104098.88|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|115665.42|5800|107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|115665.42||107568.84|2180.12||||
MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|115665.42|21034.48|107568.84|2180.12||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53113.56|30853.67|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53113.56|9903.99|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53113.56|15229.79|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53113.56|34523.82|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|GEHA [1415]|GEHA [141500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53113.56|16369.81|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53113.56|9903.99|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53113.56|49395.62|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53113.56|19805.55|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53113.56|19342.51|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|53113.56|661.96|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|Self-pay|Self-pay|53113.56|15934.07|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53113.56|16205.07|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53113.56|20234.19|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53113.56|15865.65|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53113.56|47802.21|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53113.56|725|49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53113.56||49395.62|661.96||||
MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53113.56|15229.79|49395.62|661.96||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|31008.19|13407.64|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31008.19|13407.64|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31008.19|16643.6|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31008.19|18164.7|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|31008.19|15536.21|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31008.19|15536.21|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31008.19|15536.21|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|31008.19|13086.75|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|31008.19|11483.39|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31008.19|18623.44|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|31008.19||31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|31008.19||31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|GEHA [1415]|GEHA [141500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|31008.19|7000|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31008.19|8403.65|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|31008.19|26645.84|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31008.19|14933.55|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|31008.19||31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31008.19|13407.64|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31008.19|14584.41|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31008.19|2550|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31008.19|13407.64|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MULTIPLAN [1680]|HMA [168003]|31008.19|20.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MULTIPLAN [1680]|IHC HS [168011]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31008.19||31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|31008.19|16880.62|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31008.19|13407.64|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|Self-pay|Self-pay|31008.19|9302.46|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31008.19|13407.64|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|31008.19|31514.31|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31008.19|13236.24|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|TRUSTMARK [2030]|STARMARK [203000]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31008.19|11941.68|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|UMR [2035]|UMR OPTIONS [203501]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31008.19|2797.62|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31008.19|7695.49|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31008.19|25786.3|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31008.19|1450|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31008.19|26261.93|31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31008.19||31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|31008.19||31514.31|20.3||||
MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|31008.19|11483.39|31514.31|20.3||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27066.5|15456.23|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27066.5|15966.88|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27066.5|9353.69|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27066.5|8190.79|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27066.5|17294.81|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27066.5||24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27066.5||24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|GEHA [1415]|GEHA [141500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27066.5|7000|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27066.5|5726.79|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27066.5|24744.88|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27066.5|10651.7|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27066.5||24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27066.5|10402.67|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27066.5|1700|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27066.5|7631.69|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MULTIPLAN [1680]|HMA [168003]|27066.5|71.05|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27066.5||24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27066.5|15432.93|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27066.5|10303.79|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|Self-pay|Self-pay|27066.5|8119.95|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27066.5|11104.43|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27066.5|23545.38|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27066.5|9778.78|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27066.5|8535.26|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|UMR [2035]|UMR OPTIONS [203501]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27066.5|1934.01|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27066.5|5685.34|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27066.5|23946.66|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27066.5|1450|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27066.5|19621.15|24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27066.5||24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27066.5||24744.88|71.05||||
MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27066.5|8190.79|24744.88|71.05||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24782.93|14454.51|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24782.93|14342.53|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|24782.93|7161.65|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24782.93|16173.93|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|24782.93||23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|24782.93||23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|GEHA [1415]|GEHA [141500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|24782.93|7569.64|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24782.93|5061.41|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|24782.93|23141.16|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24782.93|9313.35|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|24782.93||23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24782.93|9095.61|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24782.93|1700|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|24782.93|569.64|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|24782.93||23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|24782.93|14380.09|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|Self-pay|Self-pay|24782.93|7434.88|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|24782.93|22571.12|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24782.93|9700.3|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24782.93|7455.99|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24782.93|1740.9|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24782.93|5028.84|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24782.93|22394.68|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|24782.93|1450|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24782.93|18809.27|23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|24782.93||23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|24782.93||23141.16|569.64||||
MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|24782.93|7161.65|23141.16|569.64||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|GEHA [1415]|GEHA [141500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|53206.09|14093|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|Self-pay|Self-pay|53206.09|15961.83|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53206.09|14567.6|15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|53206.09||15961.83|14093||||
MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|53206.09||15961.83|14093||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42244.87|34466.05|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42244.87|23629.97|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42244.87|9719.88|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42244.87|13640.91|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42244.87|38565.88|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|GEHA [1415]|GEHA [141500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42244.87|19902.6|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42244.87|9719.88|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42244.87|55178.88|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42244.87|17739.3|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42244.87|17324.57|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42244.87|1700|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|42244.87|5833.5|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42244.87|24540.04|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|Self-pay|Self-pay|42244.87|12673.46|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42244.87|16175.33|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42244.87|18485.19|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42244.87|14208.37|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42244.87|6017.18|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42244.87|8251.72|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42244.87|53398.92|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42244.87|3625|55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42244.87||55178.88|1700||||
MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42244.87|13640.91|55178.88|1700||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40953.88|26874.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40953.88|6790.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40953.88|10722.96|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40953.88|30070.82|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40953.88|11059.55|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40953.88|6790.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40953.88|43024.4|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40953.88|13944.65|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40953.88|13618.63|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|40953.88|455.63|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|Self-pay|Self-pay|40953.88|12286.16|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40953.88|12716.91|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40953.88|14536.07|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40953.88|11172.94|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40953.88|6534.27|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40953.88|41636.52|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40953.88|2900|43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40953.88||43024.4|455.63||||
MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40953.88|10722.96|43024.4|455.63||||
MS811|DRG||Red Blood Cell Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86120.99|20724.83|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86120.99|48568.17|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86120.99|10359.42|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86120.99|15379.2|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86120.99|23190.1|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|GEHA [1415]|GEHA [141500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86120.99|15861.95|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86120.99|10359.42|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86120.99|33179.68|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86120.99|19999.85|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86120.99|19532.27|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86120.99|3400|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|86120.99|10.15|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|Self-pay|Self-pay|86120.99|25836.3|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86120.99|18084.35|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86120.99|15977.66|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86120.99|16021.49|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86120.99|5514.89|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86120.99|9274.84|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86120.99|32109.37|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86120.99|1450|48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86120.99||48568.17|10.15||||
MS811|DRG||Red Blood Cell Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86120.99|15379.2|48568.17|10.15||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41210.22|13252.13|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41210.22|24436.73|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41210.22|6590.82|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41210.22|9815.35|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41210.22|14828.51|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41210.22||35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41210.22||35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|GEHA [1415]|GEHA [141500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41210.22|10123.45|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41210.22|6590.82|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41210.22|21216.17|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41210.22|12764.35|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41210.22||35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41210.22|12465.93|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41210.22|2550|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MULTIPLAN [1680]|HMA [168003]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41210.22||35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41210.22|35949.51|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|Self-pay|Self-pay|41210.22|12363.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41210.22|11935.46|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41210.22|18014.52|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41210.22|13310.49|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41210.22|10230.91|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|UMR [2035]|UMR OPTIONS [203501]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41210.22|3588.79|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41210.22|6000.07|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41210.22|20531.78|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41210.22|725|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41210.22|15046.3|35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41210.22||35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41210.22||35949.51|725||||
MS812|DRG||Red Blood Cell Disorders Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41210.22|9815.35|35949.51|725||||
MS813|DRG||Coagulation Disorders|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|AETNA [1015]|AETNA ACO WILCO [101532]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61971.64|35999.31|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61971.64|34853.34|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61971.64|13351.21|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|61971.64|17227.87|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61971.64|40281.57|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|CORESOURCE [1315]|CORESOURCE [131500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|CORVEL CORP [2235]|CORVEL CORP [223500]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|GEHA [1415]|GEHA [141500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|61971.64|18582.62|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HEALTHNET [1495]|HEALTHNET [149500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61971.64|13351.21|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HEALTHSMART [1505]|HEALTHSMART [150501]|61971.64|57633.63|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61971.64|22403.95|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61971.64|21880.16|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61971.64|5100|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MULTIPLAN [1680]|HMA [168003]|61971.64|813.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MULTIPLAN [1680]|IHC HS [168011]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|Self-pay|Self-pay|61971.64|18591.49|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61971.64|23403.12|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61971.64|15031.97|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|TRUSTMARK [2030]|STARMARK [203000]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61971.64|17964.86|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|UMR [2035]|UMR OPTIONS [203501]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61971.64|4458.87|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61971.64|10362.92|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61971.64|55774.48|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|61971.64|2900|57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|61971.64||57633.63|813.97||||
MS813|DRG||Coagulation Disorders|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|61971.64|17227.87|57633.63|813.97||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44516.15|25859.43|25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|GEHA [1415]|GEHA [141500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44516.15|3400|25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MULTIPLAN [1680]|HMA [168003]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MULTIPLAN [1680]|IHC HS [168011]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|Self-pay|Self-pay|44516.15|13354.84|25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|TRUSTMARK [2030]|STARMARK [203000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|UMR [2035]|UMR OPTIONS [203501]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44516.15|7829.45|25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44516.15||25859.43|3400||||
MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44516.15||25859.43|3400||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94717.78|55021.57|86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|GEHA [1415]|GEHA [141500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94717.78|5950|86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MULTIPLAN [1680]|HMA [168003]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|94717.78|86641.21|86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|Self-pay|Self-pay|94717.78|28415.33|86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|UMR [2035]|UMR OPTIONS [203501]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94717.78|4932.68|86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94717.78||86641.21|4932.68||||
MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94717.78||86641.21|4932.68||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|GEHA [1415]|GEHA [141500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|Self-pay|Self-pay|32300.33|9690.1|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32300.33|4561.56|9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32300.33||9690.1|4561.56||||
MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32300.33||9690.1|4561.56||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95322|55372.55|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95322|135948.12|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|95322|25720.82|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95322|61959.29|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|95322|26528.2|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95322|20318.32|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|95322|88649.47|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95322|33448.6|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95322|32666.59|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95322|13600|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|95322|440.67|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|Self-pay|Self-pay|95322|28596.6|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95322|34827.87|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95322|26769.93|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95322|5366.88|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95322|85789.8|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|95322|2175|135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|95322||135948.12|440.67||||
MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|95322|25720.82|135948.12|440.67||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52305.13|30384.04|30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52305.13|1700|30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52305.13|28947.22|30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|Self-pay|Self-pay|52305.13|15691.54|30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52305.13|3862.47|30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52305.13||30384.04|1700||||
MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52305.13||30384.04|1700||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49901.69|16052.83|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49901.69|37108.32|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49901.69|11007.28|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49901.69|17962.34|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49901.69|11352.8|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49901.69|6443.04|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49901.69|25699.97|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49901.69|14314.4|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49901.69|13979.74|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49901.69|1700|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|49901.69|259.51|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|49901.69|14970.51|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49901.69|15098.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49901.69|11605.58|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49901.69|3212.5|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49901.69|24870.94|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49901.69|2900|37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49901.69||37108.32|259.51||||
MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49901.69|11007.28|37108.32|259.51||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|Self-pay|Self-pay|200721.67|60216.5|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200721.67|37575.55|60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|200721.67||60216.5|37575.55||||
MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|200721.67||60216.5|37575.55||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|Self-pay|Self-pay|155319.98|46595.99|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|155319.98|13901|46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|155319.98||46595.99|13901||||
MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|155319.98||46595.99|13901||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|183811.72|55143.52|55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|183811.72||55143.52|55143.52||||
MS822|DRG||Lymphoma And Leukemia With Major O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|183811.72||55143.52|55143.52||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102860.72|25563.77|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102860.72|36032.27|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102860.72|33005.36|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102860.72|28604.65|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|GEHA [1415]|GEHA [141500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102860.72|36032.27|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102860.72|40926.65|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|Self-pay|Self-pay|102860.72|30858.22|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102860.72|44007.15|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102860.72|29766.66|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102860.72|39606.44|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102860.72|1450|44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102860.72||44007.15|1450||||
MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102860.72|33005.36|44007.15|1450||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110500.09|64189.52|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110500.09|31169.48|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110500.09|57460.05|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|110500.09|26363.06|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110500.09|71825.06|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|GEHA [1415]|GEHA [141500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|110500.09|35724.57|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110500.09|57460.05|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|110500.09|102765.09|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110500.09|34283.8|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110500.09|33482.27|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110500.09|2550|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|110500.09|9001.92|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|Self-pay|Self-pay|110500.09|33150.03|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110500.09|29542.55|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110500.09|35749.33|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110500.09|27478.2|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110500.09|10636.83|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110500.09|15739.68|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110500.09|99450.08|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|110500.09|5075|102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|110500.09||102765.09|2550||||
MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|110500.09|26363.06|102765.09|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54880.51|29320.08|29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54880.51|2550|29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|Self-pay|Self-pay|54880.51|16464.15|29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54880.51|6316.73|29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|54880.51||29320.08|2550||||
MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|54880.51||29320.08|2550||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104292.9|375351.62|375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104292.9|54400|375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|Self-pay|Self-pay|104292.9|31287.87|375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104292.9|256762.03|375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104292.9||375351.62|31287.87||||
MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104292.9||375351.62|31287.87||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122070.45|74883.55|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122070.45|67032.96|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|122070.45|27881.69|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122070.45|83791.19|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|122070.45|30193.56|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122070.45|67032.96|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|122070.45|119885.86|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122070.45|36258.7|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122070.45|35411|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|122070.45|1436.66|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|Self-pay|Self-pay|122070.45|36621.13|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122070.45|32016.71|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122070.45|116018.58|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122070.45|29047.09|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122070.45|16633.52|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122070.45|116018.59|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|122070.45|2900|119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|122070.45||119885.86|1436.66||||
MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|122070.45|27881.69|119885.86|1436.66||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|100910.25|30273.07|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100910.25|11208.85|30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100910.25||30273.07|11208.85||||
MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100910.25||30273.07|11208.85||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|GEHA [1415]|GEHA [141500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|Self-pay|Self-pay|83681.5|25104.45|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83681.5|21278.57|25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|83681.5||25104.45|21278.57||||
MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|83681.5||25104.45|21278.57||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70917.3|41043.61|41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70917.3|2550|41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|Self-pay|Self-pay|70917.3|21275.19|41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70917.3|8111.06|41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|70917.3||41043.61|2550||||
MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|70917.3||41043.61|2550||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36662.86|27416.02|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36662.86|15701.89|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36662.86|14288.62|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36662.86|12508.07|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36662.86|30677.26|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36662.86|12900.7|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36662.86|8708.89|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36662.86|43892.08|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36662.86|16266.1|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36662.86|15885.81|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36662.86|1700|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|36662.86|310.72|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36662.86|6437|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|Self-pay|Self-pay|36662.86|10998.86|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36662.86|14277.21|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36662.86|13038.39|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36662.86|3178.59|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36662.86|42476.2|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36662.86|4350|43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36662.86||43892.08|310.72||||
MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36662.86|12508.07|43892.08|310.72||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20091|10635.69|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20091|12477.39|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|20091|8678.05|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20091|11900.85|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|20091|8950.45|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20091|5777.66|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|20091|17027.37|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20091|11285.35|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20091|11021.51|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20091|850|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|20091|9581.95|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|Self-pay|Self-pay|20091|6027.3|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|20091|18081.9|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20091|11798.93|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20091|9069.07|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20091|2175.94|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20091|16478.1|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|20091|1450|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20091|15068.25|18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|20091||18081.9|850||||
MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|20091|8678.05|18081.9|850||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17041|8044.57|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17041|10286|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17041|8110.06|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17041|6831.42|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17041|6831.42|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17041|6831.42|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17041|5987.55|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17041|9001.47|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17041|6175.5|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17041|4296.71|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|17041|12879.03|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17041|7786.5|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17041|4340.23|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17041|7604.46|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17041|1700|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|17041|184.6|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|17041|10107.96|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|17041|5112.3|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17041|6919.76|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17041|6233.68|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17041|1577.53|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17041|12463.58|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17041|1450|12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17041||12879.03|184.6||||
MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17041|5987.55|12879.03|184.6||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57734.84|59743.09|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57734.84|53479.79|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|57734.84|67482.03|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57734.84|66849.73|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|57734.84|69600.3|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57734.84|53479.79|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|57734.84|95646.55|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57734.84|31719.36|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57734.84|85705.2|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|57734.84|428.95|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|Self-pay|Self-pay|57734.84|17320.45|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57734.84|74277.53|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57734.84|102845.75|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57734.84|70362.66|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57734.84|92561.18|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|57734.84|4350|102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|57734.84||102845.75|428.95||||
MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|57734.84|67482.03|102845.75|428.95||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|16645|16361.96|16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|Self-pay|Self-pay|16645|4993.5|16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|16645||16361.96|4993.5||||
MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|16645||16361.96|4993.5||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34896.23|20271.22|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34896.23|9442.1|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|34896.23|13084.53|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34896.23|22682.55|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|34896.23|13495.25|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34896.23|9442.1|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|34896.23|32453.49|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34896.23|13089.04|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34896.23|16617.93|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|34896.23|40.6|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|34896.23|10468.87|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34896.23|18612.98|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34896.23|3504.33|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34896.23|13602.45|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34896.23|31406.61|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|34896.23|1450|32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|34896.23||32453.49|40.6||||
MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|34896.23|13084.53|32453.49|40.6||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84959.59|32601.89|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84959.59|46019.93|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84959.59|35908.58|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84959.59|36479.98|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|GEHA [1415]|GEHA [141500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84959.59|37035.75|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84959.59|52194.43|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84959.59|46697.25|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84959.59|45605.5|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84959.59|5100|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MULTIPLAN [1680]|HMA [168003]|84959.59|232.15|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MULTIPLAN [1680]|IHC HS [168011]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|Self-pay|Self-pay|84959.59|25487.88|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84959.59|41632.14|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84959.59|76463.64|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84959.59|25079.34|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|TRUSTMARK [2030]|STARMARK [203000]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84959.59|37398.59|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|UMR [2035]|UMR OPTIONS [203501]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84959.59|14211.17|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84959.59|21357.96|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84959.59|50510.74|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84959.59|1450|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84959.59|63719.7|76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84959.59||76463.64|232.15||||
MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84959.59|35908.58|76463.64|232.15||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30918.19|70106.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|GEHA [1415]|GEHA [141500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30918.19|11050|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MULTIPLAN [1680]|HMA [168003]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|Self-pay|Self-pay|30918.19|9275.46|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|UMR [2035]|UMR OPTIONS [203501]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30918.19|10314.78|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30918.19|10864.97|70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30918.19||70106.97|9275.46||||
MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30918.19||70106.97|9275.46||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|GEHA [1415]|GEHA [141500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|Self-pay|Self-pay|26983.46|8095.04|8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|26983.46||8095.04|8095.04||||
MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|26983.46||8095.04|8095.04||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|Self-pay|Self-pay|27619.87|8285.96|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27619.87|12347.31|12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27619.87||12347.31|8285.96||||
MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27619.87||12347.31|8285.96||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|Self-pay|Self-pay|44771.8|13431.54|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|44771.8|12920.25|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44771.8|7994.46|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|44771.8|10800.52|13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|44771.8||13431.54|7994.46||||
MS844|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|44771.8||13431.54|7994.46||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|GEHA [1415]|GEHA [141500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MULTIPLAN [1680]|HMA [168003]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|Self-pay|Self-pay|74835.07|22450.52|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|UMR [2035]|UMR OPTIONS [203501]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74835.07|17764.27|22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|74835.07||22450.52|17764.27||||
MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|74835.07||22450.52|17764.27||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37110.93|21335.66|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37110.93|9341.97|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37110.93|14897.52|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37110.93|23873.61|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|GEHA [1415]|GEHA [141500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37110.93|21786.11|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37110.93|9341.97|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37110.93|34157.63|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37110.93|19373.45|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37110.93|18920.51|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MULTIPLAN [1680]|HMA [168003]|37110.93|6420.96|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|Self-pay|Self-pay|37110.93|11133.28|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37110.93|17052.78|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37110.93|14014.3|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37110.93|15528.38|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37110.93|33055.77|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37110.93|2175|34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37110.93||34157.63|2175||||
MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37110.93|14897.52|34157.63|2175||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|Self-pay|Self-pay|42893.4|12868.02|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42893.4|17764.27|17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42893.4||17764.27|12868.02||||
MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42893.4||17764.27|12868.02||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|183949.16|63834.79|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183949.16|63834.79|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183949.16|90185.71|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183949.16|104638.68|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|183949.16|74815.31|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183949.16|74815.31|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183949.16|80730.89|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|183949.16|63019.82|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|183949.16|55390.97|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183949.16|100913.61|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|183949.16||146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|183949.16||146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|183949.16|60569.12|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183949.16|80730.89|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|183949.16|144384.11|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183949.16|72033.1|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|183949.16|32877.09|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183949.16|63834.79|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183949.16|70349.02|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183949.16|7650|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183949.16|46282.98|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|183949.16|3439.42|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|183949.16||146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|183949.16|109471.91|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183949.16|63834.79|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|Self-pay|Self-pay|183949.16|55184.75|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183949.16|69329.21|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183949.16|32877.09|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|183949.16|146539.22|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183949.16|59342.89|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183949.16|57505.7|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183949.16|26863.5|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183949.16|32824.85|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183949.16|139726.55|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|183949.16|10875|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|183949.16|122165.7|146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|183949.16||146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|183949.16||146539.22|3439.42||||
MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|183949.16|55390.97|146539.22|3439.42||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103944.43|54258.52|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103944.43|66701.38|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103944.43|19280.68|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|103944.43|26693.5|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|103944.43|23662.53|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103944.43|60712.74|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|103944.43||93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|103944.43||93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|103944.43|25203.7|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103944.43|19280.68|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|103944.43|86865.93|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103944.43|30771.9|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|103944.43||93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103944.43|30052.47|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103944.43|3400|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|103944.43|798.4|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|103944.43||93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|103944.43|59328.26|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103944.43|31689.76|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|Self-pay|Self-pay|103944.43|31183.33|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103944.43|32329.02|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|103944.43|93076.57|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103944.43|24376.72|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103944.43|24357.87|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103944.43|13500|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103944.43|14150.2|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103944.43|84063.79|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|103944.43|2900|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|103944.43|77563.82|93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|103944.43||93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|103944.43||93076.57|798.4||||
MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|103944.43|23662.53|93076.57|798.4||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106554.39|61471.06|61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106554.39|5100|61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|106554.39|31966.32|61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106554.39|10183.6|61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106554.39||61471.06|5100||||
MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106554.39||61471.06|5100||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|143320.31|83254.78|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|143320.31|75085.07|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|143320.31|74526.56|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|143320.31|52002.49|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|143320.31|93158.21|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|143320.31|54873.81|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|143320.31|74526.56|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|143320.31|133287.89|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|143320.31|67626.55|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|143320.31|66045.49|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|143320.31|7650|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|143320.31|1238.96|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|Self-pay|Self-pay|143320.31|42996.09|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|143320.31|60181.58|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|143320.31|68779.67|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|143320.31|52866.49|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|143320.31|19448.34|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|143320.31|26881.9|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|143320.31|128988.28|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|143320.31|6525|133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|143320.31||133287.89|1238.96||||
MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|143320.31|52002.49|133287.89|1238.96||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104184.64|58877.92|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104184.64|47050.02|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104184.64|52705.3|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104184.64|23441.76|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104184.64|65881.63|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|GEHA [1415]|GEHA [141500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104184.64|27734.01|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104184.64|52705.3|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|104184.64|94261.4|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104184.64|30484.8|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104184.64|14042.38|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104184.64|29772.09|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104184.64|6800|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MULTIPLAN [1680]|HMA [168003]|104184.64|3556.41|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|Self-pay|Self-pay|104184.64|31255.39|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104184.64|26879.11|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104184.64|14020.27|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104184.64|30786.46|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104184.64|23663.56|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|UMR [2035]|UMR OPTIONS [203501]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104184.64|7855.2|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104184.64|13569.67|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104184.64|91220.71|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104184.64|3625|94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104184.64||94261.4|3556.41||||
MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104184.64|23441.76|94261.4|3556.41||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50450.43|29306.66|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50450.43|10812.43|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50450.43|15159.54|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50450.43|32792.78|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|GEHA [1415]|GEHA [141500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50450.43|16561.7|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50450.43|10812.43|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50450.43|46918.9|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50450.43|19714.2|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50450.43|19253.3|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|50450.43|926.3|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|Self-pay|Self-pay|50450.43|15135.13|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50450.43|18235.78|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50450.43|11171.51|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50450.43|15681.89|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50450.43|45405.38|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50450.43|1450|46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50450.43||46918.9|926.3||||
MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50450.43|15159.54|46918.9|926.3||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72079.43|45590.39|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72079.43|39377.1|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72079.43|14943.6|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|72079.43|21148.21|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72079.43|51013.51|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|GEHA [1415]|GEHA [141500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|72079.43|24111.88|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72079.43|14943.6|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|72079.43|72988.54|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72079.43|27502.15|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72079.43|26859.17|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72079.43|3400|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MULTIPLAN [1680]|HMA [168003]|72079.43|2299.83|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MULTIPLAN [1680]|IHC HS [168011]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|72079.43|38182.57|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|Self-pay|Self-pay|72079.43|21623.83|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72079.43|24778.1|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72079.43|28427.58|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|TRUSTMARK [2030]|STARMARK [203000]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72079.43|21850.44|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|UMR [2035]|UMR OPTIONS [203501]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72079.43|8525.46|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72079.43|12670.35|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72079.43|70634.08|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|72079.43|2900|72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|72079.43||72988.54|2299.83||||
MS862|DRG||Postoperative And Post-Traumatic Infections With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|72079.43|21148.21|72988.54|2299.83||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|40638.48|12618.23|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40638.48|12618.23|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40638.48|21659.88|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40638.48|26590.26|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|40638.48|14788.76|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40638.48|14788.76|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40638.48|7942.57|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|40638.48|14788.76|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|40638.48|11277.11|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40638.48|24236.4|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|GEHA [1415]|GEHA [141500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|40638.48|12836.72|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40638.48|7942.57|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|40638.48|34676.7|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40638.48|14665.3|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40638.48|12618.23|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40638.48|14322.44|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40638.48|3400|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40638.48|12618.23|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MULTIPLAN [1680]|HMA [168003]|40638.48|1205.62|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40638.48|12618.23|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|Self-pay|Self-pay|40638.48|12191.54|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40638.48|13617.34|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40638.48|12618.23|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40638.48|11367.16|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|UMR [2035]|UMR OPTIONS [203501]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40638.48|3346.45|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40638.48|6723.69|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40638.48|33558.1|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|40638.48|2175|34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|40638.48||34676.7|1205.62||||
MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|40638.48|11277.11|34676.7|1205.62||||
MS864|DRG||Fever And Inflammatory Conditions|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|AETNA [1015]|AETNA ACO WILCO [101532]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41696.25|26783.5|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41696.25|20809.73|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41696.25|6798.34|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|41696.25|9772.98|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41696.25|29969.5|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|CORESOURCE [1315]|CORESOURCE [131500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|CORVEL CORP [2235]|CORVEL CORP [223500]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|GEHA [1415]|GEHA [141500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|41696.25|10798.78|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HEALTHNET [1495]|HEALTHNET [149500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41696.25|6798.34|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HEALTHSMART [1505]|HEALTHSMART [150501]|41696.25|42879.44|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41696.25|12709.25|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41696.25|12412.12|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41696.25|850|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MULTIPLAN [1680]|HMA [168003]|41696.25|719.03|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MULTIPLAN [1680]|IHC HS [168011]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|41696.25|14283.3|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|Self-pay|Self-pay|41696.25|12508.87|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41696.25|11763.75|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41696.25|13239.37|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|TRUSTMARK [2030]|STARMARK [203000]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41696.25|10176.25|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|UMR [2035]|UMR OPTIONS [203501]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41696.25|4828.61|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41696.25|5975.14|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41696.25|41496.23|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|41696.25|2175|42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|41696.25||42879.44|719.03||||
MS864|DRG||Fever And Inflammatory Conditions|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|41696.25|9772.98|42879.44|719.03||||
MS865|DRG||Viral Illness With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52563.86|13360.76|15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|GEHA [1415]|GEHA [141500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52563.86|850|15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MULTIPLAN [1680]|HMA [168003]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MULTIPLAN [1680]|IHC HS [168011]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|Self-pay|Self-pay|52563.86|15769.16|15769.16|850||||
MS865|DRG||Viral Illness With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|TRUSTMARK [2030]|STARMARK [203000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|UMR [2035]|UMR OPTIONS [203501]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52563.86|3742.1|15769.16|850||||
MS865|DRG||Viral Illness With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|52563.86||15769.16|850||||
MS865|DRG||Viral Illness With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|52563.86||15769.16|850||||
MS866|DRG||Viral Illness Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29022.62|12654.32|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|GEHA [1415]|GEHA [141500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29022.62|2550|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MULTIPLAN [1680]|HMA [168003]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|Self-pay|Self-pay|29022.62|8706.79|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|UMR [2035]|UMR OPTIONS [203501]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29022.62|3697.89|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29022.62|6359.18|12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29022.62||12654.32|2550||||
MS866|DRG||Viral Illness Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29022.62||12654.32|2550||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107422.56|41345.2|41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107422.56|41345.2|41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107422.56|7650|41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107422.56|30988.51|41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|Self-pay|Self-pay|107422.56|32226.77|41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107422.56|12168|41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107422.56||41345.2|7650||||
MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107422.56||41345.2|7650||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81688.28|53914.33|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81688.28|25964.98|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|81688.28|10553.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81688.28|32576.91|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81688.28|14820|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|81688.28|8889.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|81688.28|11885.9|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81688.28|60327.61|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|GEHA [1415]|GEHA [141500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|81688.28|12259|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81688.28|14820|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|81688.28|86314.88|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81688.28|15457|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81688.28|12441|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81688.28|4250|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MULTIPLAN [1680]|HMA [168003]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|Self-pay|Self-pay|81688.28|24506.48|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81688.28|14325.79|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|81688.28|19601.8|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81688.28|10875|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81688.28|12309.19|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|UMR [2035]|UMR OPTIONS [203501]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81688.28|12037.04|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81688.28|83530.53|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|81688.28|9425|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|81688.28|20418.54|86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|81688.28||86314.88|4250||||
MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|81688.28|11885.9|86314.88|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100881|58601.78|58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|GEHA [1415]|GEHA [141500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100881|4250|58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|Self-pay|Self-pay|100881|30264.3|58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100881|5344.28|58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100881||58601.78|4250||||
MS869|DRG||Other Infectious And Parasitic Diseases Diagnoses Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100881||58601.78|4250||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|AETNA [1015]|AETNA ACO WILCO [101532]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|389951.15|255403.83|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|389951.15|231579.54|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|389951.15|42600.5|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|389951.15|228627.98|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|389951.15|219834.6|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|389951.15|285784.98|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|CORESOURCE [1315]|CORESOURCE [131500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|CORVEL CORP [2235]|CORVEL CORP [223500]|389951.15||415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|389951.15||415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|GEHA [1415]|GEHA [141500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|389951.15|82783.48|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HEALTHNET [1495]|HEALTHNET [149500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|389951.15|228627.98|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HEALTHSMART [1505]|HEALTHSMART [150501]|389951.15|408892.35|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|389951.15|197851.14|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|389951.15|50393.43|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|389951.15|197851.14|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|389951.15|8500|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MULTIPLAN [1680]|HMA [168003]|389951.15|8734.98|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MULTIPLAN [1680]|IHC HS [168011]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|389951.15||415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|389951.15|247739.73|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|Self-pay|Self-pay|389951.15|116985.34|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|389951.15|219834.6|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|389951.15|50312.18|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|389951.15|415412.4|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|389951.15|97211.79|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|TRUSTMARK [2030]|STARMARK [203000]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|389951.15|74720.42|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|UMR [2035]|UMR OPTIONS [203501]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|389951.15|33082.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|389951.15|48160.36|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|389951.15|395702.28|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|389951.15|16675|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|389951.15|346177|415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|389951.15||415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|389951.15||415412.4|8500||||
MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|389951.15|219834.6|415412.4|8500||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77792.79|41774.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77792.79|49347.16|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77792.79|14593.14|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|77792.79|20875.03|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77792.79|46743.76|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|77792.79||66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|77792.79||66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|GEHA [1415]|GEHA [141500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|77792.79|21530.3|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77792.79|14593.14|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|77792.79|66879.53|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77792.79|27146.9|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|77792.79|14311.56|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77792.79|26512.22|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77792.79|850|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MULTIPLAN [1680]|HMA [168003]|77792.79|516.37|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MULTIPLAN [1680]|IHC HS [168011]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|77792.79||66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|77792.79|45923.01|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|Self-pay|Self-pay|77792.79|23337.84|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77792.79|24645.61|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|77792.79|66240.31|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77792.79|28267.19|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|TRUSTMARK [2030]|STARMARK [203000]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77792.79|21727.17|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|UMR [2035]|UMR OPTIONS [203501]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77792.79|9188.91|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77792.79|12509.55|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77792.79|64722.13|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|77792.79|3625|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77792.79|55200.26|66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|77792.79||66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|77792.79||66879.53|516.37||||
MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|77792.79|20875.03|66879.53|516.37||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49237.19|25480.24|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49237.19|26750.29|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49237.19|8501.36|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|49237.19|13020.48|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|49237.19|11443.25|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49237.19|28511.21|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|49237.19||50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|49237.19||50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|GEHA [1415]|GEHA [141500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|49237.19|11802.45|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49237.19|8501.36|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|49237.19|40792.98|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49237.19|14881.35|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|49237.19|6969.02|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49237.19|14533.43|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49237.19|2550|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MULTIPLAN [1680]|HMA [168003]|49237.19|253.87|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|49237.19||50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|49237.19|28160.14|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49237.19|15457.53|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|Self-pay|Self-pay|49237.19|14771.16|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49237.19|14258.19|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|49237.19|50009.74|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49237.19|11986.71|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49237.19|11881.21|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|UMR [2035]|UMR OPTIONS [203501]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49237.19|6132.28|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49237.19|6958.23|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49237.19|39477.08|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|49237.19|2175|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49237.19|41718.9|50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|49237.19||50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|49237.19||50009.74|253.87||||
MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|49237.19|11443.25|50009.74|253.87||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|AETNA [1015]|AETNA ACO WILCO [101532]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198533.44|115313.22|115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|CORESOURCE [1315]|CORESOURCE [131500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|CORVEL CORP [2235]|CORVEL CORP [223500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|GEHA [1415]|GEHA [141500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HEALTHNET [1495]|HEALTHNET [149500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HEALTHSMART [1505]|HEALTHSMART [150501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198533.44|11900|115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MULTIPLAN [1680]|HMA [168003]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MULTIPLAN [1680]|IHC HS [168011]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|Self-pay|Self-pay|198533.44|59560.03|115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|TRUSTMARK [2030]|STARMARK [203000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|UMR [2035]|UMR OPTIONS [203501]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198533.44|18285.05|115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|198533.44||115313.22|11900||||
MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|198533.44||115313.22|11900||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|AETNA [1015]|AETNA ACO WILCO [101532]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25505|794|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25505|6984.45|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25505|14239.73|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25505|4005.2|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25505|12222.73|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25505|12378.89|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|CORESOURCE [1315]|CORESOURCE [131500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|GEHA [1415]|GEHA [141500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25505|11035.1|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HEALTHNET [1495]|HEALTHNET [149500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25505|4005.2|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25505|17711.34|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25505|15747.47|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25505|5905.49|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25505|14461.65|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25505|2970.15|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MULTIPLAN [1680]|HMA [168003]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MULTIPLAN [1680]|IHC HS [168011]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25505|13647.66|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|Self-pay|Self-pay|25505|7651.5|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25505|12532.91|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|TRUSTMARK [2030]|STARMARK [203000]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25505|13995.93|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|UMR [2035]|UMR OPTIONS [203501]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25505|3530.38|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25505|5896.4|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25505|17140.01|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25505|3328.17|17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25505||17711.34|794||||
MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25505|12222.73|17711.34|794||||
MS881|DRG||Depressive Neuroses|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|AETNA [1015]|AETNA ACO WILCO [101532]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29368|10893.61|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29368|12104.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29368|3135|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29368|8942.3|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29368|12189.45|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|CORESOURCE [1315]|CORESOURCE [131500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|CORVEL CORP [2235]|CORVEL CORP [223500]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|GEHA [1415]|GEHA [141500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29368|9223|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HEALTHNET [1495]|HEALTHNET [149500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29368|3135|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HEALTHSMART [1505]|HEALTHSMART [150501]|29368|17440.29|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29368|11629|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29368|5494.67|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29368|11357.12|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29368|3733.73|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MULTIPLAN [1680]|HMA [168003]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MULTIPLAN [1680]|IHC HS [168011]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|29368|11299.27|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|Self-pay|Self-pay|29368|8810.4|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29368|10081.86|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|TRUSTMARK [2030]|STARMARK [203000]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29368|9320.28|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|UMR [2035]|UMR OPTIONS [203501]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29368|3654.98|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29368|16877.7|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29368|2803.47|17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29368||17440.29|2803.47||||
MS881|DRG||Depressive Neuroses|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29368|8942.3|17440.29|2803.47||||
MS882|DRG||Neuroses Except Depressive|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|AETNA [1015]|AETNA ACO WILCO [101532]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23025|794|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23025|7353.62|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23025|9327.19|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23025|2090|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23025|9183.14|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23025|8228.35|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|CORESOURCE [1315]|CORESOURCE [131500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|CORVEL CORP [2235]|CORVEL CORP [223500]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|GEHA [1415]|GEHA [141500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23025|9471.4|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HEALTHNET [1495]|HEALTHNET [149500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23025|2090|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23025|11772.87|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23025|11942.2|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23025|11663|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23025|3455.83|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MULTIPLAN [1680]|HMA [168003]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MULTIPLAN [1680]|IHC HS [168011]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|Self-pay|Self-pay|23025|6907.5|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23025|10533.43|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|TRUSTMARK [2030]|STARMARK [203000]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23025|9571.49|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|UMR [2035]|UMR OPTIONS [203501]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23025|3400.36|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23025|5627.98|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23025|11393.1|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23025|2218.78|11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23025||11942.2|794||||
MS882|DRG||Neuroses Except Depressive|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23025|9183.14|11942.2|794||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|AETNA [1015]|AETNA ACO WILCO [101532]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27166.36|3468.61|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27166.36|12644.09|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27166.36|1045|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27166.36|4478.33|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27166.36|3881.22|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|CORESOURCE [1315]|CORESOURCE [131500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|GEHA [1415]|GEHA [141500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27166.36|5971.1|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HEALTHNET [1495]|HEALTHNET [149500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27166.36|1045|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27166.36|5553.13|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27166.36|5971.1|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27166.36|5971.1|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27166.36|4160.3|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MULTIPLAN [1680]|HMA [168003]|27166.36|33.66|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MULTIPLAN [1680]|IHC HS [168011]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|Self-pay|Self-pay|27166.36|8149.91|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27166.36|5971.1|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|TRUSTMARK [2030]|STARMARK [203000]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27166.36|5971.1|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|UMR [2035]|UMR OPTIONS [203501]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27166.36|4187.22|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27166.36|5373.99|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27166.36|1109.39|12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27166.36||12644.09|33.66||||
MS883|DRG||Disorders Of Personality And Impulse Control|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27166.36|4478.33|12644.09|33.66||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|AETNA [1015]|AETNA ACO WILCO [101532]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30931.35|3176|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30931.35|17968.02|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|CORESOURCE [1315]|CORESOURCE [131500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|CORVEL CORP [2235]|CORVEL CORP [223500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|GEHA [1415]|GEHA [141500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HEALTHNET [1495]|HEALTHNET [149500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HEALTHSMART [1505]|HEALTHSMART [150501]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30931.35|1700|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MULTIPLAN [1680]|HMA [168003]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MULTIPLAN [1680]|IHC HS [168011]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|Self-pay|Self-pay|30931.35|9279.4|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|TRUSTMARK [2030]|STARMARK [203000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|UMR [2035]|UMR OPTIONS [203501]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30931.35|4738.1|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30931.35|9721.09|17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30931.35||17968.02|1700||||
MS884|DRG||Organic Disturbances And Intellectual Disability|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30931.35||17968.02|1700||||
MS885|DRG||Psychoses|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|AETNA [1015]|AETNA ACO WILCO [101532]|33253.49|5546.95|25328.33|3000||||
MS885|DRG||Psychoses|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33253.49|5546.95|25328.33|3000||||
MS885|DRG||Psychoses|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33253.49|3191.31|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33253.49|15820.67|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33253.49|15667.01|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|33253.49|4437.56|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33253.49|5001.51|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33253.49|5225|25328.33|3000||||
MS885|DRG||Psychoses|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|33253.49|4672.45|25328.33|3000||||
MS885|DRG||Psychoses|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|33253.49|13819.31|25328.33|3000||||
MS885|DRG||Psychoses|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33253.49|17702.59|25328.33|3000||||
MS885|DRG||Psychoses|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|CORESOURCE [1315]|CORESOURCE [131500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|CORVEL CORP [2235]|CORVEL CORP [223500]|33253.49||25328.33|3000||||
MS885|DRG||Psychoses|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|33253.49||25328.33|3000||||
MS885|DRG||Psychoses|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|GEHA [1415]|GEHA [141500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|33253.49|14253.1|25328.33|3000||||
MS885|DRG||Psychoses|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|HEALTHNET [1495]|HEALTHNET [149500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33253.49|5225|25328.33|3000||||
MS885|DRG||Psychoses|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|HEALTHSMART [1505]|HEALTHSMART [150501]|33253.49|25328.33|25328.33|3000||||
MS885|DRG||Psychoses|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33253.49|17971.3|25328.33|3000||||
MS885|DRG||Psychoses|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33253.49|8356.73|25328.33|3000||||
MS885|DRG||Psychoses|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|33253.49|8369.76|25328.33|3000||||
MS885|DRG||Psychoses|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33253.49|5546.95|25328.33|3000||||
MS885|DRG||Psychoses|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33253.49|17551.14|25328.33|3000||||
MS885|DRG||Psychoses|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33253.49|4051.83|25328.33|3000||||
MS885|DRG||Psychoses|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33253.49|5546.95|25328.33|3000||||
MS885|DRG||Psychoses|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|MULTIPLAN [1680]|HMA [168003]|33253.49|5546.95|25328.33|3000||||
MS885|DRG||Psychoses|1|MULTIPLAN [1680]|IHC HS [168011]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|33253.49||25328.33|3000||||
MS885|DRG||Psychoses|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|33253.49|18282.08|25328.33|3000||||
MS885|DRG||Psychoses|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33253.49|3000|25328.33|3000||||
MS885|DRG||Psychoses|1|Self-pay|Self-pay|33253.49|9976.05|25328.33|3000||||
MS885|DRG||Psychoses|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33253.49|15865.72|25328.33|3000||||
MS885|DRG||Psychoses|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|33253.49|15651|25328.33|3000||||
MS885|DRG||Psychoses|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33253.49|11689.38|25328.33|3000||||
MS885|DRG||Psychoses|1|TRUSTMARK [2030]|STARMARK [203000]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33253.49|14387.47|25328.33|3000||||
MS885|DRG||Psychoses|1|UMR [2035]|UMR OPTIONS [203501]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33253.49|4668.96|25328.33|3000||||
MS885|DRG||Psychoses|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33253.49|8842.67|25328.33|3000||||
MS885|DRG||Psychoses|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33253.49|24511.28|25328.33|3000||||
MS885|DRG||Psychoses|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|33253.49|16485.98|25328.33|3000||||
MS885|DRG||Psychoses|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33253.49|13042.5|25328.33|3000||||
MS885|DRG||Psychoses|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|33253.49||25328.33|3000||||
MS885|DRG||Psychoses|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|33253.49||25328.33|3000||||
MS885|DRG||Psychoses|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|33253.49|13819.31|25328.33|3000||||
MS886|DRG||Behavioral And Developmental Disorders|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|AETNA [1015]|AETNA ACO WILCO [101532]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|544053.53|316040.71|316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|CORESOURCE [1315]|CORESOURCE [131500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|CORVEL CORP [2235]|CORVEL CORP [223500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|GEHA [1415]|GEHA [141500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HEALTHNET [1495]|HEALTHNET [149500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HEALTHSMART [1505]|HEALTHSMART [150501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|544053.53|58650|316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MULTIPLAN [1680]|HMA [168003]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MULTIPLAN [1680]|IHC HS [168011]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|Self-pay|Self-pay|544053.53|163216.06|316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|TRUSTMARK [2030]|STARMARK [203000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|UMR [2035]|UMR OPTIONS [203501]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|544053.53|6681.86|316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|544053.53||316040.71|6681.86||||
MS886|DRG||Behavioral And Developmental Disorders|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|544053.53||316040.71|6681.86||||
MS887|DRG||Other Mental Disorder Diagnoses|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|AETNA [1015]|AETNA ACO WILCO [101532]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|CORESOURCE [1315]|CORESOURCE [131500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|GEHA [1415]|GEHA [141500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HEALTHNET [1495]|HEALTHNET [149500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MULTIPLAN [1680]|HMA [168003]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MULTIPLAN [1680]|IHC HS [168011]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|Self-pay|Self-pay|169710.89|50913.27|152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169710.89|152739.8|152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|TRUSTMARK [2030]|STARMARK [203000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|UMR [2035]|UMR OPTIONS [203501]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169710.89|127283.17|152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169710.89||152739.8|50913.27||||
MS887|DRG||Other Mental Disorder Diagnoses|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169710.89||152739.8|50913.27||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|AETNA [1015]|AETNA ACO WILCO [101532]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36246.89|14990.69|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36246.89|21666.98|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36246.89|3593.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36246.89|6121.35|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36246.89|16773.89|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|CORESOURCE [1315]|CORESOURCE [131500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|GEHA [1415]|GEHA [141500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36246.89|6313.5|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HEALTHNET [1495]|HEALTHNET [149500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36246.89|3593.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36246.89|23999.56|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36246.89|7960.5|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36246.89|7774.39|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36246.89|1700|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MULTIPLAN [1680]|HMA [168003]|36246.89|204.65|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MULTIPLAN [1680]|IHC HS [168011]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36246.89|6605.41|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|Self-pay|Self-pay|36246.89|10874.07|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36246.89|7088.54|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36246.89|11117.91|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|TRUSTMARK [2030]|STARMARK [203000]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36246.89|6367.43|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|UMR [2035]|UMR OPTIONS [203501]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36246.89|2384.55|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36246.89|23225.38|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36246.89|725|23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36246.89||23999.56|204.65||||
MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36246.89|6121.35|23999.56|204.65||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|65511.45|22052.57|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65511.45|22052.57|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65511.45|40159.94|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65511.45|32774.44|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|65511.45|22648.18|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65511.45|22648.18|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65511.45|12309.53|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|65511.45|22648.18|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|65511.45|19850.35|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65511.45|44937.09|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|GEHA [1415]|GEHA [141500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|65511.45|22077.79|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65511.45|12309.53|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|65511.45|64294.61|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65511.45|25814.35|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65511.45|22052.57|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65511.45|25210.83|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65511.45|2550|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65511.45|22052.57|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MULTIPLAN [1680]|HMA [168003]|65511.45|1604.34|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MULTIPLAN [1680]|IHC HS [168011]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|65511.45|32321.91|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65511.45|22052.57|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|Self-pay|Self-pay|65511.45|19653.43|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65511.45|22114.66|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65511.45|22052.57|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|TRUSTMARK [2030]|STARMARK [203000]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65511.45|20666.51|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|UMR [2035]|UMR OPTIONS [203501]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65511.45|4580.92|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65511.45|11548.5|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65511.45|62220.59|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|65511.45|2900|64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|65511.45||64294.61|1604.34||||
MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|65511.45|19850.35|64294.61|1604.34||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37188.49|3970|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37188.49|20712.48|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37188.49|21203.08|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37188.49|5575.79|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|37188.49|9221.05|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37188.49|23176.3|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|GEHA [1415]|GEHA [141500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|37188.49|9510.5|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37188.49|5575.79|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|37188.49|33159.94|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37188.49|11991.5|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|37188.49|5658.99|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37188.49|11711.15|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37188.49|1700|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MULTIPLAN [1680]|HMA [168003]|37188.49|199.79|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|37188.49|12658.2|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|Self-pay|Self-pay|37188.49|11156.55|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37188.49|10675.39|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37188.49|12490.4|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37188.49|9600.57|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|UMR [2035]|UMR OPTIONS [203501]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37188.49|3806.62|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37188.49|5650.29|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37188.49|32090.27|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|37188.49|1450|33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|37188.49||33159.94|199.79||||
MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|37188.49|9221.05|33159.94|199.79||||
MS901|DRG||Wound Debridements For Injuries With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|GEHA [1415]|GEHA [141500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MULTIPLAN [1680]|HMA [168003]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MULTIPLAN [1680]|IHC HS [168011]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|Self-pay|Self-pay|522190.84|156657.25|156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|TRUSTMARK [2030]|STARMARK [203000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|UMR [2035]|UMR OPTIONS [203501]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|522190.84||156657.25|156657.25||||
MS901|DRG||Wound Debridements For Injuries With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|522190.84||156657.25|156657.25||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84636.44|50983.15|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84636.44|28572.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84636.44|14077.15|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84636.44|21901.95|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84636.44|57047.76|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|GEHA [1415]|GEHA [141500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84636.44|24252.24|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84636.44|14077.15|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84636.44|81622.17|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84636.44|28482.35|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84636.44|27816.45|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84636.44|1700|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MULTIPLAN [1680]|HMA [168003]|84636.44|1662.79|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|Self-pay|Self-pay|84636.44|25390.93|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84636.44|27012.96|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84636.44|24991.16|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84636.44|22822.71|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|UMR [2035]|UMR OPTIONS [203501]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84636.44|8101.2|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84636.44|13113.97|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84636.44|78989.21|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84636.44|3625|81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84636.44||81622.17|1662.79||||
MS902|DRG||Wound Debridements For Injuries With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84636.44|21901.95|81622.17|1662.79||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|GEHA [1415]|GEHA [141500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|Self-pay|Self-pay|89568.79|26870.64|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89568.79|7673.55|26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|89568.79||26870.64|7673.55||||
MS903|DRG||Wound Debridements For Injuries Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|89568.79||26870.64|7673.55||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|GEHA [1415]|GEHA [141500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|Self-pay|Self-pay|123878.04|37163.41|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123878.04|24721.13|37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|123878.04||37163.41|24721.13||||
MS904|DRG||Skin Grafts For Injuries With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|123878.04||37163.41|24721.13||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47122.09|27308.11|27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|GEHA [1415]|GEHA [141500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47122.09|850|27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|Self-pay|Self-pay|47122.09|14136.63|27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47122.09|6764.98|27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|47122.09||27308.11|850||||
MS905|DRG||Skin Grafts For Injuries Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|47122.09||27308.11|850||||
MS906|DRG||Hand Procedures For Injuries|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|AETNA [1015]|AETNA ACO WILCO [101532]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42463.32|24666.94|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42463.32|9519.62|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42463.32|20112.37|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42463.32|27601.15|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|CORESOURCE [1315]|CORESOURCE [131500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|GEHA [1415]|GEHA [141500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42463.32|21857.45|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HEALTHNET [1495]|HEALTHNET [149500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42463.32|9519.62|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42463.32|39490.89|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42463.32|26155.1|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42463.32|25543.61|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MULTIPLAN [1680]|HMA [168003]|42463.32|1113.75|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MULTIPLAN [1680]|IHC HS [168011]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|Self-pay|Self-pay|42463.32|12739|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42463.32|23582.94|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42463.32|27141.47|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|TRUSTMARK [2030]|STARMARK [203000]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42463.32|20861.89|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|UMR [2035]|UMR OPTIONS [203501]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42463.32|38217|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|42463.32|2900|39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42463.32||39490.89|1113.75||||
MS906|DRG||Hand Procedures For Injuries|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42463.32|20112.37|39490.89|1113.75||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182823.9|190038.78|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182823.9|81780.01|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182823.9|170115.64|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|182823.9|163572.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182823.9|212644.55|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|GEHA [1415]|GEHA [141500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|182823.9|55575.12|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182823.9|170115.64|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|182823.9|304245.27|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182823.9|147215.46|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182823.9|147215.46|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182823.9|850|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MULTIPLAN [1680]|HMA [168003]|182823.9|10170.82|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MULTIPLAN [1680]|IHC HS [168011]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|182823.9|136355.81|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|Self-pay|Self-pay|182823.9|54847.17|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182823.9|163572.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182823.9|59873.73|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|TRUSTMARK [2030]|STARMARK [203000]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182823.9|46021.07|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|UMR [2035]|UMR OPTIONS [203501]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182823.9|16796.14|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182823.9|26133.59|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182823.9|294430.91|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|182823.9|5800|304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|182823.9||304245.27|850||||
MS907|DRG||Other O.R. Procedures For Injuries With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|182823.9|163572.73|304245.27|850||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102058.12|52096.73|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102058.12|93587.03|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102058.12|15806.81|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|102058.12|22861.96|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102058.12|58293.82|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|GEHA [1415]|GEHA [141500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|102058.12|25621.3|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102058.12|15806.81|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|102058.12|83405|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102058.12|29730.8|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102058.12|29035.71|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102058.12|5950|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MULTIPLAN [1680]|HMA [168003]|102058.12|715.55|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|Self-pay|Self-pay|102058.12|30617.44|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102058.12|27383.41|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102058.12|21416.1|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102058.12|23729.85|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|UMR [2035]|UMR OPTIONS [203501]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102058.12|7829.87|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102058.12|14211.38|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102058.12|80714.52|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|102058.12|2900|93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|102058.12||93587.03|715.55||||
MS908|DRG||Other O.R. Procedures For Injuries With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|102058.12|22861.96|93587.03|715.55||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|GEHA [1415]|GEHA [141500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|82090.01|47686.09|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|Self-pay|Self-pay|82090.01|24627|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82090.01|9220.38|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|82090.01|20803.21|47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|82090.01||47686.09|9220.38||||
MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|82090.01|20803.21|47686.09|9220.38||||
MS913|DRG||Traumatic Injury With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|GEHA [1415]|GEHA [141500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MULTIPLAN [1680]|HMA [168003]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MULTIPLAN [1680]|IHC HS [168011]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|Self-pay|Self-pay|21854.99|6556.5|6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|TRUSTMARK [2030]|STARMARK [203000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|UMR [2035]|UMR OPTIONS [203501]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|21854.99||6556.5|6556.5||||
MS913|DRG||Traumatic Injury With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|21854.99||6556.5|6556.5||||
MS914|DRG||Traumatic Injury Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27187.73|13803.61|13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|GEHA [1415]|GEHA [141500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27187.73|3068.28|13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MULTIPLAN [1680]|HMA [168003]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|Self-pay|Self-pay|27187.73|8156.32|13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|UMR [2035]|UMR OPTIONS [203501]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27187.73|3456.38|13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27187.73||13803.61|3068.28||||
MS914|DRG||Traumatic Injury Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27187.73||13803.61|3068.28||||
MS915|DRG||Allergic Reactions With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60041.62|16833.34|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60041.62|34878.18|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60041.62|12420.16|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|60041.62|18949.43|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60041.62|18835.73|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|GEHA [1415]|GEHA [141500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|60041.62|19544.25|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60041.62|12420.16|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|60041.62|26949.59|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60041.62|24642.75|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60041.62|24066.62|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60041.62|2550|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MULTIPLAN [1680]|HMA [168003]|60041.62|253.78|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MULTIPLAN [1680]|IHC HS [168011]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|Self-pay|Self-pay|60041.62|18012.49|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60041.62|21872.66|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|60041.62|29551.71|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60041.62|25685.89|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|TRUSTMARK [2030]|STARMARK [203000]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60041.62|19743.09|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|UMR [2035]|UMR OPTIONS [203501]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60041.62|3824.85|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60041.62|11376.19|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60041.62|26080.24|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|60041.62|725|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60041.62|24626.44|34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|60041.62||34878.18|253.78||||
MS915|DRG||Allergic Reactions With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|60041.62|18949.43|34878.18|253.78||||
MS916|DRG||Allergic Reactions Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18741|34471.78|34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|GEHA [1415]|GEHA [141500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18741|1700|34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MULTIPLAN [1680]|HMA [168003]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18741|8382.98|34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|Self-pay|Self-pay|18741|5622.3|34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|UMR [2035]|UMR OPTIONS [203501]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18741|3013.05|34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18741||34471.78|1700||||
MS916|DRG||Allergic Reactions Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18741||34471.78|1700||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50950.76|29597.31|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50950.76|31536.86|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50950.76|11346.18|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|50950.76|16485.28|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50950.76|33117.99|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|50950.76||71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|50950.76||71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|GEHA [1415]|GEHA [141500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|50950.76|17722.98|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50950.76|11346.18|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|50950.76|47384.2|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50950.76|21438.25|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|50950.76||71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50950.76|20937.04|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50950.76|2550|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MULTIPLAN [1680]|HMA [168003]|50950.76|720.23|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MULTIPLAN [1680]|IHC HS [168011]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|50950.76||71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|50950.76|24190.37|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|Self-pay|Self-pay|50950.76|15285.23|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50950.76|18955.04|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|50950.76|71122.76|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50950.76|22355.62|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|TRUSTMARK [2030]|STARMARK [203000]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50950.76|17183.33|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|UMR [2035]|UMR OPTIONS [203501]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50950.76|4070.69|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50950.76|9925.83|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50950.76|45855.68|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|50950.76|1450|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|50950.76|59268.97|71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|50950.76||71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|50950.76||71122.76|720.23||||
MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|50950.76|16485.28|71122.76|720.23||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36378.97|16329.66|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36378.97|15215.43|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36378.97|5177.69|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|36378.97|8826.34|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36378.97|18272.14|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|GEHA [1415]|GEHA [141500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|36378.97|9712.75|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36378.97|5177.69|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|36378.97|26143.22|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36378.97|11478.2|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36378.97|11209.85|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36378.97|3820.15|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MULTIPLAN [1680]|HMA [168003]|36378.97|609.35|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|36378.97|14343.68|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|Self-pay|Self-pay|36378.97|10913.69|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36378.97|10142.7|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36378.97|10082.71|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36378.97|9200.49|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|UMR [2035]|UMR OPTIONS [203501]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36378.97|3498.27|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36378.97|5344.45|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36378.97|25299.89|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|36378.97|725|26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|36378.97||26143.22|609.35||||
MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|36378.97|8826.34|26143.22|609.35||||
MS919|DRG||Complications Of Treatment With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62967.16|36405.24|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62967.16|39037.39|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62967.16|13525.63|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|62967.16|20561.72|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62967.16|40735.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|GEHA [1415]|GEHA [141500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|62967.16|21799.9|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62967.16|13525.63|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|62967.16|58283.49|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62967.16|26739.45|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62967.16|26114.3|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62967.16|3400|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MULTIPLAN [1680]|HMA [168003]|62967.16|592.75|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MULTIPLAN [1680]|IHC HS [168011]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|62967.16|76649.39|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|Self-pay|Self-pay|62967.16|18890.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62967.16|23669.46|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62967.16|23379.76|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|TRUSTMARK [2030]|STARMARK [203000]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62967.16|21334.07|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|UMR [2035]|UMR OPTIONS [203501]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62967.16|4895.85|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62967.16|12325.15|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62967.16|56403.36|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|62967.16|1450|76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|62967.16||76649.39|592.75||||
MS919|DRG||Complications Of Treatment With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|62967.16|20561.72|76649.39|592.75||||
MS920|DRG||Complications Of Treatment With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35390.38|18461.87|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35390.38|48912.06|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35390.38|7953.88|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|35390.38|11424.29|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35390.38|20657.96|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|GEHA [1415]|GEHA [141500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|35390.38|11782.9|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35390.38|7953.88|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|35390.38|29556.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35390.38|14856.7|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35390.38|14509.36|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35390.38|4250|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MULTIPLAN [1680]|HMA [168003]|35390.38|40.6|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|Self-pay|Self-pay|35390.38|10617.11|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35390.38|13510.54|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35390.38|6957.84|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35390.38|15543.78|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35390.38|11947.5|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|UMR [2035]|UMR OPTIONS [203501]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35390.38|3900.72|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35390.38|7614.47|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35390.38|28603.33|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|35390.38|1450|48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|35390.38||48912.06|40.6||||
MS920|DRG||Complications Of Treatment With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|35390.38|11424.29|48912.06|40.6||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17595.23|10221.06|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17595.23|33985.7|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17595.23|5331.12|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|17595.23|7781.59|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17595.23|11436.9|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|GEHA [1415]|GEHA [141500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|17595.23|8025.85|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17595.23|5331.12|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|17595.23|16363.56|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17595.23|10119.55|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17595.23|9882.96|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17595.23|1700|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|17595.23|133|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|Self-pay|Self-pay|17595.23|5278.57|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17595.23|9589.74|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17595.23|10461.37|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17595.23|8040.98|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17595.23|2661.17|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17595.23|15835.71|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|17595.23|725|33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|17595.23||33985.7|133||||
MS921|DRG||Complications Of Treatment Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|17595.23|7781.59|33985.7|133||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|GEHA [1415]|GEHA [141500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MULTIPLAN [1680]|HMA [168003]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MULTIPLAN [1680]|IHC HS [168011]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|104106.02|25283.92|31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|Self-pay|Self-pay|104106.02|31231.81|31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|TRUSTMARK [2030]|STARMARK [203000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|UMR [2035]|UMR OPTIONS [203501]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104106.02||31231.81|25283.92||||
MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104106.02||31231.81|25283.92||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27278.28|10396.85|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27278.28|56754.29|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27278.28|5933.51|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|27278.28|10478.77|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27278.28|11633.58|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|GEHA [1415]|GEHA [141500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|27278.28|10807.7|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27278.28|5933.51|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|27278.28|16644.97|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27278.28|13627.1|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27278.28|13308.51|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27278.28|1700|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MULTIPLAN [1680]|HMA [168003]|27278.28|431.49|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|Self-pay|Self-pay|27278.28|8183.48|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27278.28|11040.43|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27278.28|14077.61|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27278.28|10820.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|UMR [2035]|UMR OPTIONS [203501]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27278.28|4303.94|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27278.28|6390.55|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27278.28|16108.04|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|27278.28|725|56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|27278.28||56754.29|431.49||||
MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|27278.28|10478.77|56754.29|431.49||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|AETNA [1015]|AETNA ACO WILCO [101532]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|143455.7|83426.8|83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|CORESOURCE [1315]|CORESOURCE [131500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|CORVEL CORP [2235]|CORVEL CORP [223500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|GEHA [1415]|GEHA [141500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HEALTHNET [1495]|HEALTHNET [149500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HEALTHSMART [1505]|HEALTHSMART [150501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|143455.7|16150|83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MULTIPLAN [1680]|HMA [168003]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MULTIPLAN [1680]|IHC HS [168011]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|Self-pay|Self-pay|143455.7|43036.71|83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|TRUSTMARK [2030]|STARMARK [203000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|UMR [2035]|UMR OPTIONS [203501]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|143455.7|25688|83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|143455.7||83426.8|16150||||
MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|143455.7||83426.8|16150||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|AETNA [1015]|AETNA ACO WILCO [101532]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84778.86|49234.3|49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|CORESOURCE [1315]|CORESOURCE [131500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|CORVEL CORP [2235]|CORVEL CORP [223500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|GEHA [1415]|GEHA [141500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HEALTHNET [1495]|HEALTHNET [149500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HEALTHSMART [1505]|HEALTHSMART [150501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84778.86|9350|49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MULTIPLAN [1680]|HMA [168003]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MULTIPLAN [1680]|IHC HS [168011]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|Self-pay|Self-pay|84778.86|25433.66|49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|TRUSTMARK [2030]|STARMARK [203000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|UMR [2035]|UMR OPTIONS [203501]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84778.86|14872|49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|84778.86||49234.3|9350||||
MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|84778.86||49234.3|9350||||
MS935|DRG||Non-Extensive Burns|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|AETNA [1015]|AETNA ACO WILCO [101532]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|CORESOURCE [1315]|CORESOURCE [131500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|CORVEL CORP [2235]|CORVEL CORP [223500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|GEHA [1415]|GEHA [141500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HEALTHNET [1495]|HEALTHNET [149500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HEALTHSMART [1505]|HEALTHSMART [150501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MULTIPLAN [1680]|HMA [168003]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MULTIPLAN [1680]|IHC HS [168011]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|Self-pay|Self-pay|68096.1|20428.83|21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|68096.1|20665.59|21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|TRUSTMARK [2030]|STARMARK [203000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|UMR [2035]|UMR OPTIONS [203501]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68096.1|21526.65|21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|68096.1||21526.65|20428.83||||
MS935|DRG||Non-Extensive Burns|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|68096.1||21526.65|20428.83||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97585.52|56276.56|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97585.52|22324.95|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|97585.52|37626.79|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97585.52|62970.84|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|GEHA [1415]|GEHA [141500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|97585.52|52296.9|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97585.52|22324.95|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|97585.52|90096.74|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97585.52|48931.7|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97585.52|47787.71|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MULTIPLAN [1680]|HMA [168003]|97585.52|402.56|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MULTIPLAN [1680]|IHC HS [168011]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|Self-pay|Self-pay|97585.52|29275.66|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97585.52|47077.99|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97585.52|43157.73|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|TRUSTMARK [2030]|STARMARK [203000]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97585.52|39381.51|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|UMR [2035]|UMR OPTIONS [203501]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97585.52|87190.39|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|97585.52|2175|90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|97585.52||90096.74|402.56||||
MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|97585.52|37626.79|90096.74|402.56||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108781.92|62075.88|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|GEHA [1415]|GEHA [141500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108781.92|3400|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MULTIPLAN [1680]|HMA [168003]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|108781.92|46781.64|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|Self-pay|Self-pay|108781.92|32634.58|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|UMR [2035]|UMR OPTIONS [203501]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108781.92|8386.67|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108781.92|15705.46|62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|108781.92||62075.88|3400||||
MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|108781.92||62075.88|3400||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86855.19|35048.28|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86855.19|10926.28|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86855.19|21442.57|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86855.19|39217.38|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|GEHA [1415]|GEHA [141500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86855.19|22115.65|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86855.19|10926.28|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86855.19|56111.03|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86855.19|27884.95|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86855.19|27233.02|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|86855.19|348.76|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|Self-pay|Self-pay|86855.19|26056.56|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86855.19|25121.51|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86855.19|22125.75|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86855.19|22384.26|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86855.19|207307.39|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86855.19|54301|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86855.19|1450|207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86855.19||207307.39|348.76||||
MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86855.19|21442.57|207307.39|348.76||||
MS947|DRG||Signs And Symptoms With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94868.85|22311.41|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94868.85|12420|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94868.85|60612.22|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94868.85|43773.61|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94868.85|22314.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|94868.85|9741.72|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94868.85|34019.94|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94868.85|13680|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|94868.85|8205.72|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|94868.85|13313.1|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94868.85|62999.86|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94868.85|22314.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94868.85|22314.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|94868.85||90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|94868.85||90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|GEHA [1415]|GEHA [141500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|94868.85|13731|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94868.85|13680|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|94868.85|90138.26|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94868.85|17313|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94868.85|22314.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|94868.85||90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94868.85|22314.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94868.85|11484|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94868.85|9350|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94868.85|22757.64|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MULTIPLAN [1680]|HMA [168003]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MULTIPLAN [1680]|IHC HS [168011]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|94868.85|33740.62|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|94868.85|51118.96|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|Self-pay|Self-pay|94868.85|28460.65|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94868.85|15871.13|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94868.85|22311.41|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|94868.85|23137.22|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94868.85|11365.34|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|TRUSTMARK [2030]|STARMARK [203000]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94868.85|13840.86|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|UMR [2035]|UMR OPTIONS [203501]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94868.85|14872|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94868.85|22311.41|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94868.85|87230.58|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|94868.85|8700|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|94868.85|24101.27|90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|94868.85||90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|94868.85||90138.26|8205.72||||
MS947|DRG||Signs And Symptoms With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|94868.85|13313.1|90138.26|8205.72||||
MS948|DRG||Signs And Symptoms Without McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86591.13|20418.54|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|86591.13|11365.34|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86591.13|22864.22|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86591.13|11385|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86591.13|48463.22|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86591.13|52942.31|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86591.13|21268.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|86591.13|8929.91|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86591.13|6194.54|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86591.13|12540|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|86591.13|7521.91|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|86591.13|8776.17|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86591.13|54228.11|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86591.13|21268.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86591.13|21268.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|CORESOURCE [1315]|CORESOURCE [131500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|86591.13||77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|86591.13||77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|GEHA [1415]|GEHA [141500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|86591.13|9051.65|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HEALTHNET [1495]|HEALTHNET [149500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86591.13|12540|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|86591.13|77587.91|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86591.13|11412.95|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86591.13|21268.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|86591.13||77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86591.13|25150.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86591.13|21268.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86591.13|10527|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86591.13|10200|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86591.13|30866.69|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86591.13|20826.91|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MULTIPLAN [1680]|HMA [168003]|86591.13|40186.69|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MULTIPLAN [1680]|IHC HS [168011]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|86591.13|21360.86|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|86591.13|16627.45|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86591.13|25150.64|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|Self-pay|Self-pay|86591.13|25977.34|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86591.13|10445.55|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86591.13|20418.54|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|86591.13|18674.55|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86591.13|37268.67|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|TRUSTMARK [2030]|STARMARK [203000]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86591.13|9136.53|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|UMR [2035]|UMR OPTIONS [203501]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86591.13|16224|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86591.13|20418.54|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86591.13|75085.08|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|86591.13|7975|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86591.13|19452.66|77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|86591.13||77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|86591.13||77587.91|6194.54||||
MS948|DRG||Signs And Symptoms Without McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|86591.13|8776.17|77587.91|6194.54||||
MS949|DRG||Aftercare With Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88713.5|27153.31|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88713.5|16560|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88713.5|56443.27|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88713.5|47882.76|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88713.5|26528.95|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|88713.5|9741.72|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88713.5|6757.68|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88713.5|13680|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|88713.5|8205.72|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|88713.5|12375.39|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88713.5|53024.91|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88713.5|26528.95|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88713.5|26528.95|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|88713.5||75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|88713.5||75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|GEHA [1415]|GEHA [141500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|88713.5|12763.85|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88713.5|13680|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|88713.5|75866.41|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88713.5|16093.55|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88713.5|26528.95|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|88713.5||75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88713.5|26528.95|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88713.5|11484|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88713.5|9350|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88713.5|27696.38|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|88713.5|24907.67|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|88713.5|46605.59|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|Self-pay|Self-pay|88713.5|26614.05|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88713.5|15758.91|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88713.5|27153.31|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|88713.5|26067.18|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88713.5|11365.34|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88713.5|12875.57|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88713.5|16900|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88713.5|27153.31|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88713.5|73419.1|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|88713.5|8700|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|88713.5|27153.31|75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|88713.5||75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|88713.5||75866.41|6757.68||||
MS949|DRG||Aftercare With Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|88713.5|12375.39|75866.41|6757.68||||
MS950|DRG||Aftercare Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77245|23898.31|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77245|12420|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77245|41341.91|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77245|42953.61|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77245|21721.81|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|77245|7306.29|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77245|5068.26|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77245|10260|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|77245|6154.29|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77245|39638.99|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77245|21721.81|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77245|21721.81|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|77245||56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|77245||56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|GEHA [1415]|GEHA [141500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|77245|8512.3|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77245|10260|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|77245|56714.25|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77245|10732.9|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77245|21721.81|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|77245||56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77245|21721.81|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77245|8613|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77245|7650|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77245|24376.28|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|77245|194.09|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|77245|21035.7|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|77245||56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|Self-pay|Self-pay|77245|23173.5|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77245|10875.49|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77245|23898.31|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|77245|21251.95|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77245|8253.23|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77245|8593.41|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77245|12168|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77245|23898.31|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77245|54884.77|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|77245|6525|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77245|22137.45|56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|77245||56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|77245||56714.25|194.09||||
MS950|DRG||Aftercare Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|77245|8253.23|56714.25|194.09||||
MS951|DRG||Other Factors Influencing Health Status|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|AETNA [1015]|AETNA ACO WILCO [101532]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18116|33443.17|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18116|10637.62|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18116|5994.07|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|18116|9351.51|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18116|37421.33|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|CORESOURCE [1315]|CORESOURCE [131500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|CORVEL CORP [2235]|CORVEL CORP [223500]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|GEHA [1415]|GEHA [141500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|18116|9645.05|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HEALTHNET [1495]|HEALTHNET [149500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18116|5994.07|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HEALTHSMART [1505]|HEALTHSMART [150501]|18116|53541.29|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18116|12161.15|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18116|11876.83|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18116|1700|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MULTIPLAN [1680]|HMA [168003]|18116|287.37|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MULTIPLAN [1680]|IHC HS [168011]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|18116|6225.51|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|Self-pay|Self-pay|18116|5434.8|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18116|10768.68|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18116|12667.43|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|TRUSTMARK [2030]|STARMARK [203000]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18116|9736.64|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|UMR [2035]|UMR OPTIONS [203501]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18116|2403.13|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18116|51814.16|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|18116|1450|53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|18116||53541.29|287.37||||
MS951|DRG||Other Factors Influencing Health Status|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|18116|9351.51|53541.29|287.37||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|AETNA [1015]|AETNA ACO WILCO [101532]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142882.51|83000.49|83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|CORESOURCE [1315]|CORESOURCE [131500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|CORVEL CORP [2235]|CORVEL CORP [223500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|GEHA [1415]|GEHA [141500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HEALTHNET [1495]|HEALTHNET [149500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HEALTHSMART [1505]|HEALTHSMART [150501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142882.51|850|83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MULTIPLAN [1680]|HMA [168003]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MULTIPLAN [1680]|IHC HS [168011]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|Self-pay|Self-pay|142882.51|42864.75|83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|TRUSTMARK [2030]|STARMARK [203000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|UMR [2035]|UMR OPTIONS [203501]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142882.51|34689.04|83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|142882.51||83000.49|850||||
MS955|DRG||Craniotomy For Multiple Significant Trauma|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|142882.51||83000.49|850||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|AETNA [1015]|AETNA ACO WILCO [101532]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|CORESOURCE [1315]|CORESOURCE [131500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|GEHA [1415]|GEHA [141500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HEALTHNET [1495]|HEALTHNET [149500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HEALTHSMART [1505]|HEALTHSMART [150501]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MULTIPLAN [1680]|HMA [168003]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MULTIPLAN [1680]|IHC HS [168011]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|Self-pay|Self-pay|111698.64|33509.59|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|TRUSTMARK [2030]|STARMARK [203000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|UMR [2035]|UMR OPTIONS [203501]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111698.64|21277.28|33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|111698.64||33509.59|21277.28||||
MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|111698.64||33509.59|21277.28||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|GEHA [1415]|GEHA [141500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MULTIPLAN [1680]|HMA [168003]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MULTIPLAN [1680]|IHC HS [168011]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|Self-pay|Self-pay|279260.91|83778.27|83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|TRUSTMARK [2030]|STARMARK [203000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|UMR [2035]|UMR OPTIONS [203501]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279260.91||83778.27|83778.27||||
MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279260.91||83778.27|83778.27||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|GEHA [1415]|GEHA [141500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MULTIPLAN [1680]|HMA [168003]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|Self-pay|Self-pay|169794.44|50938.33|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|UMR [2035]|UMR OPTIONS [203501]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169794.44|32465.69|50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|169794.44||50938.33|32465.69||||
MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|169794.44||50938.33|32465.69||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|GEHA [1415]|GEHA [141500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MULTIPLAN [1680]|HMA [168003]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MULTIPLAN [1680]|IHC HS [168011]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|Self-pay|Self-pay|88804.28|26641.28|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|TRUSTMARK [2030]|STARMARK [203000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|UMR [2035]|UMR OPTIONS [203501]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88804.28|18138.33|26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|88804.28||26641.28|18138.33||||
MS963|DRG||Other Multiple Significant Trauma With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|88804.28||26641.28|18138.33||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|GEHA [1415]|GEHA [141500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MULTIPLAN [1680]|HMA [168003]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|Self-pay|Self-pay|25565.53|7669.66|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|UMR [2035]|UMR OPTIONS [203501]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25565.53|10013.13|10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|25565.53||10013.13|7669.66||||
MS964|DRG||Other Multiple Significant Trauma With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|25565.53||10013.13|7669.66||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|445721.51|258919.63|258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|GEHA [1415]|GEHA [141500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|445721.51|13600|258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MULTIPLAN [1680]|HMA [168003]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MULTIPLAN [1680]|IHC HS [168011]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|Self-pay|Self-pay|445721.51|133716.45|258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|TRUSTMARK [2030]|STARMARK [203000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|UMR [2035]|UMR OPTIONS [203501]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|445721.51|43676.36|258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|445721.51||258919.63|13600||||
MS969|DRG||Hiv With Extensive O.R. Procedures With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|445721.51||258919.63|13600||||
MS974|DRG||Hiv With Major Related Condition With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87574.56|27409.37|50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|GEHA [1415]|GEHA [141500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87574.56|2550|50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MULTIPLAN [1680]|HMA [168003]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MULTIPLAN [1680]|IHC HS [168011]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|87574.56|50872.06|50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|Self-pay|Self-pay|87574.56|26272.37|50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|TRUSTMARK [2030]|STARMARK [203000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|UMR [2035]|UMR OPTIONS [203501]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87574.56|11821.14|50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|87574.56||50872.06|2550||||
MS974|DRG||Hiv With Major Related Condition With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|87574.56||50872.06|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58612.78|34048.16|34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|GEHA [1415]|GEHA [141500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58612.78|2550|34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MULTIPLAN [1680]|HMA [168003]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|58612.78|21781.14|34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|Self-pay|Self-pay|58612.78|17583.83|34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|UMR [2035]|UMR OPTIONS [203501]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58612.78|7891.03|34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|58612.78||34048.16|2550||||
MS975|DRG||Hiv With Major Related Condition With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|58612.78||34048.16|2550||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92059.05|53477.09|53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|GEHA [1415]|GEHA [141500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92059.05|7116.02|53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|Self-pay|Self-pay|92059.05|27617.71|53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92059.05|7116.02|53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|92059.05||53477.09|7116.02||||
MS976|DRG||Hiv With Major Related Condition Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|92059.05||53477.09|7116.02||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|AETNA [1015]|AETNA ACO WILCO [101532]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77684.26|45201.09|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77684.26|44265.88|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|77684.26|8118.1|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77684.26|5631.4|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77684.26|11400|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|77684.26|6838.1|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77684.26|50577.91|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|CORESOURCE [1315]|CORESOURCE [131500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|CORVEL CORP [2235]|CORVEL CORP [223500]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|GEHA [1415]|GEHA [141500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|77684.26|30222.89|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HEALTHNET [1495]|HEALTHNET [149500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77684.26|11400|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HEALTHSMART [1505]|HEALTHSMART [150501]|77684.26|72365.31|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77684.26|77812.16|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77684.26|9570|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77684.26|2550|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MULTIPLAN [1680]|HMA [168003]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MULTIPLAN [1680]|IHC HS [168011]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|77684.26|17266.55|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|77684.26|46858.79|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|Self-pay|Self-pay|77684.26|23305.28|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77684.26|77812.16|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77684.26|26011.03|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|TRUSTMARK [2030]|STARMARK [203000]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77684.26|77812.16|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|UMR [2035]|UMR OPTIONS [203501]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77684.26|5854.24|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77684.26|70030.95|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|77684.26|7250|77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|77684.26||77812.16|2550||||
MS977|DRG||Hiv With Or Without Other Related Condition|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|77684.26|26011.03|77812.16|2550||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151684.97|130236.63|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151684.97|74736.32|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151684.97|116582.97|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|151684.97|51451.68|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151684.97|145728.71|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|GEHA [1415]|GEHA [141500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|151684.97|56613.39|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151684.97|116582.97|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|151684.97|208504.15|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151684.97|66910.25|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151684.97|65345.93|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151684.97|1700|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MULTIPLAN [1680]|HMA [168003]|151684.97|3546.64|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|151684.97|115975.89|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|Self-pay|Self-pay|151684.97|45505.49|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151684.97|58268.5|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151684.97|69719.29|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151684.97|53588.71|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UMR [2035]|UMR OPTIONS [203501]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151684.97|19769.12|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151684.97|30506.28|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151684.97|201778.22|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|151684.97|6525|208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|151684.97||208504.15|1700||||
MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|151684.97|51451.68|208504.15|1700||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|115796.99|83831.08|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|115796.99|66275.43|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|115796.99|75042.45|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|115796.99|28283.09|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|115796.99|93803.06|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|GEHA [1415]|GEHA [141500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|115796.99|29170.9|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|115796.99|75042.45|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|115796.99|134210.53|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|115796.99|36780.7|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|115796.99|35920.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|115796.99|4250|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MULTIPLAN [1680]|HMA [168003]|115796.99|292.59|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|Self-pay|Self-pay|115796.99|34739.1|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|115796.99|33582.33|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|115796.99|29061.91|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|115796.99|29554.16|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|115796.99|10409.31|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|115796.99|16869.79|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|115796.99|129881.17|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|115796.99|2900|134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|115796.99||134210.53|292.59||||
MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|115796.99|28283.09|134210.53|292.59||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106781.54|62029.4|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106781.54|27424.49|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106781.54|55526.4|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106781.54|18423.15|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106781.54|69408|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106781.54|19001.45|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106781.54|55526.4|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106781.54|99306.83|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106781.54|23958.35|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106781.54|23398.22|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106781.54|850|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|106781.54|382.11|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|Self-pay|Self-pay|106781.54|32034.46|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106781.54|22248.51|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106781.54|21090.72|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106781.54|19245.32|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106781.54|5265.9|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106781.54|11859.82|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106781.54|96103.39|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106781.54|725|99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106781.54||99306.83|382.11||||
MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106781.54|18423.15|99306.83|382.11||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|164532.24|95437.23|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|164532.24|82001.93|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|164532.24|85431.86|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|164532.24|36526.29|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|164532.24|106789.82|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CORESOURCE [1315]|CORESOURCE [131500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|GEHA [1415]|GEHA [141500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|164532.24|39317.13|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHNET [1495]|HEALTHNET [149500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|164532.24|85431.86|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|164532.24|152791.58|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|164532.24|47500.55|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|164532.24|46390.02|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|164532.24|5100|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MULTIPLAN [1680]|HMA [168003]|164532.24|1644.28|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MULTIPLAN [1680]|IHC HS [168011]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|164532.24|73391.71|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|Self-pay|Self-pay|164532.24|49359.67|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|164532.24|43753.42|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|164532.24|49357.89|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|TRUSTMARK [2030]|STARMARK [203000]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|164532.24|37938.22|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UMR [2035]|UMR OPTIONS [203501]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|164532.24|10440.17|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|164532.24|21755.98|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|164532.24|147862.84|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|164532.24|7250|152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|164532.24||152791.58|1644.28||||
MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|164532.24|36526.29|152791.58|1644.28||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA [1015]|AETNA ACO WILCO [101532]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101032.53|49151.7|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101032.53|66191.07|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101032.53|14246.72|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|101032.53|19026.36|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101032.53|54998.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CORESOURCE [1315]|CORESOURCE [131500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CORVEL CORP [2235]|CORVEL CORP [223500]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|GEHA [1415]|GEHA [141500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|101032.53|21228.63|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHNET [1495]|HEALTHNET [149500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101032.53|14246.72|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HEALTHSMART [1505]|HEALTHSMART [150501]|101032.53|78690.11|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101032.53|24742.8|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101032.53|24164.33|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101032.53|8500|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MULTIPLAN [1680]|HMA [168003]|101032.53|1605.03|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MULTIPLAN [1680]|IHC HS [168011]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|101032.53|82967.33|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|Self-pay|Self-pay|101032.53|30309.76|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101032.53|23124.61|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101032.53|25430.18|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|TRUSTMARK [2030]|STARMARK [203000]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101032.53|19546.54|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UMR [2035]|UMR OPTIONS [203501]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101032.53|5206.38|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101032.53|11421.47|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101032.53|76151.71|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|101032.53|3625|82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|101032.53||82967.33|1605.03||||
MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|101032.53|19026.36|82967.33|1605.03||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA ACO WILCO [101532]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117887.46|68480.81|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117887.46|43481.66|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117887.46|61301.48|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|117887.46|12528.14|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117887.46|76626.85|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CORESOURCE [1315]|CORESOURCE [131500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|CORVEL CORP [2235]|CORVEL CORP [223500]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|GEHA [1415]|GEHA [141500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|117887.46|14227.41|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHNET [1495]|HEALTHNET [149500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117887.46|61301.48|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HEALTHSMART [1505]|HEALTHSMART [150501]|117887.46|109635.34|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117887.46|16292.2|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117887.46|15911.3|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117887.46|3400|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|HMA [168003]|117887.46|1306.01|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MULTIPLAN [1680]|IHC HS [168011]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|Self-pay|Self-pay|117887.46|35366.24|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117887.46|14947.71|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|117887.46|129642.41|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117887.46|16884.36|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|TRUSTMARK [2030]|STARMARK [203000]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117887.46|12977.92|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UMR [2035]|UMR OPTIONS [203501]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117887.46|3201.08|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117887.46|106098.72|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|117887.46|3625|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|117887.46|108035.34|129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|117887.46||129642.41|1306.01||||
MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|117887.46|12528.14|129642.41|1306.01||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|AETNA [1015]|AETNA ACO WILCO [101532]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32778.61|15177.2|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32778.61|19041.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32778.61|5061.41|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|32778.61|7161.65|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32778.61|16982.58|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|CORESOURCE [1315]|CORESOURCE [131500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|CORVEL CORP [2235]|CORVEL CORP [223500]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|GEHA [1415]|GEHA [141500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|32778.61|7000|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HEALTHNET [1495]|HEALTHNET [149500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32778.61|5061.41|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HEALTHSMART [1505]|HEALTHSMART [150501]|32778.61|24298.15|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32778.61|9313.35|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32778.61|9095.61|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32778.61|2550|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MULTIPLAN [1680]|HMA [168003]|32778.61|31.5|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MULTIPLAN [1680]|IHC HS [168011]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|Self-pay|Self-pay|32778.61|9833.58|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32778.61|8698.09|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|TRUSTMARK [2030]|STARMARK [203000]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32778.61|7455.99|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|UMR [2035]|UMR OPTIONS [203501]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32778.61|1944.79|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32778.61|23514.34|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|32778.61|1450|24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|32778.61||24298.15|31.5||||
MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|32778.61|7161.65|24298.15|31.5||||
MS999|DRG||Ungroupable|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|AETNA [1015]|AETNA ACO WILCO [101532]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|CORESOURCE [1315]|CORESOURCE [131500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|CORVEL CORP [2235]|CORVEL CORP [223500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|GEHA [1415]|GEHA [141500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HEALTHNET [1495]|HEALTHNET [149500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HEALTHSMART [1505]|HEALTHSMART [150501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MULTIPLAN [1680]|HMA [168003]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MULTIPLAN [1680]|IHC HS [168011]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|Self-pay|Self-pay|131585.61|39475.68|39475.68|39475.68||||
MS999|DRG||Ungroupable|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|TRUSTMARK [2030]|STARMARK [203000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|UMR [2035]|UMR OPTIONS [203501]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|131585.61||39475.68|39475.68||||
MS999|DRG||Ungroupable|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|131585.61||39475.68|39475.68||||